【摘要】 目的探讨床边插管腹膜透析(PD)治疗重症急性胰腺炎(SAP)的可行性及疗效。方法采用前瞻性随机对照研究,将33例SAP患者随机分治疗组16例(行内科常规治疗基础上配合床边插管PD)和对照组17例(仅采用内科常规治疗),观察2组治疗前后病情及生化指标的变化以及床边插管PD的安全性。结果治疗组治疗期间发生脏器功能损害9例次(56.25%),明显低于对照组30例次(176.47%)(P<0.01);治疗组病死率(18.75%)明显低于对照组(47.06%)(P<0.05)。治疗组治疗48h后,血尿素氮(BUN)、肌酐(Scr)、天冬氨酸转氨酶(AST)、血淀粉酶(AMS)、脂肪酶(LPS)下降水平与治疗48h、72h后APACHEⅡ评分降低水平,分别与对照组相比较,差异均有统计学意义(P<0.05)。无1例因插管出现严重的并发症。结论床边插管PD是治疗SAP安全、简单、有效的方法,早期配合PD治疗,可明显降低SAP的死亡率,值得推广应用。更多还原

【Abstract】 Objective To evaluate the feasibility and efficacy of peritoneal dialysis(PD) by bedside intubation in the treatment of patients with severe acute pancreatitis(SAP).Methods In this prospective randomized controlled study,33 patients with SAP were randomized into two groups:the therapeutic group(n=16) treated with PD by bedside intubation based on the routine internal medicine therapy,while the contrast group treated only with the routine therapy.The changes of the general conditions and blood biochemical indexes before and after treatment were observed,the safety of PD patients by bedside intubation as well.Results The organ dysfunction occurred in 9 patients(56.25%) in the therapeutic group and 30 patients(176.47%) in the control group,there was significantly difference(P<0.01).The mortality of therapeutic group(18.75%) was significantly lower than that of the control group(47.06%),P<0.05.The level of blood urea nitrogen(BUN),serum creatinine(Scr),aspartate aminotransferase(AST),amylas(AMS) and lipase(LPS) decreased notably after treatment of forty-four hours as well as the APACHEⅡ score decreasing significantly after treatment of forty-four and seventy-two hours,the difference between the two groups was significant(P<0.05).No serious complication caused by bedside intubation was found.Conclusions PD by bedside intubation is safe,simple and effective for SAP.It can reduce mortality obviously and is worthy to be used widely.更多还原