• 1. 四川大學(xué)華西醫(yī)院中西醫(yī)結(jié)合科（成都 610041)2. 四川大學(xué)華西醫(yī)院普外三（成都 610041);

目的 　評(píng)價(jià)早期血液濾過治療重癥急性胰腺炎（SAP）的有效性和安全性。
方法 　計(jì)算機(jī)檢索Cochrane圖書館臨床對(duì)照試驗(yàn)資料庫（2005年第4期）、MEDLINE和中國生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫，檢索年限為1990～2006年。手檢所獲文獻(xiàn)的參考文獻(xiàn)。納入比較早期血液濾過（HF）與常規(guī)保守治療（NHF）治療SAP的臨床隨機(jī)對(duì)照試驗(yàn)（RCT）和非隨機(jī)對(duì)照研究（CCT），其至少報(bào)道了病死率或治愈率。由兩名評(píng)價(jià)員獨(dú)立選擇試驗(yàn)和提取資料。并按Cochrane系統(tǒng)評(píng)價(jià)員手冊(cè)的4條質(zhì)量評(píng)價(jià)標(biāo)準(zhǔn)對(duì)納入文獻(xiàn)的方法學(xué)質(zhì)量進(jìn)行評(píng)價(jià)，而后應(yīng)用RevMan 4.2.8軟件做Meta分析。
結(jié)果 　納入10個(gè)RCT和6個(gè)CCT，共891例患者，均來自中國。納入研究質(zhì)量均較低。各試驗(yàn)均具有基線可比性。Meta分析發(fā)現(xiàn)，與NHF組相比HF組明顯提高了總體治愈率[RR 1.14，95%CI（1.04，1.25）]，降低了總體病死率[RR 0.49，95%CI（0.32，0.74）]，并且明顯降低了治療后APACHE-II評(píng)分、中轉(zhuǎn)手術(shù)率和SAP并發(fā)癥發(fā)生率，縮短了腹痛、腹脹癥狀改善時(shí)間和住院時(shí)間。持續(xù)血液濾過組（CVVH）不能有效改善總體預(yù)后并可能發(fā)生不良反應(yīng)，而反復(fù)或間歇短時(shí)血液濾過組（RSVVH/ISVVH） 無論是否聯(lián)合腹膜透析治療，均能明顯改善預(yù)后并且無不良反應(yīng)報(bào)道。
結(jié)論 　根據(jù)目前證據(jù)，早期RSVVH/ISVVH治療SAP患者可能是安全有效的，但尚不能證明CVVH的有效性。目前所獲研究?jī)H來自中國且方法學(xué)質(zhì)量較低，需要進(jìn)一步開展高質(zhì)量大樣本的RCT來評(píng)價(jià)早期血液濾過治療SAP的有效性和安全性。

引用本文： 姜坤,陳心足,夏慶,唐文富,王蕾. 早期血液濾過治療重癥急性胰腺炎的系統(tǒng)評(píng)價(jià). 中國循證醫(yī)學(xué)雜志, 2007, 07(2): 121-134. doi: 復(fù)制

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  1. 1. Chinese medical association, Society of surgery, Pancreatic disease group. Diagnostic and therapeutic guidelines for acute pancreatitis (Draft). Chinese Journal of Digestion, 2004, 24: 190–192.
  2. 2. Mao EQ, Tang YQ, Zhang SD. Discussion of improve the prognosis of severe acute pancreatitis. Chinese Journal of Practical Surgery, 2003, 23(1): 50–52.
  3. 3. Mao EQ, Tang YQ, Han TQ, et al. Effects of short veno venous hemofiltration on severe acute pancreatitis. Chiese Journal of Surgery, 1999, 37(3): 141–143.
  4. 4. Yang FF, You YW, Lin X, et al. Clinical observation of short-time hemofiltration and peritoneal dialysis on severe acute pancreatitis. Youjiang Medical Journal, 2005, 33(3): 233–234.
  5. 5. Chen ZY, Li Y, Li MZ, et al. Application of blood purification combining cortical sugar hormone to sever acute pancreatitis. Chinese Journal of Primary Medicine Pharmacy, 2005, 12(8): 1070–1071.
  6. 6. Feng GH, Cai Y, Jia PH. Combination of hemofiltration and peritoneal dialysis in the treatment of severe acute pancreatitis. Chinese Journal of Surgery, 2004, 42(5): 272–275.
  7. 7. Sun B, Zhou ZQ, Xu J, et al. Effect of early therapy of hemofiltration on the patients with severe acute pancreatitis. Journal of Clinical Surgery, 2003, 11(5): 306–208.
  8. 8. Sun WJ, Zong WJ, Wu LY, et al. Study on early hemofiltration for treating severe acute pancreatitis. Modern Medicine Health, 2004, 20(18): 1833–1834.
  9. 9. Sun ZX, Sun CY. Combined treatment of abdmninal compartment syndrome complicating with fulminant acute pancreatitis: a report of 40 cases. World Chinese Journal of Digestology, 2005, 13(14): 1797–1799.
  10. 10. Tao J, Wang CY, Yang ZY, et al. Comparative study on the effect of two different hemofiltration methods on severe acute pancreatitis and the indications. Chinese Journal of Experimental Surgery, 2003, 20(10): 937–939.
  11. 11. Tao J, Wang CY, Yang ZY, et al. Effect of hemofiltration on imbalance of pro- and anti-inflammatory cytokines in severe acute pancreatitis patients. Chinese Journal of General Surgery, 2004, 19(4): 233–235.
  12. 12. Wang BJ, Liu WJ. short veno-venous hemofiltration and peritoneal lavage for severe acute pancreatitis patients: a report of 58 cases. Qianwei Journal of Medicine, 2003, 20(9): 649.
  13. 13. Wang XY, Tan JX, Ren GS. Effect of hemofiltration on treatment of severe acute pancreatitis. Chongqing Medical Journal, 2005, 34(12): 1823–1824.
  14. 14. Yang ZH, Yang J, Wang YJ. Protective effect of continuous veno-venous hemofiltration on tissue and organ damage in patients with severe acute pancreatitis. Chinese Critical Care Medicine, 2004, 16(4): 232–234.
  15. 15. Yang ZY, Wang CY, Tao J, et al. Effect of intermittent short veno-venous hemofiltration on immunological function of severe acute pancreatitis. Journal of Clinical Surgery, 2004, 12(11): 667–669.
  16. 16. Zha Y, Zhou L, Liu Q, et al. Effects of RSVVH Therapy on Cytokines in Severe Acute Pancreatitis. Journal of Guiyang Medical College, 2005, 30(1): 36–38.
  17. 17. Zhang T, Zhou L. Chen XQ, et al. Effectiveness evaluation of hemofiltration for severe acute pancreatitis. Chinese Journal of the Practical Chinese With Modern Medicine, 2005, 18(19): 1132–1133.
  18. 18. Zhuang YT, liu LM, Fu JH. hemofiltration for severe acute pancreatitis: a report of 20 cases. Shandong Medical Journal, 2005, 45(25): 76.
  19. 19. Zong WJ, Wu LY, Sun WJ, et al. Clinical evaluation of continuous veno-venous hemofiltration for severe acute pancreatitis. Chinese Journal of Blood Purification, 2004, 3(10): 562–564.
  20. 20. Shen Q, Gan H, Du XG, et al. Continuous veno-venous hemofiltration for severe acute pancreatitis. Chongqing Medical Journal, 2002, 31(12): 1222–1224.
  21. 21. .Lowenfels AB, Sullivan T, Fiorianti J, et al. The epidemiology and impact of pancreatic diseases in the United States. Curr Gastroenterol Rep, 2005, 7(2): 90–95.
  22. 22. .Sekimoto M, Takada T, Kawarada Y, et al. JPN Guidelines for the management of acute pancreatitis: epidemiology, etiology, natural history, and outcome predictors in acute pancreatitis. J Hepatobiliary Pancreat Surg, 2006, 13(1):10–24.
  23. 23. .Andersson R, Andersson B, Haraldsen P, et al. Incidence, management and recurrence rate of acute pancreatitis. Scand J Gastroenterol, 2004, 39(9): 891–894.
  24. 24. .Goldacre MJ, Roberts SE. Hospital admission for acute pancreatitis in an English population, 1963-98: Database study of incidence and mortality. Br Med J,2004, 328: 1466–1469.
  25. 25. .中華醫(yī)學(xué)會(huì)消化病學(xué)分會(huì)胰腺疾病學(xué)組. 中國急性胰腺炎診治指南(草案). 中華消化雜志, 2004, 24: 190～192.
  26. 26. .Otsuki M, Hirota M, Arata S, et al; The Research Committee of Intractable Diseases of the Pancreas. Consensus of primary care in acute pancreatitis in Japan. World J Gastroenterol, 2006, 12(21): 3314–3323.
  27. 27. .Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med, 2006, 354(20): 2142–2150.
  28. 28. .Hochman D, Louie B, Bailey R. Determination of patient quality of life following severe acute pancreatitis. Can J Surg, 2006, 49(2): 101–106.
  29. 29. .Imamura M. Epidemiology of acute pancreatitis--incidence by etiology, relapse rate, cause of death and long-term prognosis. Nippon Rinsho, 2004, 62: 1993–1997.
  30. 30. .Carnovale A, Rabitti PG, Manes G, et al. Mortality in acute pancreatitis: Is it an early or a late event? J. Pancreas,2005, 6: 438–444.
  31. 31. .Kusske AM, Rongione AJ, Reber HA. Cytokine and acute pancreatitis. Gastroenterology, 1996, 110(2): 639–642.
  32. 32. .毛恩強(qiáng), 湯耀卿, 張圣道. 進(jìn)一步改善重癥急性胰腺炎預(yù)后的探討. 中國實(shí)用外科雜志, 2003, 23(1): 50～52.
  33. 33. .Blinzler L, Hausser J, Bodeker H, et al. Conservative treatment of severe necrotizing pancreatitis using early continuous venovenous hemofiltration. Contrib Nephrol, 1991, 93: 234–236.
  34. 34. .Jiang HL, Xue WJ, Li DQ, et al. Influence of continuous veno-venous hemofiltration on the course of acute pancreatitis. World J Gastroenterol, 2005, 11(31): 4815–4821.
  35. 35. .Yekebas EF, Treede H, Knoefel WT, et al. Influence of zero-balanced hemofiltration on the course of severe experimental pancreatitis in pigs. Ann Surg, 1999, 229(4): 514–522.
  36. 36. .毛恩強(qiáng), 湯耀卿, 韓天權(quán), 等. 短時(shí)血濾對(duì)重癥急性胰腺炎治療的影響. 中華外科雜志, 1999, 37(3): 141～143.
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  39. 39. .陳仲悅, 李毅, 李媚珍, 等. 大劑量地塞米松聯(lián)合血液濾過在重癥急性胰腺炎中的應(yīng)用. 中國基層醫(yī)藥, 2005, 12(8): 1070～1071.
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