连续性肾脏替代与经内镜鼻胆管引流联合治疗急性重症胆源性胰腺炎的效果观察

Effect of Continuous Renal Replacement Therapy Combined with EndoscopicNasobiliary Drainage on Acute Severe Biliary Pancreatitis

目的:探究连续性肾脏替代(CRRT)与经内镜鼻胆管引流(ENBD)共同应用于急性重症胆源性胰腺炎(ASBP)治疗中的效果。方法:选取78例ASBP患者随机分为对照组和实验组各39例,对照组接受CRRT治疗,实验组在对照组的基础上接受ENBD治疗,比较两组治疗前和治疗7d后的炎性因子水平和肝功能。结果:治疗前两组血清血小板活化因子(PAF)、肿瘤坏死因子-α(TNF-α)、细胞间黏附因子-1(ICAM-1)水平间的差异不显著(P>0.05),治疗7d后实验组血清PAF、TNF-α、ICAM-1的水平均显著低于对照组(P<0.05);治疗前两组血清谷丙转氨酶(ALT)、总胆红素(TBIL)、白蛋白(ALB)水平间的差异不显著(P>0.05),治疗7 d后实验组血清ALT、TBIL水平显著低于对照组(P<0.05),ALB水平显著高于对照组(P<0.05)。结论:CRRT与ENBD联合治疗ASBP可减轻患者的炎症反应,改善肝功能,应用效果优于CRRT单独应用。

Objective:To investigate the effect of continuous renal replacement therapy(CRRT)combined with endoscopic nasobiliary drainage(ENBD)on acute severe biliary pancreatitis(ASBP).Methods:78 patients with ASBP were selected and randomly divided into control group and experimental group,with 39 cases in each group.The control group received CRRT treatment and the experimental group received CRRT combined with ENBD treatment.The levels of inflammatory factors and liver function before and 7 days after treatment were compared between the two groups.Results:There was no significant difference in serum levels of platelet activating factor(PAF),tumor necrosis factor-α(TNF-α)and intercellular adhesion factor-1(ICAM-1)between the two groups before treatment(P>0.05),and after 7 days of treatment,the levels of serum PAF,TNF-αand ICAM-1 in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in the levels of serum alanine aminotransferase(ALT),total bilirubin(TBIL)and albumin(ALB)between the two groups before treatment(P>0.05).After 7 days of treatment,the levels of serum ALT and TBIL in the experimental group were significantly lower than those in the control group(P<0.05),and the level of serum ALB was significantly higher than that in the control group(P<0.05).Conclusion:The combination of CRRT and ENBD in the treatment of acute severe biliary pancreatitis can reduce the inflammatory response and improve liver function,and the application effect is better than CRRT single application.