血液灌流联合连续性静-静脉血液滤过对重症急性胰腺炎患者炎性因子、氧化应激及血液流变学的影响

Effect of Hemoperfusion Combined with Continuous Veno-venous Hemofiltration on Inflammatory Factors,Oxidative Stress and Hemorrheology in Patients with Severe Acute Pancreatitis

目的分析血液灌流(HP)联合连续性静-静脉血液滤过(CVVH)对重症急性胰腺炎(SAP)患者炎性因子、氧化应激及血液流变学的影响。方法收集2019年2月—2021年3月收治的78例SAP的临床资料,根据不同治疗方法分为单一组(给予CVVH治疗)36例和联合组(给予HP联合CVVH治疗)42例。比较两组临床疗效、临床症状(腹痛、腹膜刺激征)消失时间、血液净化时间、住院时间,比较两组治疗前后肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、C反应蛋白(CRP)、超氧化物歧化酶(SOD)、丙二醛(MDA)、髓过氧化物酶(MPO)、全血高切还原黏度、红细胞压积、红细胞聚集指数及红细胞沉降率。结果联合组治疗总有效率高于单一组(P<0.05)。联合组腹痛消失、腹膜刺激征消失、血液净化及住院时间均短于单一组(P<0.01)。治疗后,两组TNF-α、IL-6、CRP、MDA、MPO、全血高切还原黏度、红细胞压积、红细胞聚集指数及红细胞沉降率均较治疗前降低,且联合组低于单一组(P<0.05)。治疗后,两组SOD较治疗前升高,且联合组高于单一组(P<0.05)。结论HP联合CVVH治疗SAP的效果确切,可减轻机体炎症反应和氧化应激反应,改善血液流变学。

Objective To analyze effects of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)on inflammatory factors,oxidative stress and hemorrheology in patients with severe acute pancreatitis(SAP).Methods Clinical data of 78 SAP patients admitted between February 2019 and March 2021 was collected.The patients were divided into single group(n=36,given CVVH treatment)and combination group(n=42,given HP combined CVVH treatment)according to different therapeutic methods.Clinical efficacy,disappearance times of clinical symptoms(abdominal pain,peritoneal irritation sign),time of blood purification,length of stay,and levels of tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP),superoxide dismutase(SOD),malondialdehyde(MDA),myeloperoxidase(MPO),whole blood high-shear reduction viscosity,hematocrit,erythrocyte aggregation index and erythrocyte sedimentation rate before and after treatment were compared between two groups.Results The total effective rate in combination group was significantly higher than that in single group(P<0.05).Disappearance times of abdominal pain and peritoneal irritation sign,time of blood purification and length of stay in combination group were significantly shorter than those in single group(P<0.05).After treatment,levels of TNF-α,IL-6,CRP,MDA,MPO,whole blood high-shear reduction viscosity,hematocrit,erythrocyte aggregation index and erythrocyte sedimentation rate were significantly decreased compared with those before treatment in two groups,and the above indexes in combination group were significantly decreased than those in single group(P<0.05).After treatment,SOD levels were significantly increased compared with those before treatment in two groups,and the level in combination group was significantly higher than that in single group(P<0.05).Conclusion HP combined with CVVH has a definite efficacy in treatment of SAP patients,which may reduce the body's Inflammatory reaction and oxidative stress reaction and improve hemorrheology.