本文選題：連續(xù)性腎臟替代治療 + 重癥急性胰腺炎相關(guān)性腎損傷��； 參考：《大連醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:回顧性分析CRRT在重癥急性胰腺炎相關(guān)性腎損傷治療中的療效。方法:回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院急診ICU 2013年6月-2016年6月收治的重癥急性胰腺炎相關(guān)性腎損傷患者48例,依據(jù)患者是否行CRRT治療將患者分為兩組,A組:行CRRT治療組;B組:未行CRRT治療組;所有病例均接受其它常規(guī)綜合治療�；仡橝、B兩組患者臨床資料中,治療前、治療后24小時、治療后48小時生命體征、平均動脈壓、尿量、血白細胞、血生化、動脈血氣分析等相關(guān)指標,評估患者APACHE II評分及改良Marshall評分。結(jié)果:①生命體征、平均動脈壓及尿量:A組患者行CRRT治療24小時后心率逐漸穩(wěn)定,呼吸頻率恢復(fù)至正常范圍內(nèi);患者尿量明顯增多,并持續(xù)到48小時仍有統(tǒng)計學(xué)意義(P0.05);體溫及平均動脈壓在接受治療48小時后明顯改善(P0.05),體溫基本恢復(fù)至正常范圍內(nèi),差異有統(tǒng)計學(xué)意義。B組患者經(jīng)治療48小時后,呼吸頻率基本恢復(fù)正常,其余各項指標較入院時比較,差異無統(tǒng)計學(xué)意義。②血生化及血白細胞:A組患者在接受治療后24小時,其反映病情嚴重程度及器官功能的指標:BUN、Scr、AMY、LPS明顯下降,反映患者感染控制的指標WBC也得到明顯改善,并持續(xù)到48小時(P0.05),差異有統(tǒng)計學(xué)意義。B組患者接受治療后WBC在24小時得到改善、AMY在48小時得到改善(P0.05)。③血氣分析相關(guān)指標:A組患者治療24小時后PH值即穩(wěn)定在正常范圍,P02、PC02得到明顯改善(P0.05),并持續(xù)到48小時仍有效;血鈉及血鉀在48小時內(nèi)得到恢復(fù),維持在穩(wěn)定范圍內(nèi),并較入院時明顯改善(P0.05),血鈣明顯升高,并趨于正常范圍,血乳酸明顯下降(P0.05);B組患者接受治療后,PH、PC02在48小時內(nèi)得到改善,有統(tǒng)計學(xué)意義(P0.05),其余各項指標較入院時比較均無統(tǒng)計學(xué)意義。④患者的APACHE Ⅱ評分及改良Marshall評分:A組患者接受治療后24小時APACHE Ⅱ評分及改良Marshall評分較入院時明顯下降(P0.05),并持續(xù)到48小時,評分改善更明顯;B組患者經(jīng)過治療,在48小時后APACHE Ⅱ評分及改良Marshall評分較入院時改善(P0.05);對比A、B兩組患者的APACHE Ⅱ評分及改良Marshall評分,B組患者評分改善速度、程度均不如A組患者明顯,差異有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:以上研究結(jié)果顯示,重癥急性胰腺炎相關(guān)性腎損傷患者在入院后早期(入院24小時內(nèi))即行CRRT治療,能得到較好療效。對比非CRRT治療組,CRRT聯(lián)合保守治療能有效阻斷患者病情進展,改善患者生命體征及生化指標,有利于減輕患者心、肺、腎臟等器官功能的損害程度,改善患者免疫狀態(tài)、維持患者體內(nèi)水、電解質(zhì)、內(nèi)環(huán)境穩(wěn)態(tài),對患者預(yù)后有積極意義。
[Abstract]:Objective: to retrospectively analyze the efficacy of CRRT in the treatment of renal injury associated with severe acute pancreatitis. Methods: a retrospective analysis of 48 patients with severe acute pancreatitis associated renal injury admitted from June 2013 to June 2016 in emergency department ICU, the first affiliated Hospital of Dalian Medical University, was performed. Patients were divided into two groups according to whether they were treated with CRRT: group A: group B: group B: group B: no CRRT, all patients received other routine combined therapy. To review the clinical data of two groups of patients, including vital signs, mean arterial pressure, urine volume, white blood cell, blood biochemistry, arterial blood gas analysis and so on, before treatment, 24 hours after treatment and 48 hours after treatment. APACHE II score and modified Marshall score were evaluated. Results after 24 hours of CRRT treatment, the heart rate gradually stabilized and the respiratory rate returned to the normal range, and the urine volume of the patients increased significantly in the group of 1: 1 vital signs, the mean arterial pressure and the urine volume of the patients in group A were treated with CRRT for 24 hours. After 48 hours of treatment, the body temperature and mean arterial pressure were significantly improved and the body temperature returned to normal range, and the difference was statistically significant after 48 hours of treatment. The respiratory frequency basically returned to normal, and the other indexes were not significantly different from those at admission. 2. There was no significant difference in blood biochemistry and leukocyte in group A 24 hours after treatment. WBC, an index reflecting the severity of the disease and organ function, was significantly decreased, and WBC, the indicator of infection control, was also significantly improved. The difference was statistically significant. WBC was improved at 24 hours after treatment in group B. The blood gas analysis index of group B was stable at positive value after 24 hours treatment. P0.05.3 Blood gas analysis index: 0. 05% after 24 hours of treatment, the PH value of group B was stable at a positive level. P02P02 was significantly improved in the normal range and continued to be effective for 48 hours. Blood sodium and potassium were recovered within 48 hours, maintained in a stable range, and significantly improved compared with those at admission (P 0.05), blood calcium increased significantly and tended to normal range. In group B, serum lactate decreased significantly and PHPC02 was improved within 48 hours after treatment. There was statistical significance (P 0.05). The other indexes were significantly lower than those on admission in APACHE 鈪，

本文編號：1843250