配对血浆滤过吸附联合高容量血液滤过治疗重症急性胰腺炎的临床研究

Clinical Study of Coupled Plasma Filtration Adsorption Combined with High Volume Hemofiltration Treatment in Patients with Severe Acute Pancreatitis

目的观察应用配对血浆滤过吸附(CPFA)联合高容量血液滤过(HVHF)治疗重症急性胰腺炎(SAP)的临床疗效,探讨其实用性、安全性及治疗机制。方法将29例SAP患者随机分为2组,采用前瞻性随机对照研究。在常规治疗基础上,治疗组(15例)采用CPFA+HVHF治疗,对照组(14例)采用HVHF治疗,所有患者均在重症监护中,比较治疗前后2组患者的APACHEⅡ评分,血脂,肝、肾功能,白细胞以及临床症状改善程度(心率、呼吸、平均动脉压、氧合指数等),评估脏器功能,观察不良反应及预后。结果2组患者治疗后生命体征均有明显改善,APACHEⅡ评分及白细胞下降明显,氧合指数上升,尤以治疗组效果更明显,且治疗7 d时效果优于3 d,治疗组三酰甘油下降明显(均P<0.05)。患者无血小板减少、出血、过敏、凝血等不良反应发生,治疗组需血液净化治疗的时间及住院天数少于对照组(P<0.05),但2组死亡情况无明显差异。结论CPFA联合HVHF能更有效地调控炎症,降低血脂,改善SAP患者预后。

Objective To observe the clinical efficacy of coupled plasma filtration adsorption （CPFA） combined with high volume hemofihration （HVHF） for severe acute pancreatitis （SAP） and explore the practicality, the safety and the therapeutic mechanism. Methods This was a prospective, randomized clinical trail. A total of 29 patients with SAP were di- vided into two groups： treatment group （n=15, CPFA and HVHF） and control group （n=14, HVHF）. The APACHE II score, se- rum triglyceride, liver and kidney function, white blood cell （WBC）, heart rate （HR）, respiration, mean arterial pressure （MAP） and oxygenation index were compared before and after treatment between two groups. The organ function was as- sessed, and the adverse reactions and prognosis were observed in two groups. Results After treatment, there were signifi- cant decreases in APACHE ]~ score and WBC, and significant increase in PaOJFiO2 in two groups, especially significant in treatment group. There was a significant decrease in the level of triglycerides in 7-d treatment group than that of 3-d treat- ment group （P 〈 0.05）. There were no thrombocytopenia, bleeding, allergies, blood clotting and other adverse reactions in two groups of patients. There were significant decreases in the blood purification time and the length of hospital stay in treatment group than those of control group （P 〈 0.05）. There was no significant difference in mortality between two groups. Conclu- sion CPFA combined with HVHF can effectively control inflammation, reduce the serum level of triglyceride and improve the prognosis in patients with SAP.