血液灌流联合血液滤过对高脂血症胰腺炎伴肾衰竭的疗效研究

The Treatment Effect of Hemoperfusion Combined Continue Venovenous Hemofiltration to Hyperlipidemic Acute Pancreatitis Associated with Rental Failure

目的:观察血液灌流(HP)联合血液滤过(CVVH)对高脂血症胰腺炎伴肾衰竭患者的疗效。方法:将59例高脂血症伴肾功能损伤患者随机分为两组:A组27例,在常规治疗基础上行HP+CVVH;B组32例,在常规治疗基础上行CVVH治疗。比较两组患者治疗前及治疗后48h、治疗后72h血清淀粉酶(AMY)、脂肪酶(LIPA)、甘油三酯(TG)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、血肌酐(Cr)、尿素氮(BUN)水平及急性生理与慢性健康评分(APACHEⅡ)的变化。选取30例健康志愿者作为正常对照组。结果:治疗前,两组上述各指标均显著高于正常对照组(P<0.01),治疗后48h和治疗后72h,所有指标较治疗前明显下降(P<0.01),且治疗后72h比治疗后48h下降更显著(P<0.05)。与B组同时相比较,A组治疗后48h及治疗后72h患者血清TG、TNF-α、IL-6、Cr、BUN水平及APACHEⅡ降低更明显(P<0.05)。结论:HP联合CVVH较单纯CVVH治疗能够更有效地清除高脂血症胰腺炎并肾功能衰竭患者的炎性介质,从而保护肾功能。临床可选其作为重要辅助治疗手段。

Objective：To observe the effect of hemoperfusion combined with continue venovenous hemofiltra-tion （CVVH）to the patients of the hyperlipidaemic acute pancreatitis associated with acute rental failure.Method：5 9 patients of the hyperlipidaemic acute pancreatitis associated with rental failure were divide into two groups ran-domly.The basic treatment was used in group A（n=27）associated with the HP＋CVVH.The basic treatment was used in group B（n=32）associated with the CVVH.The serum levels of amylase（AMY）,lipase（LIPA）,triglyceride （TG）,tumor necrosis factor-α（TNF-α）,lnterleukin-6 （IL-6 ）,creatinine （Cr）,blood urea nitrogen （BUN）were compared before and at 48 and 72 hour time point after the different treatment.The APACHEⅡscore was also com-pared between each group before and after treatment.Results：Before the treatment all index were higher than the control group.After different treatment all the index were decreased compared with control group at 48 and 72 hour time point （P〈0.01）.The levels of TG,TNF-α,IL-6,Cr,BUN and APACHEⅡ in group A were lower than that in group B at 48 and 72 time point （P〈0.05）.Conclusion：The HP＋CVVH treatment can remove the inflam-matory medium more effective than the CVVH ,and HP＋CVVH can protect the rental function more than the CVVH, thus HP＋CVVH can be a very important adj uvant therapy in hyperlipidamic pancreatitis associated with rental failure.