发生全身炎症反应综合征的急性胰腺炎血液净化治疗时机选择

Timing of blood purification therapy in acute pancreatitis with systemic inflammatory response syndrome

目的探讨发生全身炎症反应综合征(SIRS)的急性胰腺炎(AP)患者进行血液净化(BP)治疗的时机。方法回顾性收集贵州医科大学附属白云医院2015年5月至2023年5月、贵州医科大学附属医院2021年9月至2023年4月发生SIRS并进行BP治疗的AP患者254例,按照发生SIRS到BP治疗时间分为A组(<6 h)62例、B组(6~12 h)52例、C组(>12~24 h)52例和D组(>24 h)88例。采用病死率、自动出院率、局部并发症、全身并发症、转ICU、机械通气、住院天数及治疗费用等预后指标研究不同BP治疗时机对以上指标的影响。结果C组、D组患者的急性胰周液体积聚和肾衰竭发生率均明显高于A组(P<0.05);D组患者循环衰竭和机械通气发生率均高于A组(P<0.05);C组、D组患者的凝血功能障碍发生率高于A组、B组(P<0.05);B组、C组、D组患者转ICU发生率高于A组(P<0.05);D组患者住院天数及治疗费用均高于A组、B组和C组(P<0.05)。结论确诊SIRS 6 h内行BP治疗可以减少患者转ICU的发生率;12 h内BP治疗可以减少胰腺渗出、肾衰竭和凝血功能障碍率;24 h内BP治疗可以减少循环衰竭和机械通气率,降低住院天数及治疗费用。

Objective To explore the timing of blood purification(BP)therapy in patients with acute pancreatitis(AP)who develop systemic inflammatory response syndrome(SIRS).Methods A retrospective collection was made of 254 AP patients with SIRS who underwent BP treatment at the Affiliated Baiyun Hospital of Guizhou Medical University from May 2015 to May 2023,and at the Affiliated Hospital of Guizhou Medical University from September 2021 to April 2023.Patients were divided into Group A(<6 h,n=62),Group B(6-12 h,n=52),Group C(<12-24 h,n=52),and Group D(>24 h,n=88)based on the time from SIRS onset to BP treatment.Mortality rate,rate of patient s request for discharge,local complications,systemic complications,ICU transfer,mechanical ventilation,hospital stay,and treatment costs were used as prognostic indicators to study the impact of different BP treatment times on these indicators.Results The incidences of acute peripancreatic fluid collection and renal failure in Groups C and D were significantly higher than those in Group A(P<0.05);the incidences of circulatory failure and mechanical ventilation in Group D were significantly higher than those in Group A(P<0.05);the incidence of coagulation dysfunction in Groups C and D was significantly higher than that in Groups A and B(P<0.05);the incidence of patients transferred to ICU in Groups B,C,and D was higher than that in Group A(P<0.05);the hospital stay and treatment costs for patients in Group D were significantly higher than those in Groups A,B,and C(P<0.05).Conclusion BP treatment within 6 hours of diagnosing SIRS can reduce the incidence of patient transfer to ICU;BP treatment within 12 hours can reduce the incidence of pancreatic exudate,renal failure,and coagulation dysfunction;BP treatment within 24 hours can reduce the incidence of circulatory failure and mechanical ventilation,as well as decrease hospital stay and treatment costs.