血浆置换联合血液净化治疗高脂血症性重症急性胰腺炎患者的疗效分析

The clinical effects of plasma exchange combined with continuous renal replacement therapy in treatment of hyperlipidemic severe acute pancreatitis

目的观察血浆置换(PE)联合血液净化治疗(CRRT)高脂血症性重症急性胰腺炎(SAP)患者的临床疗效。方法回顾性分析收治的高脂血症性重症急性胰腺炎患者52例,根据是否行连续性血液净化分为对照组和治疗组,对照组给予内科常规治疗+血浆置换,治疗组给予内科常规治疗+血浆置换+连续性血液净化。比较2组治疗前、后患者的三酰甘油(TG)、血白细胞(WBC)、降钙素原(PCT)、C-反应蛋白(CRP)、白介素-6(IL-6)、APACHEⅡ评分的变化,同时观察腹痛消失的时间及住ICU时间。结果2组患者在性别比、年龄、体重指数(BMI)、入院时白细胞计数(WBC)、TG、CRP、PCT、IL-6水平等差异均无统计学意义(P>0.05)。2组患者治疗后TG、WBC、PCT、CRP、IL-6、APACHEⅡ评分均下降,但治疗组患者WBC、PCT、CRP、IL-6、APACHEⅡ评分在相同时间点明显低于单纯血浆置换组(P<0.05)。治疗组较对照组腹痛好转时间及住ICU时间明显缩短,差异有统计学意义(P<0.05)。结论血浆置换基础上联合CRRT治疗可快速降低血脂,清除重症急性胰腺炎患者体内的炎性因子,缩短患者住院时间,改善预后。

Objective To investigate the clinical effects of plasma exchange(PE)combined with continuous renal replacement therapy(CRRT)in treatment of hyperlipidemic severe acute pancreatitis(SAP).Methods The clinical data about 52 patients with hyperlipidemic SAP who were treated in our hospital were retrospectively analyzed,who were divided into two groups.The patients in control group were treated by routine medical treatment+plasma exchange,however,the patients in observation group,on thebasis of control group,were treated by CRRT.The changes of TG,WBC,PCT,CRP,IL-6 and APACHEⅡscores before and after treatment,and the extinction time of abdominal pain and ICU stay duration were observed and compared between the two groups.Results There were no significant differences in gender,age,body mass index(BMI),WBC,TG,CRP,PCT,IL-6 levels between the two groups(P>0.05).After treatment the scores of TG,WBC,PCT,CRP,IL-6 and APACHEⅡin both groups were decreased,moreover,which in observation group were significantly lower than those in control group(P<0.05).In addition the improvement time of abdominal pain and the length of staying in ICU in observation group were significantly shorter than those in control group(P<0.05).Conclusion The PE combined with CRRT can rapidly decrease theblood lipid levels,clear inflammatory factors in patients with SAP,moreover,which can shorten the hospital stay and improve the prognosis of patients.