喻超,孙诚谊,江建新,潘耀振,左石,邓亚竹
YU Chao,SUN Chengyi,JIANG Jianxin,PAN Yaozhen,ZUO Shi,DENG Yazhu(Department of Hepatobiliary Surgery

• 1:贵阳医学院附院肝胆外科

摘要(Abstract)：

目的:观察组合型血液净化联合早期肠内营养治疗高脂血症性胰腺炎疗效。方法:将35例急性高脂性胰腺炎患者分为实验组和对照组,两组均予以常规治疗及组合型(血液灌流+血液透析)血液净化,实验组给予早期肠内营养,观察两组治疗前后血清甘油三脂、总胆固醇、尿素氮、肌酐、淀粉酶及急性生理和慢性健康状态评分(APACHEⅡ);比较两组治疗7 d后血浆内毒素及C反应蛋白变化,同时比较住院时间及并发症形成情况。结果:两组患者经组合型血液净化后,血清甘油三脂、总胆固醇及APACHEⅡ均下降,治疗后第7天实验组血浆内毒素水平为(25.1±7.3)EU/L、C反应蛋白(83.2±4.6)mg/L,对照组为(51.5±8.5)EU/L和(101.1±5.9)mg/L,差异有统计学意义(P<0.05)。结论:组合型血液净化联合早期肠内营养治疗高脂血症性胰腺炎能显著降低血脂并保护肠道黏膜屏障,使高脂血症性胰腺炎患者得到较好治疗。
Objective: To observe the curative effect of combined type blood purification plus early enteral nutrition in treating acute hyperlipidemic pancreatitis(HLP).Methods: Tirty-five patients with HLP were divided into treatment group and control group.Both the two groups were given conventional therapy and combined type blood purification.Besides these therapies,the treatment group was given early enteral nutrition.Triglyceride(TG),total cholesterol(TC),blood urea nitrogen(BUN),creatinine(CRE)and amylase(AMY) levels in serum,the scores of acute physiology and chronic health state Ⅱ(APACHE Ⅱ) as well as serum levels of endotoxin and C-reactive protein(CRP) in the first day and the 7th day after therapy were observed.In the same time,the hospitalization days and the occurrence of complication of the two groups were compared.Results: TG,TC levels and APACHE Ⅱ scores were decreased obviously in both the two groups.In the 7th day,serum level of endotoxin was(25.1±7.3)EU/L and CRP level was(83.2±4.6)mg/L in the treatment group.Serum level of endotoxin was(51.5±8.5) EU/L and CRP level was(101.1±5.9)mg/L in the control group.Statistical difference were found between the two groups(P<0.05).Conclusions: The application of combined type blood purification plus early enteral nutrition in treatment of HLP can obviously reduce blood lipid levels and protect intestinal mucosa barrier of patients,which is good for patients with HLP.

关键词(KeyWords)： 血液净化;肠道营养;高脂血症;胰腺炎
blood purification;enteral nutrition;hyperlipidemia;pancreatitis

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金资助项目(81160311)

作者(Author): 喻超,孙诚谊,江建新,潘耀振,左石,邓亚竹
YU Chao,SUN Chengyi,JIANG Jianxin,PAN Yaozhen,ZUO Shi,DENG Yazhu(Department of Hepatobiliary Surgery

DOI: 10.19367/j.cnki.1000-2707.2012.03.004

参考文献(References)：

• [1]Toskes PP.Hyperlipidemic pancreatitis[J].GastroenterolClic North Am,1990(4):783-791.
• [2]Kyriakids AV,Karydakis P,Neofytou N,et al.Plas-mapheresis in the management of acute severe hyperlipi-demic pancreatitis:report of 5 cases[J].Pancreatology,2005(2-3):201-204.
• [3]宋康颉,昝建宝,孙小明,等.早期胃肠复苏和肠内营养治疗重症急性胰腺炎[J].胆胰外科杂志,2008(4)281-283.
• [4]中华医学会消化病分会胰腺学组.重症急性胰腺炎诊疗指南[J].中国消化内镜杂志,2007(10)34-36.
• [5]Wang Y,Sternfeld L,Yang F,et al.Enhanced susceptibility topan-creatitis in severe hypertriglyceridaemic lipoprotein li-pase-deficient mice and agonist-like function of pancreatic li-pase in pancreatic cells[J].Gut,2009(3):422-430.
• [6]Gan SI,Edwards AL,Symonds CJ,et al.Hypertriglycer-idemia-induced pancreatitis:a case-based review[J].World J Gastroenterol,2006(7):197-202.

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