血液灌流对急性重症胰腺炎的炎性介质吸附临床疗效观察

Hemoperfusion in clinical treatment with severe acute pancreatitis and observation of patients with inflammatory factor adsorption

目的研究血液灌流(hemoperfusion,HP)在重症急性胰腺炎(severe acute pancreatitis,SAP)中炎性介质吸附的临床治疗效果。方法 76例SAP患者随机分为治疗组40例和对照组36例,对照组采取常规治疗,治疗组采用常规治疗的基础上给予血液灌流治疗。在HP治疗前和治疗后12h、24h及48h,对患者进行C-反应蛋白检测,同时采用酶联免疫吸附(enzyme linked immunosorbent assay,ELISA)检测血清中肿瘤坏死因子(Tumor necrosis factor,TNF)、白细胞介素-6(Interleukin-6,IL-6)、白细胞介素8(IL-8)水平变化,同时采用APACHEⅡ、SAPSⅡ和MODS评分。结果治疗后患者的C-反应蛋白、肿瘤坏死因子,IL-6,IL-8水平均明显低于治疗前,76例SAP患者中65例治愈(存活率为85.5%),11例死亡(病死率为14.5%)。结论 HP治疗对重症急性胰腺炎有明显的治疗效果,能有效地防治并发症,降低病死率。

Objective To evaluate HP in the inflammatory factor adsorption of the treatment of severe acute pancreatitis.Methods 76 patients with SAP were randomly divided into treatment group 40 cases and control group 36 cases,the control group to take conventional treatment,given hemoperfusion in the treatment group were treated with conventional therapy.C-reactive protein,tumor necrosis factor,IL-6,IL-8 were detected with（enzyme linked immunosorbent assay,ELISA） before HP and on 12,24 and 48 hours after HP.At the same time,APACHE II,SAPS II and MODS scores were assessed.Results In the hemoperfusion group,the C-reactive protein,tumor necrosis factor,IL-6,IL-8 were significantly lower than in the non-hemoperfusion group on on 12,24 and 48 hours after after-therapy（P〈0.05）.65 patients were cured（survival rate 85.5%） and 11 patients died （mortality rate 14.5%）.Conclusion HP treatment can effectively improve the prognosis of patients with SAP and decrease the production of cytokines.