连续性肾脏替代治疗单用及联合血液灌流、血浆置换在高脂血症性重症急性胰腺炎的疗效评价

Evaluation of continuous renal replacement therapy in combination with hemoperfusion and plasma exchange in hyperlipidemic severe acute pancreatitis

目的探讨连续性肾脏替代治疗（CRRT）血液灌流（HP）联合连续性静脉-静脉血液滤过治疗（HP/CVVH）、血浆置换（PE）联合连续性静脉-静脉血液滤过治疗（PE/CVVH）对高脂血症性重症急性胰腺炎（HLSAP）的治疗价值及效果评价。方法将68例HLSAP患者随机分为CVVH组、HP＋CVVH组和PE＋CVVH组,均予重症急性胰腺炎常规治疗,并分别予以单纯CVVH、HP＋CVVH、PE＋CVVH治疗。比较治疗前和治疗72 h后三组患者生命体征、APACHEⅡ评分、甘油三酯（TG）、C反应蛋白（CRP）、重要脏器功能指标变化值;CT检查评价治疗前与治疗1周后CT严重程度指数（CTSI）变化;记录治疗1周内主要并发症发生率、平均住院天数及死亡率。结果三组患者治疗前各项指标差异无显著性。但各组患者治疗后各项指标均有好转（P〈0.05）,治疗72 h后三组间APACHEⅡ评分、血和尿淀粉酶比较差异均无统计学意义（P〉0.05）;HP＋CVVH、PE＋CVVH两组与CVVH组比较其余实验室指标改善更明显（P〈0.05）。治疗1周后三组患者CTSI均较治疗前下降（P〈0.05）,且HP＋CVVH组和PE＋CVVH组较CVVH组改善更明显（P〈0.05）。HP＋CVVH组和PE＋CVVH组较CVVH组临床情况更好,死亡率低,住院时间短（P〈0.05）。结论 HP、PE联合CVVH治疗较单纯CVVH治疗能够更快降低患者血TG水平,改善临床症状,可减少系统炎性反应综合征及多器官功能障碍综合征/多器官功能衰竭的发生,有效降低死亡率,减少住院时间。

Aim To investigate therapeutic value and effectiveness evaluation of the continuous renal replacement therapy（ CRRT） hemoperfusion combined with continuous veno-venous hemofiltration（ HP/CVVH）,plasma exchange combined with continuous veno-venous hemofiltration（ PE/CVVH） on hyperlipidemic patients with severe acute pancreatitis（ HLSAP）. Methods 68 patients were randomly divided into CVVH group,HP ＋CVVH group,PE＋CVVH group,herein are SAP and conventional therapy alone CVVH,HP ＋CVVH,PE＋CVVH treatment. The vital signs,APACHE II score,triglyceride（ TG）,C reactive protein（ CRP） and important organ function indexes of the three groups were compared before and after treatment for 72 h; The CT severity index（ CTSI） change was evaluated by CT examination before and after 1 week of treatment; The incidence of major complications,average length of stay and mortality were recorded within 1 week of treatment. Results There was no significant difference between the three groups before treatment.But all the indexes were improved after treatment in each group（ P〈0.05）. There was no significant difference in APACHEⅡ score,serum amylase,and urine amylase between the three groups after treatment for 72 h（ P〉0.05）; Remaining laboratory parameters improved more significantly in HP ＋CVVH,PE＋CVVH groups compared with CVVH group（ P〈 0.05）.After 1 week of treatment,the CTSI of three groups decreased compared with before treatment（ P〈0.05）,and the improvement of HP ＋CVVH group and PE ＋ CVVH group was more obvious than that of CVVH group（ P 〈 0. 05）. Compared with CVVH group,the clinical situation of HP ＋CVVH group and PE＋CVVH group was better,the mortality rate was lower and the length of stay was shorter（ P〈0.05）. Conclusion Compared with CVVH alone,HP,PE combined with CVVH treatment can reduce the serum TG level of patients more quickly, improve clinical symptoms, reduce systemic inflammatory response syndrome（ MODS） and multiple organ dysfunction syndrome/multiple organ failure（ MOF） occurs,effectively reduce mortality and hospital stay.