Influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis complicated by MODS

Objective:To study the influence of continuous blood purification on inflammation and target organ damage in patients with severe acute pancreatitis accompanied by MODS.Methods: A total of 78 patients with severe acute pancreatitis complicated by MODS who were treated in our hospital between June 2012 and March 2016 were selected and divided into control group (n=39) and observation group (n=39) according to random number table. Control group were treated with routine treatment, observation group were treated with conventional treatment plus continuous blood purification, and serum inflammatory factors, liver function indexes and renal function indexes were compared between two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of inflammatory factors, liver function indexes and renal function indexes were not statistically significant between two groups of patients. After treatment, serum inflammatory factors IL-6, IL-8, MCP-1 and HMGB1 levels of observation group were lower than those of control group, liver function indexes ALT, AST, TBIL and ALP levels of observation group were lower than those of control group, and renal function indexes Scr and BUN levels of observation group were lower than those of control group.Conclusion: Continuous blood purification can reduce the systemic inflammatory response as well as liver and kidney injury in patients with severe acute pancreatitis complicated by MODS.

Sequential blood purification therapy for critical patients with hyperlipidemic severe acute pancreatitis

AIM: To evaluate the efficacy of sequential blood purification therapy in the treatment of critical patients with hyperlipidemic severe acute pancreatitis.METHODS: Thirty-one intensive care unit(ICU) patients with hyperlipidemic severe acute pancreatitis treated at the Second Affiliated Hospital of Harbin Medical University were divided into either a study group(n = 15; July 1, 2012 to June 30, 2014) or a control group(n = 16; July 1, 2010 to June 30, 2012) based on the implementation of sequential blood purification therapy. The control group received continuous venous-venous hemofiltration(CVVH) on the basis of conventional treatments, and the therapeutic dose of CVVH was 30 m L/kg per hour. The study group received sequential plasma exchange and CVVH on the basis of conventional treatments. The anticoagulation regimen of CVVH is the regional citrate anticoagulation. Mortality rate on day 28, rates of systemic and local complications, duration of ICU, and time to target serum lipid level, as well as physiologic and laboratory indices were compared between the two groups.RESULTS: The mortality rate on day 28 was significantly lower in the study group than in the control group(13.33% vs 37.50%; P < 0.05). The duration of ICU stay was significantly shorter in the study group than in the control group(7.4 ± 1.35 d vs 9.19 ± 2.99 d, P < 0.05). The time to target serum lipid level was significantly shorter in the study group than in the control group(3.47 ± 0.52 d vs 7.90 ± 1.14 d, P < 0.01). There were no significant differences in the rates of systemic complications and local complications between the two groups(60% vs 50% and 80% vs 81%, respectively). In the comparisons of physiologic and laboratory indices, serum albumin and C-reactive protein were significantly better in the study group than in the control group after treatment(37.8 ± 4.6 g/L vs 38.9 ± 5.7 g/L, and 20.5 ± 6.4 mg/L vs 28.5 ± 7.1 mg/L, respectively, both P < 0.05). With the exception of plateletcrit, no other indices showed significant differences between the two groups.CONCLUSION: Sequential blood purification therapy is effective in the treatment of ICU patients with hyperlipidemic severe acute pancreatitis and can improve patient prognosis.

Prognostic value of red blood cell distribution width for severe acute pancreatitis

BACKGROUND Severe acute pancreatitis(SAP)is a common condition in the intensive care unit(ICU)and has a high mortality.Early evaluation of the severity and prognosis is very important for SAP therapy.Recently,red blood cell distribution(RDW)was associated with mortality of sepsis patients and could be used as a predictor of prognosis.Similarly,RDW may be associated with the prognosis of SAP patients and be used as a prognostic indicator for SAP patients.AIM To investigate the prognostic value of RDW for SAP patients.METHODS We retrospectively enrolled SAP patients admitted to the ICU of the First Affiliated Hospital of China Medical University from June 2015 to June 2017.According to the prognosis at 90 d,SAP patients were divided into a survival group and a non-survival group.RDW was extracted from a routine blood test.Demographic parameters and RDW were recorded and compared between the two groups.The receiver operator characteristic(ROC)curve was constructed and Cox regression analysis was performed to investigate the prognostic value of RDW for SAP patients.RESULTS In this retrospective cohort study,42 SAP patients were enrolled,of whom 22 survived(survival group)and 20 died(non-survival group).The baseline parameters were comparable between the two groups.The coefficient of variation of RDW(RDW-CV),standard deviation of RDW(RDW-SD),Acute Physiology and Chronic Health Evaluation II(APACHE II)score,and Sequential Organ Failure Assessment(SOFA)score were significantly higher in the non-survival group than in the survival group(P<0.05).The RDW-CV and RDW-SD were significantly correlated with the APACHE II score and SOFA score,respectively.The areas under the ROC curves(AUCs)of RDW-CV and RDW-SD were all greater than those of the APACHE II score and SOFA score,among which,the AUC of RDW-SD was the greatest.The results demonstrated that RDW had better prognostic value for predicting the mortality of SAP patients.When the RDW-SD was greater than 45.5,the sensitivity for predicting prognosis was 77.8%and the specificity was 70.8%.Both RDW-CV and RDW-SD could be used as independent risk factors to predict the mortality of SAP patients in multivariate logistic regression analysis and univariate Cox proportional hazards regression analysis,similar to the APACHE II and SOFA scores.CONCLUSION The RDW is greater in the non-surviving SAP patients than in the surviving patients.RDW is significantly correlated with the APACHE II and SOFA scores.RDW has better prognostic value for SAP patients than the APACHE II and SOFA scores and could easily be used by clinicians for the treatment of SAP patients.

Continuous regional arterial infusion for the treatment of severe acute pancreatitis: a meta-analysis

BACKGROUND： Continuous regional arterial infusion（CRAI） is a drug delivery system, which dramatically increases the drug concentration in the pancreas. Previous clinical and basic studies have demonstrated the possible therapeutic efficacy of CRAI for severe acute pancreatitis（SAP）. This meta-analysis of all published randomized controlled trials（RCTs） was conducted to assess the efficacy and safety of CRAI for the treatment of SAP. DATA SOURCES： Up to August 10, 2014, RCTs comparing CRAI with intravenous infusion for SAP in PubM ed, Embase, EBSCO, MEDLINE, Science Citation Index Expanded, Cochrane Library, China Academic Journals Full-Text Database, Chinese Biomedical Literature Database, and Chinese Scientific Journals Database were selected by two independent reviewers. The relative risk（RR） and their 95% confidence intervals（CI） for duration of elevated serum amylase and urine amylase, duration of abdominal pain, infection rate, incidence of complication, overall mortality, curative rate, hospital stay and details of subgroup analysis were extracted. Meta-analyses were made using the software Review Manager（RevM an version 5.10）.RESULTS： Six RCTs with 390 patients meeting the inclusion criteria were included in the final analysis. Compared with intravenous infusion route, CRAI significantly shortened the duration of elevated urine amylase（MD=-2.40, 95% CI=-3.20,-1.60; P〈0.00001） and the duration of abdominal pain（MD=-1.46, 95% CI=-1.94,-0.98; P〈0.00001）, decreased the incidence of complication（RR=0.35, 95% CI=0.15, 0.81; P=0.01） and overall mortality（RR=0.25, 95% CI=0.08, 0.78;P=0.02）, shortened the duration of hospital stay（MD=-10.36, 95% CI=-17.05,-3.68; P=0.002）, and increased the curative rate（RR=1.66, 95% CI=1.13, 2.46; P=0.01）. No mortality and catheter-related infections due to CRAI administration was reported in these studies. Subgroup analysis showed that the combination of drug administration via CRAI did not significantly improve the outcomes.CONCLUSION： CRAI is effective for the treatment of SAP, and the combination of drug administration via CRAI did not have a significant effect on the improvement of the outcomes.

Use of Continuous Venovenous Hemodiafiltration with a High Cutoff Membrane in a Patient with Severe Acute Pancreatitis

In patients with severe acute pancreatitis (SAP) early and persistent elevated circulating levels of interleukins (IL)-1, 2 and 6 and tumor necrosis factor (TNF)-α are linked to severity of disease and early multiple organ failure (MOF), while persistently elevated serum IL-10 is linked to immune paralysis and infectious complications. Although experimental and clinical evidence exists that continuous venovenous hemodiafiltration with high cutoff membranes (HCO-CVVHDF) efficiently removes inflammatory mediators from blood of patients with severe sepsis or septic shock, data are lacking on the subset of patients with SAP, particularly in cases with uninfected necrosis. We treated with HCO-CVVHDF a 59-year-old man admitted to our intensive care unit (ICU) with SAP inducing early-onset cardiovascular, respiratory and renal dysfunctions associated with high circulating levels of IL-6 and TNF-α and without overt clinical or laboratory signs of infection. During the treatment, cardiovascular, respiratory and renal functions rapidly normalized and circulating levels of IL-6 and TNF-α consistently decreased. The patient was discharged from ICU on day 20.

Research Progress of Continuous Blood Purification in the Treatment of Severe Sepsis in Children

Pediatric sepsis is the most common disease in pediatric critical illness,because the main reason for the disease is that children's immune level is not high or the immune system is not perfect,when children's lung,abdominal cavity and blood system are infected,it will cause systemic inflammation and immune dysfunction.Early clinical symptoms are mainly irregular and intermittent fever.When the disease develops to severe sepsis,the children will suffer from acute heart failure,oliguria,respiratory alkalosis and even multiple organ failure.The incidence of death is high.It is reported that the incidence rate of sepsis in children can reach 0.3%,and the mortality rate is 50%.High incidence rate,high mortality rate and high treatment cost are the biggest problems in the pediatric field.In the past,the clinical hope of clearing away heat and toxin,promoting blood circulation and removing stasis,strengthening inflammation and other methods in traditional Chinese medicine,but the treatment effect is not ideal.With the improvement of modem medical understanding of sepsis,continuous blood purification therapy is introduced into the treatment of children with severe sepsis.In order to further explore the effect of continuous blood purification in the treatment of children with severe sepsis,the author summarizes the clinical practice experience and relevant literature,hoping to provide reference for relevant medical staff。

Effect of continuous blood purification on T lymphocyte subsets and inflammatory response in patients with severe sepsis

Objective:To investigate the effects of continuous blood purification (CBP) on T lymphocyte subsets and inflammatory response in patients with severe sepsis, and to provide scientific evidence for the treatment of severe sepsis patients. Methods:96 cases of severe sepsis patients from June 2013 to June 2016 in Yulin First People's Hospital were as the research subjects, randomly divided into observation group and control group, 48 cases in each group. The control group received routine treatment of sepsis, while the observation group adopted CBP therapy on the basis of the control group, fasting venous blood was collected 7 d before and after treatment respectively, and the change of IL-6, TNF-α, CRP levels, CD3+, CD4+, CD8+lymphocyte percentage and ratio of CD4+/CD8+in two groups were compared before and after treatment in two groups. Results:Before treatment, there were no significant differences in IL-6, TNF-α, and CRP levels between the two groups (P>0.05). After treatment, the IL-6 and TNF-αlevels of observation group and the control group were significantly decreased, CRP level in the observation group decreased significantly, and the IL-6, TNF-αand CRP levels were significantly lower in the observation group than in the control group (P<0.05). Before treatment, there was no statistical difference in the percentage of T cell subsets between the two groups (P<0.05). After treatment, the two groups of patients with CD3+, CD4+, CD8+and CD4+/CD8+were significantly elevated (P<0.05). After treatment, the CD3+, CD4+and CD4+/CD8+were significantly higher in the observation group than in the control group (P<0.05). Conclusions:CBP therapy can effectively reduce the level of inflammatory factors in patients with severe sepsis, reduce the inflammatory response, and can effectively improve the immune function of patients, and the effect is significant.

Oxygen radical formation does not have an impact in the treatment of severe acute experimental pancreatitis using free cellular hemoglobin

AIM： Microcirculatory dysfunction and free oxygen radicals are important factors in the pathogenesis of severe acute pancreatitis. Additional oxygen delivery might enhance lipid peroxidation but may also improve pancreatic microcirculation. This study assesses the effect of free cellular bovine hemoglobin on the formation of oxygen radicals and microcirculation in a rodent model of severe acute pancreatitis. METHODS： Fifteen minutes after induction of acute pancreatitis Wistar rats received either 0.8 mL bovine hemoglobin （HBOC-200）, hydroxyethyl starch （HES） or 2.4 mL of normal saline to ensure normovolemic substitution. After 6 h of examination the pancreas was excised and rapidly processed for indirect measurement of lipid peroxidation products malondialdehyde （MDA） and reduced glutathione （GSH） in pancreatic tissue. RESULTS： The single application of HBOC-200 improved pancreatic microcirculation and reduced histopathological tissue damage significantly. Tissue concentration of MDA did not differ between the groups. Also no differences in GSH levels were detected.CONCLUSION： Though the single application of HBOC-200 and HES improve pancreatic microcirculation, no differences in lipid peroxidation products were detected. The beneficial effect of additional oxygen supply （HBOC-200） does not lead to enhanced lipid peroxidation.

Correlation of fibrinogen-like protein 2 with progression of acute pancreatitis in rats

AIM: To examine fibrinogen-like protein 2 (fgl2) expression during taurocholate-induced acute pancreatitis progression in rats and its correlation with pancreatic injury severity. METHODS: Forty-eight male Sprague-Dawley rats were randomly divided into the severe acute pancreatitis (SAP) group (n = 24) and the sham operation (SO) group (n = 24). Sodium taurocholate (4% at doses of 1 mL/kg body weight) was retrogradely injected into the biliopancreatic ducts of the rats to induce SAP. Pancreatic tissues were prepared immediately after sacrifice. At the time of sacrifice, blood was obtained for determination of serum amylase activity and isolation of peripheral blood mononuclear cells (PBMCs). Pancreatic tissue specimens were obtained for routine light microscopy including hematoxylin and eosin staining, and the severity of pancreatic injury was evaluated 1, 4 and 8 h after induction. Expression of fgl2 mRNA was measured in the pancreas and PBMCs using reverse transcription polymerase chain reaction. Expression of fgl2 protein was evaluated in pancreatic tissues using Western blotting and immunohistochemical staining. Masson staining was also performed to observe microthrombosis. RESULTS: At each time point, levels of fgl2 mRNAs in pancreatic tissues and PBMCs were higher (P < 0.05) in the SAP group than in the SO group. For pancreatic tissue in SAP vs SO, the levels were: after 1 h, 3.911 ± 1.277 vs 1.000 ± 0.673; after 4 h, 9.850 ± 3.095 vs 1.136 ± 0.609; and after 8 h, 12.870 ± 3.046 vs 1.177 ± 0.458. For PBMCs in SAP vs SO, the levels were: after 1 h, 2.678 ± 1.509 vs 1.000 ± 0.965; after 4 h, 6.922 ± 1.984 vs 1.051 ± 0.781; and after 8 h, 13.533 ± 6.575 vs 1.306 ± 1.179. Levels of fgl2 protein expression as determined by Western blotting and immunohistochemical staining were markedly up-regulated (P < 0.001) in the SAP group compared with those in the SO group. For Western blotting in SAP vs SO, the results were: after 1 h, 2.183 ± 0.115 vs 1.110 ± 0.158; after 4 h, 2.697 ± 0.090 vs 0.947 ± 0.361; and after 8 h, 3.258 ± 0.094 vs 1.208 ± 0.082. For immunohistochemical staining in SAP vs SO, the results were: after 1 h, 1.793 ± 0.463 vs 0.808 ± 0.252; after 4 h, 4.535 ± 0.550 vs 0.871 ± 0.318; and after 8 h, 6.071 ± 0.941 vs 1.020 ± 0.406. Moreover, we observed a positive correlation in the pancreas (r = 0.852, P < 0.001) and PBMCs (r = 0.735, P < 0.001) between fgl2 expression and the severity of pancreatic injury. Masson staining showed that microthrombosis (%) in rats with SAP was increased (P < 0.001) compared with that in the SO group and it was closely correlated with fgl2 expression in the pancreas (r = 0.842, P < 0.001). For Masson staining in SAP vs SO, the results were: after 1 h, 26.880 ± 9.031 vs 8.630 ± 3.739; after 4 h, 53.750 ± 19.039 vs 8.500 ± 4.472; and after 8 h, 80.250 ± 12.915 vs 10.630 ± 7.003.CONCLUSION: Microthrombosis due to fgl2 overexpression contributes to pancreatic impairment in rats with SAP, and fgl2 level may serve as a biomarker during early stages of disease.

乌司他丁联合早期血液灌流治疗重症急性胰腺炎的临床疗效研究

目的探讨乌司他丁联合早期血液灌流对重症急性胰腺炎的治疗效果。方法60例重症急性胰腺炎患者,按随机数字表法将患者分为研究组和对照组,各30例。对照组应用乌司他丁治疗,研究组在对照组基础上开展早期血液灌流治疗。对比两组治疗效果及治疗前后血清炎性因子、症状评分、免疫功能指标、生活质量评分。结果研究组总有效率96.67%高于对照组的80.00%(P<0.05)。治疗后,两组C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平均较治疗前降低,且研究组CRP(5.89±1.06)mg/L、PCT(0.46±0.15)ng/ml、TNF-α(10.83±2.07)ng/L低于对照组的(7.02±1.27)mg/L、(0.69±0.23)ng/ml、(13.49±2.46)ng/L(P<0.05)。治疗后,两组腹痛、发热、恶心呕吐评分均比治疗前明显降低,且研究组腹痛评分(1.17±0.39)分、发热评分(1.06±0.31)分、恶心呕吐评分(1.16±0.40)分低于对照组的(1.58±0.43)、(1.52±0.48)、(1.61±0.45)分(P<0.05)。治疗后,两组CD3^(+)、CD4^(+)/CD8^(+)比治疗前均明显升高,且研究组CD3^(+)(41.92±2.43)%、CD4^(+)/CD8^(+)(1.89±0.34)高于对照组的(38.05±2.18)%、(1.52±0.31)(P<0.05)。治疗后,两组生理、心理、环境和社会关系评分比治疗前均明显升高,且研究组生理评分(89.75±6.48)分、心理评分(89.07±6.02)分、环境评分(90.14±6.15)分和社会关系评分(89.96±6.27)分均高于对照组的(82.93±6.85)、(82.40±6.13)、(83.27±6.30)、(83.14±6.54)分(P<0.05)。结论对重症急性胰腺炎患者实施早期血液灌流与乌司他丁联合治疗可增强临床效果,改善患者症状、炎症反应,提升免疫功能及生活质量。

杂合式血液净化序贯疗法与丹参注射液联合治疗重症急性胰腺炎的效果分析

目的分析杂合式血液净化序贯疗法与丹参注射液联合治疗重症急性胰腺炎(SAP)的效果。方法98例SAP患者,使用随机数字表法分为对照组(49例)与研究组(49例)。两组均接受基础治疗,对照组应用杂合式血液净化序贯疗法,研究组在其基础上联合丹参注射液治疗。比较两组患者的临床疗效、症状与体征改善时间、不良反应发生情况。结果研究组患者总有效率95.92%高于对照组的81.63%(P<0.05)。研究组腹痛腹胀消失时间、血尿淀粉酶恢复正常时间、尿恢复正常时间、体温恢复正常时间分别为(4.23±0.95)、(4.15±1.06)、(6.00±0.92)、(5.02±0.85)d,均短于对照组的(6.00±0.86)、(6.45±1.09)、(7.56±1.00)、(6.50±0.79)d(P<0.05)。两组不良反应发生率比较未见差异性(P>0.05)。结论杂合式血液净化序贯疗法与丹参注射液联合治疗SAP效果确切,能够促进患者症状与体征恢复,具有临床推广价值。

连续性血液净化对重症心力衰竭合并肾衰竭患者心肾功能指标的影响

目的探究重症心力衰竭合并肾衰竭患者应用连续性血液净化对心肾功能的改善效果。方法随机选取2018年1月—2023年12月中国人民解放军联勤保障部队第九〇三医院收治的150例重症心力衰竭合并肾衰竭患者为研究对象,根据不同治疗方法分为研究组、参照组,每组75例。参照组行血液净化治疗,研究组行连续性血液净化治疗,比较两组患者的生命体征、血气指标、心功能、肾功能。结果研究组的呼吸频率(20.19±3.51)次/min、心率(91.45±7.58)次/min、平均动脉压(83.41±3.22)mmHg优于参照组的(27.81±5.22)次/min、(106.94±8.69)次/min、(86.52±4.19)mmHg,差异有统计学意义(t=10.491、11.633、5.097,P均<0.05)。研究组的血气指标、心功能及肾功能水平均优于参照组,差异有统计学意义(P均<0.05)。结论对比常规血液净化,连续性血液净化治疗重症心力衰竭合并肾衰竭患者的效果更好,患者生命体征平稳,血气指标改善,心肾功能提高。

连续性血液净化治疗重症心力衰竭合并急性肾损伤对患者肾功能、心功能的影响

目的研究重症心力衰竭伴急性肾损伤患者实施连续性血液净化(Continuous Blood Purification,CBP)治疗的临床效果。方法随机选择2020年1月-2022年6月溧阳市人民医院重症医学科的40例重症心力衰竭合并急性肾损伤患者为研究对象,按照抛硬币法分为对照组和研究组。对照组(20例)予以常规治疗,研究组(20例)予以连续性血液净化治疗。对两组治疗效果、肾功能指标和心功能指标进行对比。结果研究组总疗效(95.00%)较对照组(70.00%)高,差异有统计学意义(χ^(2)=4.329,P=0.037)。研究组血肌酐和血尿素氮水平低于对照组,差异有统计学意义(P均<0.05)。研究组左室射血分数、心排血量高于对照组,差异有统计学意义(P均<0.05)。结论连续血液净化运用于重症心力衰竭并急性肾损伤患者中能提高治疗效果,改善肾功能与心功能。

血液标志物对预测重症急性胰腺炎继发脓毒症的应用进展

重症急性胰腺炎(SAP)是急性胰腺炎(AP)最严重的类型,是临床常见危重症,随着医疗水平不断提升,SAP早期死亡率明显降低,死亡高峰期主要集中在发病后期,而后期死亡原因主要是胰腺或胰周坏死感染后继发脓毒症,若能早期预测SAP继发脓毒症的风险,则可指导医务人员进行恰当的早期监测和干预,从而改善患者临床结局。该文综述了血液标志物对预测SAP继发脓毒症的应用进展。

基于药代动力学的临床常见药物急性中毒血液净化治疗共识

近年来,药物导致的急性中毒逐年增多,但多数药物中毒缺乏特效解毒剂。血液净化治疗在药物急性中毒治疗方面具有重要作用,但目前国内关于其在临床常见药物急性中毒方面的应用尚无统一推荐意见。本专家共识以药代动力学为核心,对血液净化治疗在临床常见药物急性中毒治疗中的应用策略进行归纳、总结,旨在增进临床医生对药代动力学特征及相应血液净化治疗模式的理解,从而使其在诊治药物急性中毒患者时可以基于中毒药物的药代动力学特征选择合理的血液净化治疗模式,并制定恰当的血液净化治疗方案,最终提高临床常见药物急性中毒患者救治效果。

基于降钙素原水平指导抗生素联合连续性血液净化治疗重症急性胰腺炎的效果

目的探讨基于降钙素原(PCT)监测水平指导应用抗生素联合连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者预后转归及免疫内稳状态的影响。方法选取2020年2月至2022年6月赣州市人民医院收治的80例SAP患者作为研究对象,按照随机数字表法分为研究组与对照组,每组40例。入院后两组均采取常规干预、CBP,对照组在上述基础参照SAP诊治指南抗生素应用原则给予抗生素治疗,研究组每天监测PCT指导应用抗生素。比较两组预后转归效果、治疗情况、治疗前后免疫内稳状态相关指标水平。结果研究组治疗总有效率为90.00%,高于对照组的72.50%,差异有统计学意义(P<0.05)。研究组抗生素应用时间、CBP时间、住院时间均短于对照组,住院治疗费用少于对照组,差异有统计学意义(P<0.05)。治疗后,两组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于治疗前,白细胞介素-1(IL-1)、干扰素γ(IFN-γ)水平均低于治疗前,且研究组CD4^(+)、CD8^(+)水平及CD4^(+)/CD8^(+)均高于对照组,IL-1、IFN-γ水平均低于对照组,差异有统计学意义(P<0.05)。结论基于PCT监测水平指导应用抗生素联合CBP治疗SAP可缩短治疗时间,改善机体免疫内稳状态,增强治疗效果,有助于减轻家庭经济负担。

血清脂蛋白(a)、降钙素原、红细胞分布宽度水平与急性胰腺炎严重程度关系及其预后评估价值

目的探讨血清脂蛋白(a)[Lp(a)]、降钙素原(PCT)、红细胞分布宽度(RDW)水平与急性胰腺炎(AP)严重程度的关系及其预后评估价值。方法选取2022年1月至12月如皋市人民医院收治的180例AP患者为研究对象。根据AP病情严重程度分为轻症AP组(n=75)、中重症AP组(n=54)与重症AP组(n=51);根据预后情况分为预后良好组(n=137)与预后不良组(n=43)。收集患者一般资料,常规检测血液生化指标和血清Lp(a)、PCT、RDW水平。采用Spearman相关性分析对Lp(a)、PCT和RDW与急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分的相关性进行分析;采用Logistic回归模型分析AP预后不良的独立危险因素;绘制受试者工作特征(ROC)曲线,评估Lp(a)、PCT和RDW对AP预后的预测价值。结果中重症AP组和重症AP组血清Lp(a)、PCT、RDW水平及APACHEⅡ评分高于轻症AP组,且重症AP组高于中重症AP组,差异有统计学意义(P<0.05)。Spearman相关性分析显示,血清Lp(a)、PCT和RDW水平与AP严重程度(APACHEⅡ评分)呈正相关(r=0.711、0.874、0.759,P<0.001)。APACHEⅡ评分、Lp(a)、PCT、RDW、急性胰腺炎严重程度床旁指数评分、Ranson评分是AP预后不良的独立危险因素(P<0.05)。血清Lp(a)、PCT、RDW及三者联合预测AP预后不良的曲线下面积分别为0.816、0.921、0.793、0.951,三者联合的预测价值最高。结论血清Lp(a)、PCT、RDW水平与AP严重程度呈正相关,是AP预后不良的独立危险因素,三者联合对AP预后不良的预测价值最高。

血液净化联合不同时机的营养治疗对急性胰腺炎继发性感染临床疗效的影响及危险因素的分析

目的探讨血液净化联合不同时机的营养治疗对急性胰腺炎(acute pancreatitis,AP)继发性感染的临床疗效及其影响因素。方法回顾性分析2021年1月—2023年7月在河南科技大学第一附属医院肾脏内科收治的80例AP继发性感染患者的临床资料,根据血液净化和营养治疗的开始时间,将患者分为四组。比较四组患者的一般资料、严重程度评分、感染相关指标、并发症发生率和病死率,并分析影响临床疗效的危险因素。结果治疗后,四组患者的严重程度评分、感染相关指标均较治疗前明显改善(P<0.05),且A组优于B组、C组和D组(P<0.05)。A组的并发症发生率和病死率均低于B组、C组和D组(P<0.05)。多因素Logistic回归分析显示,血液净化和营养治疗的开始时间、治疗后的严重程度评分和感染相关指标是影响临床疗效的独立危险因素(P<0.05)。结论血液净化联合不同时机的营养治疗能够改善AP继发性感染患者的临床疗效,且血液净化和营养治疗的开始时间、治疗后的严重程度评分和感染相关指标是影响临床疗效的重要危险因素,应予以重视。

改良CT严重指数评分联合血清学指标评估急性胰腺炎患者预后的价值

目的探讨改良CT严重指数评分(MCTSI)联合血清学指标评估急性胰腺炎(AP)患者预后的价值。方法选择2018年1月至2022年1月南通市第一人民医院收治的248例AP患者为研究对象,根据病情将患者分为轻症组(n=152)与中重症组(n=96)。所有患者均接受胰腺增强CT检查、血常规及血钙、血清淀粉酶、血清脂肪酶、降钙素原(PCT)、白细胞介素-6(IL-6)、IL-17、C-反应蛋白(CRP)水平检测,统计28 d内死亡率,比较病情不同严重程度、不同预后AP患者MCTSI评分及实验室指标水平差异。结果多因素Logistic分析显示,MCTSI及血清淀粉酶、血清脂肪酶、PCT水平是影响AP患者严重程度的独立性危险因素(P<0.05)。发病后28 d内,248例患者中196例存活、52例死亡,总体生存率为79.03%。轻症组、中重症组的生存率分别为91.4%(139/152)、59.4%(57/96),中重症组患者的生存率显著较低(χ2=12.94,P<0.001)。ROC曲线分析显示,MCTSI、PCT、血钙单独预测患者28 d内死亡的AUC分别为0.870、0.785、0.679,敏感性分别为72.6%、68.4%、69.3%,特异性分别为75.9%、69.7%、64.4%。当三者联合检测时,可将AUC提高至0.913。多因素Cox生存分析显示,MCTSI及血清淀粉酶、血清脂肪酶、PCT水平是影响AP患者预后的独立性危险因素。结论MCTSI评分联合血清学指标检测,可提高AP病情严重程度及预后的预测效能。

去脂血浆净化治疗急性高脂血症性胰腺炎的效果分析

目的:分析去脂血浆净化治疗急性高脂血症性胰腺炎的临床效果。方法:选取2020年1月—2022年9月东台市人民医院收治的急性高脂血症性胰腺炎患者85例,按照随机数字表法分为研究组和对照组,对照组(42例)使用血浆置换治疗,研究组(43例)则采用去脂血浆净化血液灌流治疗,比较两组临床疗效。结果:研究组治疗总有效率、高密度脂蛋白胆固醇(HDL-C)、转化生长因子-β(TGF-β)水平和平均动脉压(MAP)均高于对照组,三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、淀粉酶(AMS)、降钙素原(PCT)、C反应蛋白(CRP)、白介素-6(IL-6)水平均低于对照组,腹痛消失时间早于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。结论:去脂血浆净化应用于血液灌流治疗急性高脂血症性胰腺炎效果显著,能够有效稳定患者血脂水平,同时改善其免疫功能。