低分子肝素钙持续性区域动脉灌注治疗重症急性胰腺炎8例

Application of continuous regional arterial perfusion of low molecular weight heparin calcium in treating severe acute pancreatitis: clinical results in 8 patients

目的评价低分子肝素钙(LMWHC)持续性区域动脉灌注(CRAI)在重症急性胰腺炎(SAP治疗中的应用。方法收集2012年7月至2016年1月南京大学医学院附属金陵医院收治的16例SAP患者临床资料。8例接受LMWHC经CRAI治疗(CRAI组),8例接受非LMWHC常规治疗(对照组),比较两组治疗效果。结果两组患者入院时改良CT严重度指数(MCTSI)、急性胰腺炎严重度床旁指数(BISAP)、活化部分凝血活酶时间(APTT)和血小板(PLT)计数差异无统计学意义(P>0.05)。CRAI组、对照组住院期间感染发生率分别为0、100%(8/8)(P<0.01),腹腔出血率分别为0、100%(8/8)(P<0.01),中转手术率分别为0、62.5%(5/8)(P<0.01),病死率分别为0、25%(2/8)(P>0.01);住院时间分别为(11.0±2.8)d、(51.0±23.3)d(P<0.05)。CRAI组治疗前后APTT、PLT计数差异无统计学意义(P>0.05)。结论CRAI途径LMWHC治疗可有效抑制SAP炎症改变和病情进展,明显降低患者住院感染发生率、腹腔出血率、中转手术率及住院时间。

Objective To discuss the application of continuous regional arterial infusion(CRAI)of low molecular weight heparin calcium(LMWHC)in treating severe acute pancreatitis(SAP).Methods The clinical data of 16 patients with SAP,who were admitted to the Affiliated Jinling Hospital of Medical College of Nanjing University,China,during the period from July 2012 to January 2016,were collected.Of the 16 patients,8 received CRAI of LMWHC(CRAI group)and 8 received non-LMWHC routine therapy(control group).The therapeutic effects were compared between the two groups.Results On admission,no significant differences in modified CT severity index(MCTSI),bedside index of severe acute pancreatitis(BISAP)scores,activated partial thromboplastin time(APTT)and platelet(PLT)count existed between the two groups(P>0.05).In CRAI group and control group,the incidence of infection during hospitalization was 0 and100%(8/8)respectively(P<0.01),the intraperitoneal hemorrhage rate was 0 and 100%(8/8)respectively(P<0.01),transferring operation rate was 0 and 62.5%(5/8)respectively(P<0.01),the mortality rate was 0 and 25%(2/8)respectively(P>0.01),the hospitalization days were(11.0±2.8)days and(51.0±23.3)days respectively(P<0.05).In CRAI group,the postoperative APTT and PLT count were not significantly different from the preoperative ones(P>0.05).Conclusion CRAI of LMWHC can effectively inhibit the inflammatory reactions and progression of SAP,significantly reduce the incidences of infection,intraperitoneal hemorrhage and transferring operation,and obviously shorten the hospitalization duration.