配对血浆分离吸附法联合连续性静-静脉血液滤过治疗重症急性胰腺炎疗效观察

Observation on efficacy of continuous veno-venous hemofiltration combined with coupled plasma filtration adsorption for treatment of patients with severe acute pancreatitis

目的探讨配对血浆分离吸附法(CPFA)联合连续性静-静脉血液滤过(CVVH)技术治疗重症急性胰腺炎(SAP)患者的临床疗效和安全性,并探讨其治疗机制。方法将25例SAP患者随机分为两组,联合治疗组12例采用CPFA+CVVH治疗,对照组13例采用常规CVVH治疗。患者均在重症加强治疗病房(ICU)监护中,比较两组治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、IL-6、IL-10、急性生理学与慢性健康状况评分系统(APACHE)评分以及临床症状改善程度,同时观察治疗后不良反应及存活率。结果联合治疗组治疗10d后,促炎症因子TNF-α、IL-1β、IL-6均明显降低,抗炎症因子IL-10增加(P均<0.05),且改善程度明显好于对照组(P均<0.01);联合治疗组治疗后APACHE评分呈下降趋势,至10d明显低于治疗前和对照组(P均<0.05);联合治疗组未发生血小板减少、出血、休克、过敏等严重并发症,且其存活率67%(7/12)明显高于对照组54%(7/13),P<0.05。结论CPFA联合CVVH能有效调整炎症因子水平,改善SAP患者预后,提高存活率,且无明显不良反应。

Objective To evaluate efficacy and safety of continuous veno-venous hemofiltration （CVVH） combined with coupled plasma filtration adsorption （CPFA） for treatment of patients with severe acute pancreatitis （SAP）, and to approach the therapeutic mechanism. Methods Twenty-five patients with SAP were randomly divided into two groups： CPFA plus CVVH group or the treatment group （n=12） and CVVH alone group or control group （n= 13）. All the patients were taken care in the intensive care unit （ICU）. Clinical indicators, including changes in the mean arterial pressure, oxygenation index （PaO2/FiO2）, tumor necrosis factor-α （TNF-α）, interleukin-lβ （IL-Iβ）, IL-6, IL-10, liver and kidney functions, acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） score were detected prior to or after the intervention, the results were compared between the two groups, and the improvement of the clinical symptoms were investigated. The feasibility, tolerance of CVVH plus CPFA, therapy-related adverse reactions and the survival rate were evaluated. All patients were followed up to discharge. Results Two groups did not show any difference in baseline clinical characteristics（P〉0.05）. After 10 days of treatment, compared with the control group, TNF-α, IL-1β, IL-6 were reduced and IL-10 was elevated in the treatment group （all P〈0. 05） and the extent of improvement were greater than those in control group （all P〈0.01）. In CPFA plus CVVH group, the APACHE Ⅱ score at 10th day after treatment was significantly lower than that in the control group and before the treatment （both P〈0.05）. No therapy-related adverse reactions, including thrombocytopenia, severe hemorrhage, shock, hypersensitivity were noted, showing well-tolerance of CVVH plus CPFA. The survival rate of CPFA plus CVVH group was higher than that in the control group [670%（7/12） vs. 540% （7/13）, P〈0. 05]. Conclusion CVVH combined with CPFA was an effective and safe method in improving the prognosis and elevating the survival rate of SAP patients, and no untoward side effects were seen in the course of the treatment, the mechanism being related to its effect on regulating the level of inflammatory cytokines.