早期CVVH在腹内压增高型重症胰腺炎治疗中的应用-10年回顾.ppt

Early continuous veno-venous haemofiltration in the management of severe acute pancreatitis complicated with intra-abdominal hypertension: retrospective review of 10 years’ experience 吉林大学白求恩第一医院ICU科 早期CVVH治疗在伴有腹内压增高的急性重症胰腺炎中的应用-10年经验回顾 Annals fo Intensive Care 2012 重症医学年报 2012 Background SAP manifests itself with local inflammation, and systemic inflammation with characteristic systemic increase of vascular permeability. Exudation with inflammatory fluid accumulations in intra-abdominal, retroperitoneal and pleural cavities is characteristic of SAP 。inflammatory fluid and visceral oedema may cause elevation (IAP) with resultant (IAH) . Prolonged IAH affects visceral perfusion and organ function, leading to the development of (MODS) and impairment of bowel barrier function and thus increasing the risk of bacterial translocation and septic complications . 吉林大学白求恩第一医院ICU科 SAP 全身感染 局部感染 胸腔、腹腔、 腹膜后积液 IAH MODS、 肠道细菌移位、 脓毒症 Background In the early phase, severity of the clinical course depends on the magnitude of systemic inflammation and anti-inflammatory capacity of the immune response . Disbalanced inflammatory response facilitates invasion of infection, leading to poor prognosis with 30% to 50% mortality . Fast reduction of inflammatory fluid accumulation and decrease of visceral oedema improve early treatment prognosis considerably, while late prognosis generally depends on the presence of infection . Management of IAH and the abdominal compartment syndrome (ACS) includes conservative measures; however, when they fail, surgical treatment is the only remaining option. In the line of conservative treatment modalities, continuous veno-venous haemofiltration (CVVH) is positioned mostly as an option for treatment of renal dysfunction with relatively low C grade of evidence 吉林大学白求恩第一医院ICU科 SAP早期预后取决于抗感染治疗 的效果，不可控制的感染SAP 死亡率可在30·50%。早期快速的 减少炎性渗出聚集可以明显的 改善预后 晚期除了感染，对于 IAH或者ACS的控制 也对预后有较大影响， 如不能较好的控制IAH， 则需要进行外科 手术干预 Background It is proved that application of CVVH faci