早期区域动脉灌注肝素治疗高脂血症性SAP的临床效果

Clinical Effect of Early Regional Arterial Infusion of Heparin inthe Treatment of SAP with Hyperlipidemia

目的探讨高脂血症性重症急性胰腺炎患者使用早期区域动脉灌注肝素的治疗效果,为改善患者预后提供新的治疗依据。方法收集我院急诊外科2015年7月～2017年6月收治的符合纳入、排除标准的重症急性胰腺炎患者51例,随机分组为普通治疗组(23例)及CRAI组(28例),普通治疗组按胰腺炎常规治疗方法治疗,CRAI组通过股动脉置管,持续泵入低分子肝素,比较两组的临床治疗效果及血液学指标等情况。结果 CRAI组的胰腺坏死率、胰周感染率、死亡率分别为10.71%、21.43%、7.14%,均低于普通治疗组的43.48%、56.52%、39.13%,差异具有统计学意义(P<0.05);CRAI组患者的住院时间、ICU住院时间、血管活性药物使用时间分别为(15.22±3.71)d、(6.94±1.23)d、(4.57±1.02)d,均低于普通治疗组的(40.34±4.47)d、(20.44±2.15)d、(17.84±3.33)d,差异具有统计学意义(P<0.05);CRAI组患者血清甘油三酯水平较普通治疗组下降,差异具有统计学意义(P<0.05);两组APTT比较,差异无统计学意义(P>0.05)。结论 CRAI治疗高脂血症性重症急性胰腺炎的临床效果更好,可降低患者胰腺坏死率、胰周感染率及死亡率,缩短患者住院时间,且不影响患者的凝血功能,安全可靠。

Objective To investigate the therapeutic effect of early regional arterial infusion of heparin in patients with severe acute pancreatitis with hyperlipidemia, and to provide a new therapeutic basis for improving the prognosis of patients.Methods A total of 51 patients with severe acute pancreatitis who met the inclusion and exclusion criteria from July 2015 to June 2017 in our hospital were randomly divided into the general treatment group (23 cases) and the CRAI group (28 cases). The treatment group was treated according to the conventional treatment of pancreatitis. The CRAI group was placed in the femoral artery and the low molecular weight heparin was continuously pumped. The clinical treatment effect and hematological parameters of the two groups were compared.Results The pancreatic necrosis rate, peripancreatic infection rate and mortality rate in the CRAI group were 10.71%, 21.43%, and 7.14%, respectively, which were lower than the 43.48%, 56.52%, and 39.13% of the general treatment group,the difference was statistically significant (P<0.05);hospitalization time, ICU hospitalization time, and vasoactive drug use time in CRAI group were (15.22±3.71)d,(6.94±1.23)d,(4.57±1.02)d, respectively, which were lower than those of the general treatment group ( 40.34±4.47)d,(20.44±2.15)d,(17.84±3.33)d, the difference was statistically significant (P<0.05). The serum triglyceride level in the CRAI group was lower than that in the normal treatment group,the difference was statistically significant(P<0.05);There was no significant difference in APTT between the two groups (P>0.05).Conclusion CRAI is effective in the treatment of severe acute pancreatitis with hyperlipidemia. It can reduce pancreatic necrosis rate, peripancreatic infection rate and mortality, shorten the hospital stay, and not affect the patient's coagulation function. It is safe and reliable.