连续性血液净化在重症急性胰腺炎合并多器官功能障碍综合征中的应用效果

Effects of continuous blood purification on severe acute pancreatitis with multiple organ dysfunction syndrome

目的探讨连续性血液净化在重症急性胰腺炎(SAP)合并多器官功能障碍综合征(MODS)患者治疗中的应用效果。方法抽取2017年11月至2019年11月山西医科大学第一医院收治的SAP合并MODS患者72例,按照随机双盲原则将其分为对照组和观察组,每组36例。对照组接受临床常规综合治疗,观察组在此基础上接受连续性血液净化治疗。比较两组治疗前、后及组间急性生理与慢性健康评分(APACHE Ⅱ评分)、MODS系统评分以及炎性因子水平改善情况。结果治疗前,两组APACHEⅡ评分、MODS系统评分比较差异未见统计学意义(P>0.05);治疗后,两组各指标评分均较治疗前下降,且观察组相较于对照组各评分下降更明显,差异有统计学意义(P<0.05)。治疗前,两组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)水平比较差异未见统计学意义(P>0.05);治疗后,两组各炎性因子水平均较治疗前降低,且观察组低于对照组,差异有统计学意义(P<0.05)。结论在SAP合并MODS患者的治疗中应用连续性血液净化,可有效改善患者的脏器功能,减少炎性介质。

Objective To investigate the effects of continuous blood purification in the treatment of patients with severe acute pancreatitis(SAP)combined with multiple organ dysfunction syndrome(MODS).Methods A total of 72 SAP patients with MODS admitted to the First Hospital of Shanxi Medical University from November 2017 to November 2019 were included in the study.And they were divided into control group and observation group according to the principle of random and double-blind,with 36 cases in each group.The control group received clinical routine comprehensive treatment,and the observation group received continuous blood purification treatment based on the treatment of control group.The Acute Physiology and Chronic Health Evaluation score(APACHEⅡscore),MODS system score and the improvement of inflammatory factor levels were compared before and after treatment,and between the two groups.Results Before treatment,there was no significant difference in the APACHEⅡscore or MODS system score between the two groups(P>0.05).After treatment,the index scores of patients in each group decreased significantly,compared with preoperative scores,and decrease of observation group was more significant than that of contro group(P<0.05).Before treatment,there was no significant difference in the levels of interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)between the two groups(P>0.05).After treatment,the levels of inflammatory factors in the two groups were significantly reduced,and the indicators in the observation group were significantly lower than those in the control group,and the difference was significant(P<0.05).Conclusions The application of continuous blood purification in the treatment of patients with SAP complicated with MODS can effectively improve the patient’s organ function and reduce inflammatory mediators.