血液滤过联合早期容量复苏治疗重症急性胰腺炎并发脓毒症休克的疗效分析

Clinical efficacy of hemofiltration combined with early volume resuscitation in the treatment of severe acute pancreatitis complicated with septic shock

目的探讨血液滤过联合早期容量复苏治疗重症急性胰腺炎并发脓毒症休克的临床效果。方法选取2016年11月至2017年12月于本院接受治疗的重症急性胰腺炎并发脓毒症休克患者98例为研究对象。根据不同治疗方法将入选患者分为观察组(50例)和对照组(48例)。对照组患者接受早期容量复苏治疗,观察组患者接受早期容量复苏联合血液滤过治疗。比较两组患者治疗有效率、死亡率以及治疗前后乳酸清除率、白介素-6(interleukin,IL-6)、血清降钙素原(procalcitonin,PCT)、超敏C反应蛋白(high sensitive C reaction protein,hs-CRP)水平、急性生理学和慢性健康状况评价Ⅱ(acutephysiology and chronic health evaluation Ⅱ,APACHEⅡ)评分、序贯器官衰竭估计(sequential organ failure assessment,SOFA)评分变化情况。结果观察组患者治疗总有效率显著高于对照组(P < 0.05),死亡率显著低于对照组(P < 0.05)。治疗后,两组患者乳酸清除率均显著高于本组治疗前(均P < 0.05),IL-6、PCT、hs-CRP水平、APACHEⅡ评分和SOFA评分均显著低于本组治疗前(均P < 0.05),且观察组患者乳酸清除率显著高于对照组(P < 0.05),IL-6、PCT、hs-CRP水平、APACHEⅡ评分和SOFA评分均显著低于对照组(均P < 0.05)。结论血液滤过联合早期容量复苏治疗重症急性胰腺炎并发脓毒症休克,可提高乳酸清除率,降低炎性细胞因子水平、APACHEII评分和SOFA评分,提高临床治疗效果。

Objective To investigate the clinical effect of hemofiltration combined with early volume resuscitation in the treatment of severe acute pancreatitis complicated with septic shock. Method A total of 98 patients with severe acute pancreatitis complicated with septic shock who were treated in our hospital from November 2016 to December 2017 were enrolled. They were divided into observation group (50 cases) and control group (48 cases) according to different treatment methods. Control group patients were given early volume resuscitation and observation group patients were given early volume resuscitation combined with hemofiltration. The treatment efficiency, mortality, the levels of lactate clearance rate, interleukin-6 (IL-6), serum procalcitonin (PCT) and high sensitive C reaction protein (hs- CRP), acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores, sequential organ failure assessment (SOFA) scores before and after treatment were compared between the two groups. Result The total effective rate of observation group was significantly higher than that of control group (P < 0.05), and the mortality was significantly lower than that of control group (P < 0.05). After treatment, the lactate clearance rate of the two groups were significantly higher than those before treatment (all P < 0.05), the levels of IL-6, PCT, hs- CRP, APACHE Ⅱ score and SOFA score were significantly lower than those before treatment (all P < 0.05), and the lactate clearance rate of observation group was significantly higher than that of control group (P < 0.05), the levels of IL-6, PCT, hs-CRP, APACHE Ⅱ score and SOFA score were significantly lower than those of control group (all P < 0.05). Conclusion Hemofiltration combined with early volume resuscitation in the treatment of severe acute pancreatitis complicated with septic shock can improve the lactate clearance rate, reduce the level of inflammatory cytokines, APACHE Ⅱ score and SOFA score, and improve the clinical efficacy.