叶丹,张川,乐涛,江利东,王玺,柯丽,张奕,曾小英
YE Dan,ZHANG Chuan,LE Tao,JIANG Lidong,WANG Xi,KE Li,ZHANG Yi,ZENG Xiaoying

• 1:成都市第三人民医院重症医学科

摘要(Abstract)：

目的:研究血液灌流(HP)联合连续性静脉—静脉血液滤过(CVVH)对高脂血症性重症胰腺炎(HLSAP)患者甘油三酯(TG)、炎症因子及急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分的影响。方法:86例HLSAP患者均分为对照组和观察组,对照组在常规内科治疗基础上进行CVVH治疗,观察组在对照组的基础上再加用HP,记录治疗后两组患者腹痛、腹胀、恶心呕吐、腹膜刺激征症状缓解时间及肠鸣音恢复时间;于治疗前及治疗第1、3及7天时,监测两组患者呼吸频率(RR)、心率(HR)、平均动脉压(MAP)水平、APACHEⅡ评分、腹围及腹压,同时检测血清TG、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及C反应蛋白(CRP)水平。结果:治疗后,观察组患者腹痛、腹胀、恶心呕吐、腹膜刺激征症状缓解时间及肠鸣音恢复时间均显著短于对照组(P<0.05);治疗后,两组患者RR、HR、APACHEⅡ评分、腹围、腹压及血清TG、IL-6、TNF-α、CRP水平显著低于治疗前,同组内比较第1天<第3天<第7天(P<0.05),MAP显著高于治疗前、对照组,同组内比较第1天>第3天>第7天(P<0.05);治疗后同时点观察组RR、HR、APACHEⅡ评分、腹围、腹压及血清TG、IL-6、TNF-α、CRP水平显著低于对照组(P<0.05)。结论:HP联合CVVH治疗HLSAP能降低TG和炎症因子水平及APACHEⅡ评分,从而改善患者症状和预后,提升治疗效果。
Objective: To study the effect of hemoperfusion(HP) combined with continuous veno-venous hemofiltration(CVVH) on blood lipid, inflammatory factor and acute physiological and chronic health status Ⅱ(APACHE Ⅱ) score in patients with severe hyperlipidemia pancreatitis(HLSAP). Methods:86 patients with HLSAP were divided into control group and observation group. The control group was treated with CVVH on the basis of routine medical treatment, and the observation group was treated with HP on the basis of the control group. After treatment, the relief time of abdominal pain, abdominal distension, nausea and vomiting, abdominal irritation and intestinal sound recovery were recorded. Before treatment and on the 1 st, 3 rd and 7 th day after treatment, the mean arterial pressure(MAP) level, APACHE Ⅱ score, abdominal circumference and abdominal pressure of(RR), heart rate were measured, and the levels of serum TG, interleukin-6(IL-6), tumor necrosis factor-α(TNF-\α) and C-reactive protein(CRP) were measured at the same time. Results:After treatment, the relief time of abdominal pain, abdominal distension, nausea and vomiting, abdominal irritation and intestinal sound recovery in the observation group were significantly shorter than those in the control group(P<0.05). After treatment, the RR, HR, APACHE Ⅱ score, abdominal circumference, abdominal pressure and serum TG, IL-6, TNF-α and CRP levels in the two groups were significantly lower than those before treatment. MAP of the same group was significantly higher than that of the control group on the 1 st day < 3 rd day < 7 th day(P<0.05), and the first day > the 3 rd day > the 7 th day in the same group(P<0.05). At the same time after treatment, the RR,HR,APACHE Ⅱ score, abdominal circumference, abdominal pressure and serum TG, IL-6, TNF-α and CRP levels in the observation group were significantly lower than those in the control group(P<0.05).Conclusion:HP combined with CVVH in the treatment of HLSAP can reduce TG and inflammatory factor levels and APACHE Ⅱ scores, thus improving the symptoms and prognosis of patients and improving the therapeutic effect.

关键词(KeyWords)： 高脂血症性重症急性胰腺炎;血液灌流;连续性静脉—静脉血液滤过;血脂;炎症因子;APACHEⅡ评分
hyperlipidemia severe acute pancreatitis;hemoperfusion;continuous veno-venous hemofiltration;blood lipid;inflammatory factor;APACHE Ⅱ score

Abstract:

Keywords:

基金项目(Foundation): 四川省医学会专项课题(2016ZZ002)

作者(Author): 叶丹,张川,乐涛,江利东,王玺,柯丽,张奕,曾小英
YE Dan,ZHANG Chuan,LE Tao,JIANG Lidong,WANG Xi,KE Li,ZHANG Yi,ZENG Xiaoying

DOI: 10.19367/j.cnki.1000-2707.2019.08.025

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