早期血液灌流联合血液透析滤过治疗重症急性胰腺炎疗效及对血液内环境的影响

Early Hemoperfusion Combined with Hemodiafiltration in Severe Acute Pancreatitis and Its Effects on Blood Internal Environment

目的探讨早期血液灌流联合血液透析滤过治疗重症急性胰腺炎(SAP)的疗效及对血液内环境的影响。方法将51例SAP患者按入院顺序分为治疗组(25例)和对照组(26例),在常规治疗基础上,对照组患者48h内行连续血液透析滤过治疗,治疗组患者行血液灌流联合血液透析滤过治疗。分别于治疗前及治疗后第5天检测两组患者的血淀粉酶(AMY)、肝肾功能、碳酸氢盐(HCO3-)、C反应蛋白(CRP)、血清肿瘤坏死因子(TNF-α)、白介素-6(IL-6)等指标并观察症状消失时间、血液净化时间、住院时间等。结果对照组有1例患者死于多脏器功能衰竭、2例并发胰腺假性囊肿、其余23例及治疗组25例患者均临床治愈。两组治疗后AMY、肝肾功能、HCO3-、CRP、TNF-α、IL-6等指标均降低,与治疗前比较,差异均有统计学意义(P<0.05);治疗后治疗组AMY、CRP、TNF-α、IL-6水平低于对照组,差异均有统计学意义(P<0.05)。除腹胀消失时间外,治疗组腹痛、腹膜刺激征消失时间、血液净化时间及住院时间均少于对照组,差异有统计学意义(P<0.05)。结论早期血液灌流联合血液透析滤过治疗SAP能及时清除炎性因子,尽早使血液内环境得到稳定,避免全身炎症反应和多脏器功能衰竭,降低SAP死亡率,减少并发症,改善SAP预后,值得临床推广应用。

Objective To investigate early hemoperfusion combined with hemodiafiltration in treatment of severe acute pancreatitis（SAP） and its curative effects on blood internal environment.Methods According to hospital admission order,51 SAP patients were divided into groups treatment（n=25） and control（n=26）.Based on routine treatment,control group were given hemodiafiltration,treatment group combined with hemoperfusion within 24 h.Hemodiastase,renal function,bicarbonate（HCO-3）,C reactive protein（CRP）,serum tumor necrosis factor（TNF-α）,interleukin-6（IL-6） and time length of transference cure,blood purification and hospital stay were determined.Results In control group,1 died of multiple organ failure（MOF）,2 complicated by pancreatic pseudocyst,the others clinically cured.All treatment group cured.The indexes of hemodiastase,renal function,HCO-3,CRP,TNF-α,IL-6 were lower after treatment than before in 2 groups,the difference was significant（P0.05）.AMY,CRP,TNF-α,IL-6 higher in control group than in treatment group（P0.05）.Except extinction time of abdominal distension,the extinction time of abdominal pain and Peritoneal irritation sign,time length of blood purification and hospital stay were shorter in treatment group than in control（P0.05）.Conciusion Early hemoperfusion combined with hemodiafiltration in treatment of SAP,clearing serum inflammatory factors timely,stabilizing blood internal environment as soon as possible,avoiding systemic inflammatory reaction and MOF,reducing SAP death rate and incidence of complications and improving SAP prognosis,is worth generalizing and applying clinically.