血液灌流联合连续静脉-静脉滤过治疗高脂血症性重症急性胰腺炎疗效观察
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摘要
目的:回顾性分析血液灌流(HP)联合连续性静脉-静脉滤过(CVVH)治疗高脂血症性重症急性胰腺炎(HL-SAP)的临床疗效。方法:38例HL-SAP患者,随机分为两组:常规治疗对照组(对照组,n=18),行胰腺炎一般常规治疗;HP联合CVVH治疗组(HP+CVVH组,n=20),在对照组常规治疗的同时,进行HP联合CVVH治疗。比较两组治疗前后急性病理生理评分(APACHE II)、血清甘油三酯(TG)水平以及禁食时间、血脂恢复时间、血淀粉酶恢复时间、ICU住院时间、死亡率等指标的统计学差异。结果:两组患者入住重症监护室(ICU)时(治疗前)APACHEII、TG水平均无统计学差异(P>0.05),出ICU时(治疗后)两组以上指标均较同组治疗前显著降低(P<0.05),HP+CVVH组较对照组下降更明显(P<0.05),治疗后HP+CVVH组死亡率低于对照组(P<0.05),血清TG恢复正常时间、ICU住院时间短于对照组(P<0.05);但两组血淀粉酶恢复正常时间和禁食时间无显著差异(P>0.05)。结论:HP联合CVVH是治疗HL-SAP的较好方法。
Objective:To observe the effects of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)in the treatment of hyperlipidemic severe acute pancreatitis(HL-SAP).Method:38patients with HL-SAP were randomly divided into two groups.The patients in the constant group(CON group,n=18)were treated with routine treatment.Patients in the treatment group(HP+CVVH group,n=20)were treated with hemoperfusion combined with CVVH,the levels of APACHE II score,serum triglyceride(TG),fasting time,blood lipid recovery time,blood amylase recovery time,ICU-stay time and mortality rate were compared between the two groups before and after treatment.Results:There were no significant differences in the levels of APACHE II and TG before treatment in the two groups(P>0.05).After treatment,all the indexes were significantly lower than those before treatment(P<0.05),and HP+CVVH group decreased more significantly than CON group(P<0.05).To compare the mortality rate when patients were out of ICU,we found that HP+CVVH group was lower(P<0.05).To compare the serum TG recovery time and the ICU admission time,HP+CVVH group was shorter than CON group(P<0.05).However,there were no significant differences between the two groups in blood amylase recovery time and fasting time(P>0.05).Conclusion:Hemoperfusion combined with CVVH treatment is a better method for the treatment of HL-SAP.
Objective:To observe the effects of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)in the treatment of hyperlipidemic severe acute pancreatitis(HL-SAP).Method:38patients with HL-SAP were randomly divided into two groups.The patients in the constant group(CON group,n=18)were treated with routine treatment.Patients in the treatment group(HP+CVVH group,n=20)were treated with hemoperfusion combined with CVVH,the levels of APACHE II score,serum triglyceride(TG),fasting time,blood lipid recovery time,blood amylase recovery time,ICU-stay time and mortality rate were compared between the two groups before and after treatment.Results:There were no significant differences in the levels of APACHE II and TG before treatment in the two groups(P>0.05).After treatment,all the indexes were significantly lower than those before treatment(P<0.05),and HP+CVVH group decreased more significantly than CON group(P<0.05).To compare the mortality rate when patients were out of ICU,we found that HP+CVVH group was lower(P<0.05).To compare the serum TG recovery time and the ICU admission time,HP+CVVH group was shorter than CON group(P<0.05).However,there were no significant differences between the two groups in blood amylase recovery time and fasting time(P>0.05).Conclusion:Hemoperfusion combined with CVVH treatment is a better method for the treatment of HL-SAP.
引文
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6 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):50-53.
7 中华医学会消化病分会胰腺病学组.中国急性胰腺炎诊治指南(草案)[J].中华消化杂志,2004,24(3):190-192.
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9 李文科,王东.高脂血症性胰腺炎研究进展[J].中国全科医学,2013,16(8):2 793-2 795.
10 陈伟,孟翔凌,张震,等.高脂血症性胰腺炎的临床特点及预后[J].广东医学,2010,31(12):1 598-1 599.
11 Zhang XL,Li F,Zhen YM,et al.Clinical study of 224patients with hypertriglyceridemia pancreatitis[J].Chin Med J(Engl),2015,128(15):2 045-2 049.
12 常为民,杨进军.不同血液净化方式对高脂血症性胰腺炎的作用[J].重庆医学,2012,41(17):1 706-1 707.
13 张远超,喻莉,耿峰,等.血液灌流联合血液滤过治疗高脂血症性胰腺炎的疗效观察[J].中华肝胆外科杂志,2014,20(4):274-276.
14 黄惠斌,郑文贺,李莹,等.持续静脉-静脉血液滤过治疗高脂血症性胰腺炎的系统评价[J].中国循证医学杂志,2014,14(5):611-617.
15 叶应春,刘正刚.血液灌流联合血液滤过治疗高脂血症性重症急性胰腺炎50例疗效评估[J].现代诊断与治疗,2015,26(6):1 205-1 207.
16 Huang Z,Wang SR,Su W,et al.Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column[J].Ther Apher Dia,2010,14(6):596-602.
17 杨朝晖,杨军,汪勇俊.连续性血浆滤过对重症急性胰腺炎诱发组织器官损害的保护作用[J].中国危重病急救医学,2004,16(4):232-234.
18 周秀华.血液灌流联合连续肾脏替代治疗高脂血症性重症急性胰腺炎的研究[J].山西医药杂志,2012,41(12):1 282-1283.
19 张远超,喻莉,耿峰,等.血液灌流联合血液滤过治疗高脂血症性胰腺炎的效果观察[J].中华肝胆外科杂志,2014,20(4):274-276.
2 Yin G,Cang X,Yu G,et al.Different clinical presentations of hyperlipidemic acute pancreatitis:a retrospective study[J].Pancreas,2015,44(7):1 105-1 110.
3 钱明江,高飞,陈淼,等.血液灌流联合CVVH治疗高脂血症性重症急性胰腺炎的临床观察[J].中国医药科学,2013,3(18):16-18.
4 Stefanutti C,Labbadia G,Momzzi C.Severe hypertriglyceridemia-related acute pancreatitis:myth or reality[J].Ther Apher Dial,2013,17(4):464-465.
5 刘伟,宋晓彪,刘超,等.高脂血症性胰腺炎的研究进展[J].临床荟萃,2016,31(8):919-925.
6 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):50-53.
7 中华医学会消化病分会胰腺病学组.中国急性胰腺炎诊治指南(草案)[J].中华消化杂志,2004,24(3):190-192.
8 刘敏姬,陈维顺,金少纯,等.高脂血症性急性胰腺炎的临床特点分析[J].中国现代医药杂志,2016,18(1):55-57.
9 李文科,王东.高脂血症性胰腺炎研究进展[J].中国全科医学,2013,16(8):2 793-2 795.
10 陈伟,孟翔凌,张震,等.高脂血症性胰腺炎的临床特点及预后[J].广东医学,2010,31(12):1 598-1 599.
11 Zhang XL,Li F,Zhen YM,et al.Clinical study of 224patients with hypertriglyceridemia pancreatitis[J].Chin Med J(Engl),2015,128(15):2 045-2 049.
12 常为民,杨进军.不同血液净化方式对高脂血症性胰腺炎的作用[J].重庆医学,2012,41(17):1 706-1 707.
13 张远超,喻莉,耿峰,等.血液灌流联合血液滤过治疗高脂血症性胰腺炎的疗效观察[J].中华肝胆外科杂志,2014,20(4):274-276.
14 黄惠斌,郑文贺,李莹,等.持续静脉-静脉血液滤过治疗高脂血症性胰腺炎的系统评价[J].中国循证医学杂志,2014,14(5):611-617.
15 叶应春,刘正刚.血液灌流联合血液滤过治疗高脂血症性重症急性胰腺炎50例疗效评估[J].现代诊断与治疗,2015,26(6):1 205-1 207.
16 Huang Z,Wang SR,Su W,et al.Removal of humoral mediators and the effect on the survival of septic patients by hemoperfusion with neutral microporous resin column[J].Ther Apher Dia,2010,14(6):596-602.
17 杨朝晖,杨军,汪勇俊.连续性血浆滤过对重症急性胰腺炎诱发组织器官损害的保护作用[J].中国危重病急救医学,2004,16(4):232-234.
18 周秀华.血液灌流联合连续肾脏替代治疗高脂血症性重症急性胰腺炎的研究[J].山西医药杂志,2012,41(12):1 282-1283.
19 张远超,喻莉,耿峰,等.血液灌流联合血液滤过治疗高脂血症性胰腺炎的效果观察[J].中华肝胆外科杂志,2014,20(4):274-276.