连续性血液净化治疗对重症急性胰腺炎伴急性肾损伤患者炎症因子以及肾功能的影响

Effect of continuous blood purification on inflammatory factors and renal function in patients with severe acute pancreatitis complicated with acute kidney injury

目的探讨连续性血液净化治疗对重症急性胰腺炎(SAP)伴急性肾损伤(AKI)患者炎症因子、肾功能的影响。方法选取2016年4月至2019年6月在我院就诊的SAP伴AKI患者90例为研究对象,采用随机数字法分为对照组和观察组,每组45例。对照组患者给予常规止痛、禁食、营养支持、抑制胰酶分泌、解痉、胃肠减压、改善微循环、早期液体复苏、抗感染、维持电解质平衡等综合治疗;观察组患者在对照组治疗的基础上给予连续性血液净化治疗。检测比较两组患者治疗前、治疗72 h后的肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、血肌酐(SCr)、尿素氮(BUN)水平以及APACHEⅡ评分。结果治疗前,两组患者的TNF-α、IL-10、IL-6、SCr、BUN水平以及APACHEⅡ评分比较差异无统计学意义(P>0.05);治疗72 h后,观察组患者的TNF-α、IL-10、IL-6、SCr、BUN水平以及APACHEⅡ评分均显著低于对照组,差异有统计学意义(P<0.05)。结论在常规治疗的基础上对SAP伴AKI患者行连续性血液净化治疗,能明显降低炎症因子水平,有效改善肾功能,进而改善患者预后,值得推广应用。

Objective To investigate the effect of continuous blood purification on inflammatory factors and renal function in patients with severe acute pancreatitis(SAP)complicated with acute kidney injury(AKI).Methods A total of 90 patients with SAP complicated with AKI who were treated in our hospital from April 2016 to June 2019 were selected,and they were divided into two groups according to the random number method,with 45 cases in each group.The control group was given comprehensive treatments including routine pain relief,abrosia,nutritional support,inhibition of pancreatic enzyme secretion,spasmolysis,gastrointestinal decompression,improvement of microcirculation,early fluid resuscitation,anti-infection,and maintenance of electrolyte balance,based on which the observation group was treated with continuous blood purification.The tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),interleukin-6(IL-6)and serum creatinine(SCr),blood urea nitrogen(BUN)levels,and APACHEⅡscores of the two groups before treatment and 72 hours after treatment were detected and compared.Results Before treatment,there were no statistically significant differences in the levels of TNF-α,IL-10,IL-6,SCr,BUN,and APACHEⅡscores between the two groups(P>0.05).After 72 hours of treatment,the levels of TNF-α,IL-10,IL-6,SCr,BUN and APACHEⅡscores of the observation group were significantly lower than those of the control group,with statistically significant differences(P<0.05).Conclusion On the basis of conventional treatment,continuous blood purification treatment for patients with SAP complicated with AKI can significantly decrease the levels of inflammatory factors,effectively improve renal function,which is beneficial to improve the prognosis of patients,and is worthy of promotion and application.