CRRT联合血浆置换救治高脂血症性重症急性胰腺炎患者的疗效分析

Curative effect of CRRT combined with plasma exchange in the treatment of hyperlipidemic severe acute pancreatitis

目的探讨连续性肾脏替代治疗(CRRT)联合血浆置换(PE)救治高脂血症性重症急性胰腺炎患者的疗效及其影响因素。方法109例高脂血症性重症急性胰腺炎患者根据治疗方法分为CRRT组51例和CRRT联合PE组(联合组)58例,比较2组疗效、症状消失时间和预后情况;计算联合组患者治疗72h三酰甘油(TG)下降程度,根据TG下降程度(取60%为界限),分为高效(TG下降>60%)组37例和低效(TG下降≤60%)组21例,采用多元线性回归模型分析影响CRRT联合PE疗效的因素。结果联合组治疗72 h后总胆固醇(TC)、TG、淀粉酶(AMY)、C反应蛋白(CRP)及降钙素原(PCT)水平低于CRRT组(P<0.05);联合组腹痛、发热和恶心呕吐症状消失时间、机械通气时间和ICU住院时间短于CRRT组(P<0.05)。高效组治疗前TC和TG水平高于低效组,发病至PE开始时间短于低效组(P<0.05);多元线性回归分析显示,CRRT联合PE的TG下降程度=33.591+1.010×治疗前TC+2.088×治疗前TG-0.443×发病至PE开始时间。结论CRRT联合PE可有效减轻患者症状,有利于疾病转归,其疗效与患者治疗前TC、TG水平和发病至PE开始时间有关。

Objective To analyze the curative effect of continuous renal replacement therapy(CRRT)combined with plasma exchange(PE)in patients with severe acute pancreatitis of hyperlipidemia.Methods According to different treatment methods,109 patients with severe acute pancreatitis of hyperlipidemia were divided into the CRRT group(51 cases)and the combination group(CRRT combined with PE,58 cases).The curative effect,disappearance time of symptoms and complications were compared between the two groups.The decline degree of triglyceride(TG)was calculated in the combination group after 72 h treatment.According to the decline degree of TG(60%as the limit),patients were divided into the high efficiency group(>60%,37 cases)and the low efficiency group(≤60%,21 cases).The influencing factors on the curative effect of CRRT combined with PE were analyzed by multivariate linear regression model.Results After 72 h of treatment,levels of total cholesterol(TC),TG,amylase(AMY),C-reactive protein(CRP)and procalcitonin(PCT)were lower in the combination group than those of the CRRT group(P<0.05).The disappearance time of symptoms(abdominal pain,fever,nausea and vomiting),mechanical ventilation time and stay time in ICU were shorter in the combination group than those of the CRRT group(P<0.05).Before treatment,levels of TC and TG were higher in the high efficiency group than those of the low efficiency group,while interval from onset to PE was shorter than that in the low efficiency group(P<0.05).The results of multivariate linear regression analysis showed that the regression equation:TG decline=33.591+1.010×(TC before treatment)+2.088×(TG before treatment)-0.443×(interval from onset to PE).Conclusion CRRT combined with PE can effectively relieve symptoms,which is conducive to disease outcomes.The curative effect is related to TC and TG levels before treatment and the interval from onset to PE.