低分子肝素联合床旁持续血液滤过对高脂血症性胰腺炎的疗效分析

Effect of low molecular weight heparin combined with continuous venovenous hemofiltration on the treatment of patients with hypertriglyceridemic pancreatitis

目的 评估高脂血症性胰腺炎应用低分子肝素联合床旁持续血液滤过治疗的临床疗效.方法 60例确诊为高脂血症性胰腺炎患者随机分为低分子肝素联合床旁持续血液滤过治疗组和对照组（各30例）,观察两组患者的全血黏度、血浆黏度、甘油三酯（TG）、炎症因子、胰腺坏死CT评分、急性生理和慢性健康状况评分Ⅱ（APACHEⅡ）、器官衰竭发生率、并发症发生率和病死率等.结果 治疗组治疗第3天和第10天全血黏度、血浆黏度和TG与对照组比较差异有统计学意义（P均＜0.05）;治疗组治疗第10天炎症因子水平、胰腺坏死CT评分和APACHEⅡ评分与对照组比较差异有统计学意义（P均＜0.05）;治疗组器官衰竭发生率和并发症发生率明显降低,与对照组比较差异有统计学意义（P均＜0.05）;两组病死率比较差异无统计学意义（P＞0.05）.结论 低分子肝素联合床旁持续血液滤过治疗能降低高脂血症性胰腺炎的重症化趋势,降低多器官功能障碍综合征的发生,改善预后.

Objective To evaluate the effect of low molecular weight heparin （LMWH） combined with continuous venovenous hemofiltration （CVVH） on the treatment of patients with hypertriglyceridemic pancreatitis. Methods 60 patients with hypertriglyceridemic pancreatitis were divided randomly to treatment group （ n = 30） and control group （ n = 30）. The indexes including blood viscosity, plasma viscosity, blood triglyceride level, Balthazar CT score, APACHE Ⅱ score, organ dysfunction rate, complication rate and mortality were observed. Results The blood viscosity, plasma viscosity and blood triglyceride level in treatment group on third day and tenth day after therapy were lower than those of control group, showing a significant difference （ P 〈 0. 05 ）. There was significant difference in the inflammatory factors, Balthazar CT score and APACHE Ⅱ score on tenth day between two groups （P 〈 0. 05 ）. The organ dysfunction rate and the complication rate of treatment group were obviously lower than those of control group （ P 〈 0. 05 ）. There was no statistical difference in the mortality between two groups （P 〉 0. 05）. Conclusion LMWH combined with CVVH could weaken the aggravation tendency, decrease the incidence rate of multiple organ dysfunction and improve the prognosis of patients with hypertriglyccridemic pancreatitis.