低分子肝素、胰岛素联合血浆置换治疗高脂血症性急性胰腺炎的疗效观察

EFFECT OF LMWH,INSULIN COMBINED WITH PLASMA EXCHANGE ON THE TREATMENT OF PATIENTS WITH HYPERLIPIDAEMIA ACUTE PANCREATITIS

目的:探讨低分子肝素(LMWH)、胰岛素联合血浆置换(PE)治疗高脂血症性急性胰腺炎(HLAP)的临床效果。方法:选取2010年1月至2015年1月无锡市人民医院收治的100例HLAP患者,按随机数字表法将其分为对照组和观察组,每组50例。对照组采取LMWH、胰岛素治疗,观察组在此基础上联合PE治疗。比较两组患者的临床疗效及各项治疗指标情况。结果:治疗后,观察组总有效率为94.0%高于对照组的70.0%,差异具有统计学意义(P<0.05)。与治疗前相比,治疗后两组患者血甘油三酯(TG)、白细胞介素-6(IL-6)、肿瘤坏死因子(TNF-α)、血清淀粉酶水平及氧合指数(PaO2/FiO2)、Balthazar CT评分均明显改善,差异均具有统计学意义(P<0.05);观察组治疗后血TG、IL-6、TNF-α、血清淀粉酶水平及Balthazar CT评分均低于对照组,而PaO2/FiO2高于对照组,差异均具有统计学意义(P<0.05);观察组症状缓解时间及血清淀粉酶转阴时间均较对照组短(P<0.05)。结论:LMWH、胰岛素联合PE治疗HLAP的临床效果显著,不仅症状明显缓解,且血脂浓度及炎症因子水平均明显下调,值得临床推广应用。

Objective： To evaluate the clinical effect of low molecular weight heparin （LMWH） , insulincombined with plasma exchange （PE） on the treatment of patients with hyperlipid（HLAP）. Methods： 100 cases of HLAP patients from January 2010 to January 2015 in our hospital wererecruited and randomly divided into the observation group and the control group （50 cases in each group）.The patients in the control group were treated with LMWH and insulin, while those in the observationgroup were treated as the control group with the addi-tion of PE. The curative effect and the therapeutic in-dexes were compared between two groups. Results： The total effective rate of the observation group was higher than that of the control group （ P 〈 0 . 05）. After treatment,the serum levels of triglyceride （TG ） , interleukin （IL-6）,tumor necrosis factor （TNF-α） and amylase as well as Balthazar CT score were signifi-cantly reduced （ P 〈0. 05）,while oxygenation index was conspicuous elevated in both groups （ P 〈0. 05）. The serum levels of TG, IL-6,TNF-a,amylase and scores of Balthazar CT in the observation group after treatment were lower than those in the control group （ P 〈0. 0 5 ） , while the oxygenation index was higher than that in the control group （ P 〈 0 . 05）. The duration of clinical remission and the serum amylase recov-ery time in the observation group were shorter than those in the control group （ P 〈0. 05）. Conclusion：LMWH , insulin combined with PE is effective in the treatment of HLAP,which could not only relieve the symptoms, but also reduce blood lipid levels and inflammatory factors. Therefore it is worthy of clinical promotion and application.