血液灌流联合HVHF在重症急性胰腺炎并胰腺脓肿术后脓毒症的治疗作用

Effects of Hemoperfusion Combined with Continuous High-volume Hemofiltration for the Treatment of Sepsis after Operation of Severe Acute Pancreatitis with Pancreatic Abscess

【目的】探讨血液灌流（hemoperfusion，HP）联合持续高容量血液滤过（Continuous high-volume Hemofiltration，HVHF）对重症急性胰腺炎（severe acute pancreatitis，SAP）并胰腺脓肿术后脓毒症患者的治疗作用。【方法】20例sAP并胰腺脓肿术后脓毒症患者随机分为对照组与试验组各10例，对照组予以常规治疗，试验组在常规治疗基础上加用HP联合HVHF治疗，比较两组治疗前、后48h生命体征、APAcHEⅡ评分、白细胞、氧分压、肾功能和细胞因子TNF—α、IL-1β、IL-8水平的变化。【结果】HP联合HVHF治疗后患者各临床指标与治疗前及对照组治疗后比较明显改善，细胞因子TNF—α、IL-1β、IL-8、MCP-1的水平与治疗前及对照组治疗后比较明显降低，差异有统计学意义（P〈0．05）。【结论】HP联合HVHF能改善SAP并胰腺脓肿术后脓毒症患者的临床指标，降低患者细胞因子水平，有可能改善患者的预后。

[Objective]To explore the effect of hemoperfusion （HP） combined with continuous high-vol- ume hemofihration（HVHF） for the treatment of sepsis after operation of severe acute pancreatitis（SAP） patients with pancreatic abscess. [Methods]Twenty sepsis patients after operation of SAP with pancreatic abscess were randomly divided into control group（ n = 10） and experiment group（ n = 10）. The control group was given routine therapy. The experiment group was given HP combined with HVHF based on routine treatment. The 48-hour vital sign, APACHE11 score, white blood cell, partial pressure of oxygen, renal function and the levels of TNF-α、IL-1β、IL-8 and MCP-1 in two groups were measured before and after treatment. [Results]Compared with before treatment and the control group, the clinical indices in sepsis patients after operation of SAP with pancreatic abscess in the experiment group were improved significantly. The cytokines such as TNF-α、IL-1β、IL-8 and MCP-1 in experiment group after treatment were obviously lower than those in the control group and before treatment（ P 〈0.05）. [Conclusion] HP combined with HVHF can improve clinical indices and decrease the levels of cytokines in sepsis patients after operation of SAP with pancreatic abscess, and probably improves the prognosis of the patients.