BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to becom...BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.展开更多
AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk datab...AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.展开更多
目的探讨连续血液滤过联合早期肠内营养支持对重症胰腺炎患者临床疗效及生活质量的影响。方法采用前瞻性研究方法,选择2015年1月至2017年11月首都医科大学附属北京潞河医院收治的100例行连续血液滤过治疗的重症胰腺炎患者,采用随机数字...目的探讨连续血液滤过联合早期肠内营养支持对重症胰腺炎患者临床疗效及生活质量的影响。方法采用前瞻性研究方法,选择2015年1月至2017年11月首都医科大学附属北京潞河医院收治的100例行连续血液滤过治疗的重症胰腺炎患者,采用随机数字表法分为观察组和对照组,每组50例。对照组仅采用连续血液滤过治疗,观察组加用早期肠内营养支持。比较两组患者的临床疗效、炎症因子水平、肠道黏膜功能、免疫功能指标,并采用生活质量核心问卷(quality of life questionare core-30,QLO-C30)评价两组患者的生活质量。结果观察组治疗总有效率为92%,明显高于对照组的78%,差异有显著性(χ~2=3.73,P=0.0308);治疗后两组白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)及尿乳果糖/甘露醇比值、降钙素原、血浆二胺氧化酶水平均降低,且观察组低于对照组,差异有显著性(P<0.05);治疗后两组免疫功能指标均较治疗前改善,且观察组优于对照组,差异有显著性(P<0.05)。治疗后观察组QLO-C30量表评分明显高于对照组,差异有显著性(P<0.05)。结论在连续血液滤过治疗的基础上给予早期肠内营养支持可减轻炎症反应,改善肠道黏膜功能,增强免疫力,从而提高重症胰腺炎的临床疗效,改善患者生活质量。展开更多
目的评价早期高容量血液滤过（HVHF）治疗重症急性胰腺炎（SAP）伴急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法将入选的SAP伴有ARDS的30例患者随机分为治疗组和对照组，每组15例。以机械通气（血液净化治疗开始）为起始点，分别于0...目的评价早期高容量血液滤过（HVHF）治疗重症急性胰腺炎（SAP）伴急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法将入选的SAP伴有ARDS的30例患者随机分为治疗组和对照组，每组15例。以机械通气（血液净化治疗开始）为起始点，分别于0、12、24、36、48、60、72h采集患者以下指标：肿瘤坏死因子“（TNF-α）、白细胞介素-10（IL-10）的浓度；呼吸频率、氧合指数、动脉血二氧化碳分压；急性生理与慢性健康评分（a—cute physiology and chronic health evaluationⅡ，APACHE Ⅱ）；并记录2组患者住院期间机械通气时间、ICU住院时间、总住院时间、住院病死率及28天病死率。结果①血液净化治疗后，治疗组患者IL-10、TNF-α浓度下降，与治疗前相比差异有统计学意义（P〈0．05）；且在24h及以后各时点IL-10、TNF-α浓度较对照组同一时间点下降（P〈0．05）。②呼吸系统指标：治疗后2组患者氧合指数逐渐升高，治疗组患者在24h后各时间点与对照组相比差异有统计学意义（P〈0．05）。2组患者的呼吸频率较治疗前均下降，治疗组下降显著，在60、72h2个时点与对照组相比差异有统计学意义（P〈0．05）。治疗组平均机械通气时间少于对照组（P〈0．05）。⑧APACHEⅡ评分：治疗后2组患者的APACHEⅡ评分均逐渐下降，治疗组改善明显，在12h及以后各时间点APACHEⅡ评分低于对照组（P〈0．05）。④住院时间及病死率：治疗组ICU住院时间、总住院时间均少于对照组（P〈0．05）。治疗组患者住院病死率及28天病死率较对照组下降，但差异无统计学意义（P〉0．05）。结论早期高容量血液滤过可以清除SAP伴ARDS患者循环中炎症介质，改善患者的呼吸功能，减轻患者病情，减少ICU及总住院时间。展开更多
基金This study was supported by a grant from the Natural Science Foundation of Shandong Province （Y2006C77）.
文摘BACKGROUND：High-volume hemofiltration （HVHF） is technically possible in severe acute pancreatitis （SAP） patients complicated with multiple organ dysfunction syndrome （MODS）. Continuous HVHF is expected to become a beneficial adjunct therapy for SAP complicated with MODS. In this study, we aimed to explore the effects of fluid resuscitation and HVHF on alveolar- arterial oxygen exchange, the Acute Physiology and Chronic Health Evaluation II （APACHE II） score in patients with refractory septic shock. METHODS：A total of 89 refractory septic shock patients, who were admitted to ICU, the Provincial Hospital affiliated to Shandong University from August 2006 to December 2009, were enrolled in this retrospective study. The patients were randomly divided into two groups： fluid resuscitation （group A, n=41）, and fluid resuscitation plus high-volume hemofiltration （group B, n=48）, The levels of O2 content of central venous blood （CcvO2）, arterial oxygen content （CaO2）, alveolar-arterial oxygen pressure difference P（A-a）DO2, ratio of arterial oxygen pressure/alveolar oxygen pressure （PaO2/ PAO2）, respiratory index （RI） and oxygenation index （OI） were determined. The oxygen exchange levels of the two groups were examined based on the arterial blood gas analysis at different times （0, 24, 72 hours and 7 days of treatment） in the two groups. The APACHE II score was calculated before and after 7-day treatment in the two groups. The levels of CcvO2, CaO2 on day 7 in group A were significantly lower than those in group B （CcvO2：0.60±0.24 vs, 0.72±0.28, P〈0.05; CaO2：0.84±0.43 vs. 0.94±0.46, P〈0.05）. The level of oxygen extraction rate （O2ER） in group A on the 7th day was significantly higher than that in group B （ 28.7±2.4 vs. 21.7±3.4, P〈0.01）. The levels of P（A-a）DO2 and RI in group B on the 7th day were significantly lower than those in group A. The levels of PaO2/PAO2 and OI in group B on 7th day were significantly higher than those in group A （P〈0.05 or P〈0.01）. The APACHE II score in the two groups reduced gradually after 7-day treatment, and the APACHE II score on the 7th day in group B was significantly lower than that in group A （8.2±3.8 vs. 17.2±6.8, P〈0.01）. HVHF combined with fluid resuscitation can improve alveolar- arterial-oxygen exchange, decrease the APACHE II score in patients with refractory septic shock, and thus it increases the survival rate of patients.
基金Supported by The National Natural Science Foundation of China, No.30500684 and Clinical Research Foundation for Residency Granted by the Cooperative Project of West China Hospital and Daiichi Pharmaceutical Co. Ltd., the level Ⅰ
文摘AIM： To determine the most cost-effective hemofiltration modality for early management of severe acute pancreatitis （SAP） in China. METHODS： We carried out a search of Pub-Medline and Chinese Biomedical Disk database. Controlled clinical trials on Chinese population were included in the analysis. The four decision branches that were analyzed were： continuous or long-term veno-venous hemofiltration （CVVH/LVVH）, short-term veno-venous hemofiltration （SVVH）, SVVH plus peritoneal dialysis （PD）, and non-hemofiltration control group. The effectiveness of the technique was determined by survival rate, complications prevention and surgery preservation. The total cost of hospitalization was also assessed. RESULTS： The SVVH only technique was the least costly modality, $5809 （44449 RMB）, and was selected as the baseline treatment modality. SVVH only arm achieved the lowest C/E ratio in terms of overall survival, complications prevention and surgery preservation. In incremental cost-effectiveness analysis, the CWH/ LVVH only and the control arms were inferior to other techniques. Sensitivity analysis showed SVVH only and SVVH plus PD arms overlapped in C/survival ratio. CONCLUSION： The role of early veno-venous hemofiltration as an alternative therapy for SAP remains controversial. However, we propose that early use of short-term high-volume veno-venous hemofiltration would have a beneficial impact on the management of SAP.
文摘目的探讨连续血液滤过联合早期肠内营养支持对重症胰腺炎患者临床疗效及生活质量的影响。方法采用前瞻性研究方法,选择2015年1月至2017年11月首都医科大学附属北京潞河医院收治的100例行连续血液滤过治疗的重症胰腺炎患者,采用随机数字表法分为观察组和对照组,每组50例。对照组仅采用连续血液滤过治疗,观察组加用早期肠内营养支持。比较两组患者的临床疗效、炎症因子水平、肠道黏膜功能、免疫功能指标,并采用生活质量核心问卷(quality of life questionare core-30,QLO-C30)评价两组患者的生活质量。结果观察组治疗总有效率为92%,明显高于对照组的78%,差异有显著性(χ~2=3.73,P=0.0308);治疗后两组白细胞介素-6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、C反应蛋白(C-reactive protein,CRP)及尿乳果糖/甘露醇比值、降钙素原、血浆二胺氧化酶水平均降低,且观察组低于对照组,差异有显著性(P<0.05);治疗后两组免疫功能指标均较治疗前改善,且观察组优于对照组,差异有显著性(P<0.05)。治疗后观察组QLO-C30量表评分明显高于对照组,差异有显著性(P<0.05)。结论在连续血液滤过治疗的基础上给予早期肠内营养支持可减轻炎症反应,改善肠道黏膜功能,增强免疫力,从而提高重症胰腺炎的临床疗效,改善患者生活质量。
文摘目的评价早期高容量血液滤过（HVHF）治疗重症急性胰腺炎（SAP）伴急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法将入选的SAP伴有ARDS的30例患者随机分为治疗组和对照组，每组15例。以机械通气（血液净化治疗开始）为起始点，分别于0、12、24、36、48、60、72h采集患者以下指标：肿瘤坏死因子“（TNF-α）、白细胞介素-10（IL-10）的浓度；呼吸频率、氧合指数、动脉血二氧化碳分压；急性生理与慢性健康评分（a—cute physiology and chronic health evaluationⅡ，APACHE Ⅱ）；并记录2组患者住院期间机械通气时间、ICU住院时间、总住院时间、住院病死率及28天病死率。结果①血液净化治疗后，治疗组患者IL-10、TNF-α浓度下降，与治疗前相比差异有统计学意义（P〈0．05）；且在24h及以后各时点IL-10、TNF-α浓度较对照组同一时间点下降（P〈0．05）。②呼吸系统指标：治疗后2组患者氧合指数逐渐升高，治疗组患者在24h后各时间点与对照组相比差异有统计学意义（P〈0．05）。2组患者的呼吸频率较治疗前均下降，治疗组下降显著，在60、72h2个时点与对照组相比差异有统计学意义（P〈0．05）。治疗组平均机械通气时间少于对照组（P〈0．05）。⑧APACHEⅡ评分：治疗后2组患者的APACHEⅡ评分均逐渐下降，治疗组改善明显，在12h及以后各时间点APACHEⅡ评分低于对照组（P〈0．05）。④住院时间及病死率：治疗组ICU住院时间、总住院时间均少于对照组（P〈0．05）。治疗组患者住院病死率及28天病死率较对照组下降，但差异无统计学意义（P〉0．05）。结论早期高容量血液滤过可以清除SAP伴ARDS患者循环中炎症介质，改善患者的呼吸功能，减轻患者病情，减少ICU及总住院时间。
