摘要
目的:探讨双重血液滤过治疗高脂血症性重症急性胰腺炎(HL-SAP)的效果。方法:51例HL-SAP患者随机分为观察组(26例)和对照组(25例),对照组接受常规治疗,观察组在常规治疗的基础上加用双重血液滤过治疗,比较两组第2、7天的相关疗效指标及并发症发生情况。结果:与治疗前比较,治疗第2天,观察组血甘油三酯(TG)及血、尿淀粉酶水平较治疗前明显降低,大部分血液流变学指标明显改善,炎症因子水平明显降低,前白蛋白明显升高,SIRS评分、APACHE II评分、Ranson评分明显降低(均P<0.05);而对照组除Ranson评分明显降低外,其余指标无明显改善(均P>0.05)。治疗第7天,观察组以上指标均进一步改善,对照组大部分指标也较治疗前明显改善(均P<0.05)。治疗后同时间点比较,观察组以上指标改善程度均优于对照组(均P<0.05)。观察组的并发症发生率明显低于对照组(P<0.05)。结论:双重血液滤过能有效降低TG水平,改善微循环障碍,维持机体促抗炎细胞因子平衡,改善HL-SAP患者预后。
Objective: To investigate the clinical efficacy of double-filtration plasmapheresis (DFPP) in treatment of hypedipidemic severe acute pancreatitis (HL-SAP). Methods: Fifty-one HL-SAP patients were randomly designated to observational group (26 cases) and control group (25 cases). Patients in control group received standard routine treatment, while those in observational group underwent DFPP in addition to receiving routine treatment protocol. The treatment efficacy variables onday 2 and 7 of treatment and incidence of complications between the two groups were compared. Results: On day 2 of treatment compared with pretreatment values, the triglyceride (TG) and serum and urine amylase levels were significantly reduced, most of the hemorheological parameters were significantly improved, levels of inflammatory factors were lessened while prealbumin was elevated significantly, and the SIRS, APACHE II and Ranson's scores were significantly decreased in observational group (all P〈0.05); in control group, except for Ranson's score that was significantly decreased (P〈0.05), all the other parameters showed no significant change (all P〉0.05). On day 7 of treatment, all the above parameters in observational group were further improved, and most of them in control group were significantly improved compared with pretreatment values (all P〈0.05). In comparison, at the same time point after treatment, the degrees of improvement of all the parameters in observational group were significantly greater than those in control group (all P〈0.05). The incidence of complications in observational group was significantly lower than that in control group (P〈0.0S). Conclusion: DFPP can effectively decrease TG level, improve microcirculation, and maintain the balance between anti-inflammatory and proinflammatory responses, and thereby improve the prognosis of IlL-SAP patients.
出处
《中国普通外科杂志》
CAS
CSCD
北大核心
2014年第3期305-309,共5页
China Journal of General Surgery
关键词
胰腺炎
急性坏死性
高脂血症
血液滤过
Pancreatitis, Acute Necrotizing
Hyperlipidemias
Hemofiltration