连续性血液净化辅助治疗重症急性胰腺炎的临床效果及安全性

Clinical effect and safety of continuous blood purification as adjuvant therapy on severe acute pancreatitis

目的观察连续性血液净化治疗重症急性胰腺炎（SAP）的临床效果,分析此治疗方法的可行性与安全性,为临床应用提供理论依据。方法从2013年1月-2014年1月来本院消化科就诊的SAP患者中选取82例,随机分为观察组和对照组,每组各41例。两组患者在常规治疗的基础上,对照组加用乌司他丁,观察组加用乌司他丁与持续性血液净化。比较两组患者的腹痛等症状、体征减轻时间,C反应蛋白、血淀粉酶、脂肪酶等辅助检查结果恢复的正常时间,患者治愈时间、局部并发症发生率、改行手术治疗率和死亡率。结果经治疗,治疗组和对照组患者的腹痛等症状体征缓解时间及C反应蛋白、血淀粉酶及脂肪酶等辅助检查结果恢复正常时间,患者治愈时间、胰腺假性囊肿以及胰瘘等局部并发症发生率、改行手术治疗率差异均有统计学意义（P〈0.05）;两组患者的死亡率差异无统计学意义（P〉0.05）。结论连续性血液净化联合乌司他丁辅助治疗重症急性胰腺炎较常规治疗组症状、体征各项辅助检查结果恢复时间短,可降低局部并发症的发生率和改行手术治疗率,可行性、安全性高,值得临床推广应用。

Objective To observe the clinical effect of continuous blood purification （CBP） in the treatment of severe a-cute pancreatitis （SAP）,and analyze the feasibility and safety of CBP so as to provide theoretical basis for clinical ap-plication. Methods 82 patients with SAP visited physicians in digestive department in our hospital from January 2013 to January 2014 were selected.They were evenly divided into observation group and control group.Conventional basic treatment was provided in both groups.Besides,in the control group, ulinastatin was added,while in the observation group,ulinastatin and CBP were added.Alleviating time of symptom and sign like abdominal pain,etc.,time to return to normal in outcomes of auxiliary examinations including C-reactive protein,blood amylase, and lipase,cure time,inci-dence of local complication,rate of treatment and mortality rate after turning to surgery were compared in the two groups. Results After treatment,alleviating time of symptom and sign like abdominal pain, etc.,time to return to normal in outcomes of auxiliary examinations including C-reactive protein,blood amylase,and lipase,cure time,incidence of lo-cal complications such as pancreatic pseudocyst and pancreatic fistula,rate of treatment after turning to surgery all dis-played statistical differences （P〈0.05）.There was no significant difference in mortality rate （P〉0.05）. Conclusion CBP combining with ulinastatin as adjuvant therapy on SAP can shorten the recovery time of symptom,sign,and outcomes of auxiliary examinations and reduce the incidence of local complications,and rate of treatment after turning to surgery.It is high in feasibility and safety,and is worthy of expansion and application in clinic.