高脂血症性胰腺炎血液净化疗效观察

Observation on the therapeutic effect of blood purification for hyperlipidemic acute pancreatitis

目的评价不同的血液净化方式在高脂血症性胰腺炎治疗中的效果。方法收集2015年1月至2018年3月本院重症医学科收治的31例高脂血症性胰腺病例,按治疗过程中所采用不同的血液净化方式,分为血液灌流联合连续性静脉-静脉血液透析滤过组(HP+CVVHDF组,n=17)和血液灌流组(HP组,n=14),HP组根据所用灌流器不同分为活性炭灌流组(n=6)及树脂灌流组(n=8),观察HP+CVVHDF及HP组治疗前后血脂变化情况,对比两组患者的ICU住院时间、达到目标血脂灌流次数、腹腔感染发生率;比较活性炭灌流组及树脂灌流组治疗前后血脂变化情况,对比两组患者的ICU住院时间,灌流次数、腹腔感染发生率。结果治疗后所有患者的血清甘油三酯、胆固醇均有明显下降(P <0.05)。HP+CVVHDF组与HP组对比血脂下降比例、ICU住院时间、腹腔感染发生率、血液灌流次数及入院24、48、72小时血脂达标率无明显差别(P> 0.05);活性炭灌流及树脂灌流均可明显降低血脂,但两组血脂降低比例、血液灌流次数、入院24、48、72小时血脂达标率、ICU住院时间均无差异(P> 0.05)。结论血液灌流可有效降低高脂血症性胰腺患者血清甘油三酯、胆固醇。活性炭灌流器及树脂灌流器均可有效降低血脂,且二者降低血脂效率无明显不同。连续性静脉-静脉血液透析滤过降低血脂作用不明显。对比单纯血液灌流治疗,血液灌流联合连续性静脉-静脉血液透析滤过治疗对患者ICU住院时间及腹腔感染发生率无明显影响。

Objective To evaluate the therapeutic effect of blood purification therapy for hyperlipidemic acute pancreatitis.Methods Patients with hyperlipidemic acute pancreatitis(n=31)treated at Intensive Care Unit of Fujian Provincial Hospital from January 2015 to March 2018 were included in this study.Patients were divided into two groups according to different treatment.They were treated by hemoperfusion combined with continuous veno-venous hemodiafiltration(HP+CVVHDF group,n=17)and by hemoperfusion(HP group,n=14),respectively.Then HP group was divided into activated carbon perfusion group(n=6)and resin perfusion group(n=8)based on the type of filter.ICU length of stay(ICU-LOS),perfusion times and incidence of abdominal infection were compared and the change of triglycerides and cholesterol were observed between HP+CVVHDF group and HP group.These indices were also compared and observed between activated carbon perfusion group vs resin perfusion group.Results Triglycerides and cholesterol decreased after treatment in all groups(P<0.05).There was no significant difference in the decline ratio of blood lipids,ICU-LOS,incidence of abdominal infection,times of blood perfusion and blood lipids compliance rate in 24h/48h/72h between group HP+CVVHDF and group HP(P>0.05).A significant reduction was found in blood lipid in activated carbon perfusion group and resin perfusion group,but there was no difference in the decline ratio of blood lipids,blood lipids compliance rate in 24h/48h/72h,the times of blood perfusion and ICU-LOS.(P>0.05).Conclusion Hemoperfusion can effectively reduce serum triglyceride and cholesterol in patients with hyperlipidemic acute pancreatitis.Both activated carbon perfusion and resin perfusion could effectively reduce blood lipids,and there is no significant difference between these two approaches in the efficiency of reducing blood lipids.However,the effect of continuous veno-venous hemodiafiltration on reducing blood lipids is not obvious.The abdominal infection incidence and ICU-LOS of patients treated by hemoperfusion combined with continuous venous hemodiafiltration are not significantly different from patients treated by hemoperfusion.