大黄联合床边血浆置换治疗重症高脂血症性急性胰腺炎疗效观察

Effect of rhubarb combined with bedside plasma exchange on the treatment of patients with severe hyperlipoidemia acute pancreatitis

目的:评估重症高脂血症性急性胰腺炎应用大黄联合床边血浆置换治疗的临床疗效。方法:47例确诊为重症高脂血症性急性胰腺炎患者分为大黄联合床边血浆置换治疗组(24例)和对照组(23例),观察血浆置换的安全性,两组患者的甘油三酯(TG)、炎症因子、呼吸功能、肠道功能、BalthazarCT评分、急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)、住院时间、住院费用和病死率等。结果:24例床边血浆置换有4例发生轻微并发症,无严重并发症;治疗组治疗第2天和第8天TG和炎症因子与对照组比较明显降低(均P<0.05);治疗组机械通气人数和时间少于对照组,治疗组治疗第2天和第8天氧合指数和胸腔积液与对照组比较差异有统计学意义(均P<0.05);治疗组治疗第2天和第8天腹内压均低于对照组,肛门首次排便时间和肠内营养开始时间均早于对照组(均P<0.05);治疗组治疗第2天APACHEⅡ评分、第8天APACHEⅡ评分和BalthazarCT评分与对照组比较差异有统计学意义(均P<0.05);治疗组住院时间、住院费用和病死率均低于对照组(均P<0.05)。结论:床边血浆置换有良好的安全性;大黄联合床边血浆置换对重症高脂血症性急性胰腺炎有良好的临床疗效。

Objective： To evaluate the effect of rhubarb combined with bedside plasma exchange on the treatment of patients with severe hyperlipoidemia acute pancreatitis. Method： Forty-seven patients with severe hyperli- poidemia acute pancreatitis were divided to treatment group （n=24） and control group （n=23）. The indexes in- cluding blood triglyceride level, inflammatory factors, respiratory function, bowel function, Balthazar CT score, APACHE II score, length of stay, hospital charges and mortality were observed. Result： There are four cases of slight complications, and no serious complications in 24 cases of bedside plasma. The blood triglyceride level and inflammatory factors level in treatment group on second day and eighth day after therapy were lower than those of congrol group （P〈0.05）. The cases and duration of mechanical ventilation in treatment group were less than those of congrol group. The comparison of oxygenation index and the amount of pleural effusion between two groups on second day and eighth day after therapy showed a significant difference （P〈0.05）. The intra abdominal pressure in treatment group on second day and eighth day after therapy were lower than those of congrol group （P 〈0.05）. The first time of bowel movement and enteral nutrition in treatment group were earlier than those of congrol group （P〈0. 05）. The comparison of APACHE II score on second day, Balthazar CT score and A- PACHE 11 score on the eighth day after therapy between two groups showed a significant difference （P〈0.05）. The length of stay, hospital charges and mortality in treatment group were lower than those of congrol group （P〈 0.05）. Conclusion：The security of bedside plasma exchange is good. The combination of rhubarb and bedside plasma exchange has obvious effect on patients with severe hyperlipoidemia acute pancreatitis.