血液灌流及CRRT联合超声引导下腹腔穿刺置管引流对急性重症胰腺炎患者腹腔黏膜氧化应激损伤的影响

Effects of Hemoperfusion and CRRT combined with ultrasound-guided paracentesis catheter drainage on oxidative stress injury of abdominal mucosa in patients with acute severe pancreatitis

目的探讨血液灌流及连续肾脏替代疗法(CRRT)联合超声引导下腹腔穿刺置管引流对急性重症胰腺炎患者腹腔黏膜氧化应激损伤的影响。方法前瞻性选择2018年1月到2021年1月在辽宁省健康产业集团阜新矿总医院重症监护病房诊治的急性重症胰腺炎患者102例作为研究对象,根据单双号随机分配原则把患者分为CRRT组与对照组,每组各51例。所有患者均给予超声引导下腹腔穿刺置管引流治疗,对照组给予血液灌流治疗,CRRT组给予CRRT治疗。观察与记录两组患者的临床疗效、治疗后恢复情况、并发症发生情况以及治疗前后的血清内皮素-1、一氧化氮含量。结果治疗后7 d,CRRT组总有效率为98.04%,高于对照组(86.27%),差异有统计学意义(P<0.05)。CRRT组的肠鸣音恢复时间、总住院时间、腹痛缓解时间、体温恢复时间为(6.31±0.44)、(22.18±1.28)、(4.44±0.44)、(3.98±0.47)d,均少于对照组[(10.99±0.14)、(31.56±1.91)、(7.19±1.14)、(6.78±1.10)d],差异均有统计学意义(P<0.05)。CRRT组治疗后7 d的假性囊肿、胃肠功能障碍、胰性脑病等并发症发生率为3.92%,低于对照组(17.65%),差异有统计学意义(P<0.05)。CRRT组治疗后7 d的血清内皮素-1含量低于治疗前,血清一氧化氮含量高于治疗前,CRRT组血清内皮素-1含量为(34.59±2.58)pg/mL,低于对照组[(42.53±4.44)pg/mL],血清一氧化氮含量为(8.97±0.42)IU/mL,高于对照组[(6.98±0.53)IU/mL],差异均有统计学意义(P<0.05)。结论CRRT联合超声引导下腹腔穿刺置管引流在急性重症胰腺炎患者的应用能降低内皮素-1含量与促进一氧化氮的释放,能减少并发症的发生,改善腹腔黏膜功能,促进患者康复,提高患者的治疗总体疗效。

Objective To investigate the effect of hemoperfusion and continuous renal replacement therapy(CRRT)combined with ultrasound-guided paracentesis catheter drainage on oxidative stress injury of abdominal mucosa in patients with acute severe pancreatitis.Methods From January 2018 to January 2021,a total of 102 patients with acute severe pancreatitis who were diagnosed and treated in the intensive care unit(ICU)of Fuxin Mine General Hospital,Liaoning Health Industry Group were prospectively selected as the research subjects,and the patients were equally divided into the CRRT group and the control group accorded to the principle of random assignment of odd and even numbers.All patients were treated with ultrasound-guided paracentesis catheter drainage,the control group were treated with hemoperfusion,and the CRRT group were treated with continuous renal replacement therapy.The clinical efficacy,recovery after treatment,occurrence of complications,and serum endothelin-1 and nitric oxide levels before and after treatment in the two groups were observed and recorded.Results The total effective rate in the CRRT group at 7 days after treatment was 98.04%,which was higher than that in the control group,which was(86.27%),and the difference was statistically significant(P<0.05).The recovery time of bowel sounds,total hospital time,abdominal pain relief time,and body temperature recovery time in the CRRT group were(6.31±0.44)d,(22.18±1.28)d,(4.44±0.44)d,(3.98±0.47)d,which were less than the control group[(10.99±0.14)d,(31.56±1.91)d,(7.19±1.14)d,(6.78±1.10)d],the differences were statistically significant(P<0.05).The incidence rates of complications such as pseudocyst,gastrointestinal dysfunction,and pancreatic encephalopathy in the CRRT group were 3.92%after 7 days of treatment,which were lower than that in the control group(17.65%),the difference was statistically significant(P<0.05).The content of serum endothelin-1 in the CRRT group was lower than that before treatment,and the content of serum nitric oxide was higher than that before treatment,the content of serum endothelin-1 in the CRRT group was(34.59±2.58)pg/mL,which was lower than that of the control group[(42.53±4.44)pg/mL],and the serum nitric oxide content was(8.97±0.42)IU/mL,which was higher than In the control group[(6.98±0.53)IU/mL],the differences were statistically significant(P<0.05).Conclusion The application of CRRT combined with ultrasound-guided paracentesis catheter drainage in patients with acute severe pancreatitis can reduce the content of endothelin-1 and promote the release of nitric oxide,reduce the occurrence of complications,improve the function of abdominal mucosa,promote the recovery of patients,and improve the recovery of patients overall treatment efficacy.