Research progress on timing of CRRT treatment in patients with severe acute pancreatitis
重症急性胰腺炎患者CRRT治疗时机的研究进展

摘要

重症急性胰腺炎是临床发病率较高的急腹症之一，是由胆源性和非胆源性等病因引起胰腺内的胰酶被激活，导致胰腺组织自身消化、水肿、出血和坏死的炎症反应，又称出血坏死性胰腺炎，该病具有起病急、进展快、病情危重、病死率高等特点，临床上以急性上腹痛、发热、恶心、呕吐、血尿淀粉酶升高、白细胞记数升高为主要特点，常并发休克、全身炎症反应综合征和多器官功能障碍综合征，目前临床上尚未研究出一种有效治疗重症急性胰腺炎的方法，早期的观点认为重症急性胰腺炎患者死亡的主要原因是患者的胰腺组织坏死，所以医疗界不断地尝试外科手术在其治疗过程中的应用，但是随着研究的深入，相关研究人员发现，重症急性胰腺炎患者死亡的主要原因并不在胰腺本身，而是由胰腺炎引发的多器官功能障碍和全身性炎症反应，手术方法虽然有一定的治疗效果，但是其有很大的可能会增加感染的发生和传播，增加患者并发症的发生，因此随着重症急性胰腺炎研究的不断深入，治疗理念不断更新，目前最为常用，也是最有效的治疗手段是连续性肾脏替代治疗（CRRT），这种治疗方案主要是可将患者机体体内的炎性介质、毒物平稳的清除，为患者及时补充大量营养成分，可有效稳定患者的血流动力学情况，提高患者的生存质量，本文通过对重症急性胰腺炎患者进行连续性肾脏替代治疗的时机和效果进行了相应的的阐述以及说明，旨在为临床治疗中提供些许依据和参考。

Abstract

severe acute pancreatitis is one of the acute abdominal diseases with a high clinical incidence rate. It is caused by the activation of pancreatic enzymes in the pancreas caused by biliary and non biliary causes, which leads to the inflammatory reaction of digestion, edema, bleeding and necrosis of the pancreatic tissue itself, also known as hemorrhagic necrotizing pancreatitis. This disease has the characteristics of acute onset, rapid progress, critical condition and high mortality. Clinically, it is characterized by acute epigastric pain, fever, nausea, vomiting Hematuria amylase elevation and leukocyte count elevation are the main characteristics, which are often complicated by shock, systemic inflammatory response syndrome and multiple organ dysfunction syndrome. At present, there is no effective treatment for severe acute pancreatitis in the clinic. The early view is that the main cause of death of patients with severe acute pancreatitis is pancreatic tissue necrosis, so the medical community continues to try the application of surgery in its treatment process, However, with the deepening of the research, relevant researchers found that the main cause of death of patients with severe acute pancreatitis is not the pancreas itself, but the multiple organ dysfunction and systemic inflammatory reaction caused by pancreatitis. Although the surgical method has a certain therapeutic effect, it is likely to increase the occurrence and spread of infection and increase the occurrence of complications. Therefore, with the deepening of the research on severe acute pancreatitis, The treatment concept is constantly updated. At present, the most commonly used and effective treatment is continuous renal replacement therapy (CRRT). This treatment scheme can steadily remove inflammatory media and poisons from the patient's body, supplement a large amount of nutrients for the patient in time, effectively stabilize the patient's hemodynamics, and improve the patient's quality of life, In this paper, the opportunity and effect of continuous renal replacement therapy for patients with severe acute pancreatitis are described and explained, aiming to provide some basis and reference for clinical treatment.