【摘要】 目的分析重症急性胰腺炎(SAP)合并急性肾功能衰竭(ARF)的临床特点,并总结治疗体会。方法①回顾分析南京军区南京总医院近9年63例SAP合并ARF临床资料,用多元直线回归方法分析影响ARF发生率的相关因素;②63例病人均行肠内营养支持(62.4±20.6 d)和连续性肾脏替代治疗(CRRT)(15.6±8.7 d),51例行机械通气(21.7±12.4 d),54例早期腹腔穿刺,34例置鼻胆管或经皮经肝胆囊穿刺引流,18例行腹膜后脓肿穿刺引流,50例手术治疗。结果SAP合并ARF的死亡率为31.7%,发生率为10.6%,SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素。结论SIRS持续时间、病情严重程度、ARDS、MODS、腹腔间室综合征等是SAP合并ARF的重要影响因素;早期液体复苏、CRRT、有效维护脏器功能和局部引流是治疗成功的重要环节。更多还原

【Abstract】 Objective To observe the clinical characteristics of severe acute pancreatitis (SAP) complicated with acute renal failure (ARF) and summarize the treatment experience.Methods The mortality and morbidity were concluded by retrospectively analyzing the clinical data of 63 SAP pa- tients complicated with ARF treated in hospital in the past 9 years,and the related factors of morbidity were procured by linear regression (stepwise regression).All the 63 patients having the complication of ARF received enteral nutrition(62.4±20.6 d)and continuous renal replacement therapy (CRRT) (15.6±8.7 d).Early abdominal drainage was conducted in 54 patients and mechanical ventilation (21.7±12.4 d) in 51.Thirty-three patients underwent nasobiliary drainage or percutaneous transhe- patic gallbladder,18 were managed by paracentesis and drainage of the retroperitoneal abscess,and 50 received operation.Results The mortality of SAP patients with ARF was 31.7%,and the morbidity 10.6%.The duration of SIRS,severity,ARDS,MODS,ACS and so on were directly related factors of morbidity.Conclusion The directly related factors of SAP complicated with ARF are the duration of SIRS,severity,ARDS,MODS,ACS and so on.Early fluid resuscitation,CRRT,organ function protection and local drainage are effective methods to prevent the development of ARF and improve the prognosis.更多还原