中国普通外科杂志 ›› 2021, Vol. 30 ›› Issue (3): 321-329.doi: 10.7659/j.issn.1005-6947.2021.03.010

• 临床研究 • 上一篇    下一篇

早期腹腔穿刺引流对重症急性胰腺炎肾损伤的保护作用

杨熊1, 2,刘若鸿2,谢川1, 2,董鸿斐2,吴俊2,孙红玉2,汤礼军2   

  1. (1. 川北医学院  临床医学系, 四川 南充 637100;2. 中国人民解放军西部战区总医院 全军普通外科中心, 四川 成都 610083)
  • 收稿日期:2020-08-20 修回日期:2021-02-21 出版日期:2021-03-25 发布日期:2021-04-06
  • 通讯作者: 汤礼军, Email: tanglj2016@163.com;孙红玉, Email: shongyu2008@163.com
  • 作者简介:杨熊,川北医学院临床医学系硕士研究生,主要从事肝胆胰脾外科微创治疗方面的研究。
  • 基金资助:
    国家自然科学基金面资助项目(81772001);国家临床重点专科基金资助项目(41732113)。

Protective effect of early abdominal paracentesis drainage against kidney injury secondary to severe acute pancreatitis

YANG Xiong1,2, LIU Ruohong2, XIE Chuan1,2, DONG Hongfei2, WU Jun2, SUN Hongyu2, TANG Lijun2   

  1. (1. Department of Clinical Medicine of North Sichuan Medical College, Nanchong, Sichuan 637100, China; 2. Department of General Surgery, General Hospital of Western Theater Command, Chengdu 610083, China)
  • Received:2020-08-20 Revised:2021-02-21 Online:2021-03-25 Published:2021-04-06

摘要: 背景与目的:急性肾损伤(AKI)是重症急性胰腺炎(SAP)患者早期常见并发症,也是导致SAP患者早期死亡的重要原因,有效预防及治疗SAP患者早期AKI的发生对SAP患者的预后至关重要。SAP患者早期腹腔常积聚胰腺炎相关性腹水(PAAF),其不但可形成腹腔内高压导致肾脏的缺血损伤,而且可通过大量炎性介质及酶类等毒性物质的重吸收入血导致肾脏的急性损伤。因此,去除PAAF可能对SAP相关性AKI具有保护作用。腹腔穿刺置管引流(APD)可及时、有效的引流出PAAF而并不增加腹腔感染的风险。然而,APD能否改善SAP相关性AKI尚不清楚。为此,本研究探讨早期APD是否对SAP相关性AKI具有保护作用,试图为SAP相关性AKI的早期预防及治疗提供临床依据。
方法:回顾性分析西部战区总医院2011年1月—2020年1月收治的符合纳入标准的186例SAP患者的临床资料,根据入院时是否已发生AKI将所有SAP患者分为AKI组(57例)和非AKI组(129例);AKI组中30例行APD,27例未行APD,非AKI组中65例行APD治疗,64例未行APD。分别比较两组中行APD与未行APD患者的疗效差异,观察项目包括急性肾损伤分期(AKIN分期)、肾功能指标、炎症指标、APACHE II评分。
结果:AKI组中,行APD与未行APD患者的AKIN分期降期率分别为80.0%(24/30)、51.9%(14/27)(χ2=5.067,P=0.024),而升期率分别为0.0%(0/30)、18.5%(5/27)(P=0.019);治疗7 d后患者肾功能指标、炎症指标、APACHE II评分均较治疗前明显降低,但行APD患者各指标降低程度均明显大于未行APD患者(均P<0.05)。非AKI组中,行APD与未行APD患者的AKIN分期升期率(AKI发生率)分别为4.6%(3/65)、17.2%(11/64)(χ2=5.268,P=0.022);治疗7 d后患者肾功能指标、炎症指标、APACHE II评分均较治疗前明显降低,但行APD患者各指标降低程度均明显大于未行APD患者(均P<0.05)。
结论:对于伴有大量PAAF的SAP患者,无论其入院时是否合并AKI,早期APD治疗不但可有效降低已发生AKI患者肾损伤分期,减少未发生AKI患者肾损伤发生率,而且可有效降低肾功能指标及改善患者全身炎症状态,对肾损伤起预防及治疗作用,临床疗效显著。

关键词: 胰腺炎, 急性坏死性;急性肾损伤;腹水;穿刺抽液术

Abstract: Background and Aims: Acute kidney injury (AKI) is a common early complication in patients with severe acute pancreatitis (SAP), and it is also an important cause for early death in patients with SAP. Effective prevention and treatment of early AKI in SAP patients are critical for the prognosis of patients. The abdominal cavity of patients with SAP at the early stage often accumulates pancreatitis-related ascitic fluid (PAAF), which can not only form intra-abdominal hypertension and cause kidney ischemic injury, but also can cause kidney injury through the reabsorption of a large number of inflammatory mediators, enzymes and other toxic substances into the blood. Therefore, removing PAAF may have a protective effect against SAP-related AKI. Abdominal paracentesis drainage (APD) can drain PAAF timely and effectively without increasing the risk of abdominal infection. However, whether APD can improve SAP-related AKI is unclear. To this end, this study was conducted to investigate whether early APD has a protective effect on SAP-related AKI, and try to provide clinical evidence for the early prevention and treatment of SAP-related AKI. 
Methods: The clinical data of 186 SAP patients who met the inclusion criteria admitted to the Western Theater General Hospital from January 2011 to January 2020 were retrospectively analyzed. According to whether acute kidney injury (AKI) had occurred at the time of admission, they were divided into AKI group (57 cases) and non-AKI group (129 cases). In AKI, 30 patients underwent APD and 27 patients did not receive APD; in non-AKI group, 65 patients underwent APD and 64 patients did not receive APD. The differences in treatment efficacy between patients with and without APD were compared in either group, respectively. The studied variables included acute kidney injury stage (AKIN stage), renal function indexes, inflammation indexes, and APACHE II score. 
Results: In AKI group, the downgrading rates of the AKIN stage in patients with and without APD were 80% (24/30) and 51.9% (14/27), respectively (χ2=5.067, P=0.024), while the upgrading rates were 0.0% (0/30), 18.5% (5/27), respectively (P=0.019); after 7 days of treatment, the renal function indexes, inflammation indexes, and APACHE II scores of the patients were significantly reduced, but the decreasing amplitudes of all indexes in patients undergoing APD were significantly greater than those in patients without APD treatment (all P<0.05). In non-AKI group, the upgrading rates of the AKIN stage (the incidence of AKI) in patients with and without APD were 4.6% (3/65) and 17.2% (11/64) (χ2=5.268, P=0.022); after 7 days of treatment, the renal function indexes, inflammation indexes, and APACHE II scores of the patients were significantly reduced, but the decreasing amplitudes of all indexes in patients undergoing APD were significantly greater than those in patients without APD treatment (all P<0.05). 
Conclusion: For SAP patients with a large amount of PAAF, regardless of whether they are combined with AKI at the time of admission, early APD treatment can not only effectively reduce the stage of renal injury in patients with AKI, reduce the incidence of renal injury in patients without AKI, but also effectively decrease renal function index and improve the systemic inflammation. So, it has preventive and therapeutic effects against kidney injury, with a demonstrable efficacy.

Key words: Pancreatitis, Acute Necrotizing, Acute Kidney Injury, Ascites, Paracentesis

中图分类号: 

  • R657.5
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