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 hyp...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.展开更多
Objective:To excavate the medical pattern of hyperlipidemic acute pancreatitis based on Chinese Medicine Inheritance Assistant Platform software,hope to offer ideas for the treatment of the disease.Methods:Inpatient c...Objective:To excavate the medical pattern of hyperlipidemic acute pancreatitis based on Chinese Medicine Inheritance Assistant Platform software,hope to offer ideas for the treatment of the disease.Methods:Inpatient cases admitted to the Department of Gastroenterology of Shenzhen Hospital of Traditional Chinese Medicine for HLAP from September 2013 to June 2020 were collected,information on evidence patterns and formulations was extracted,an Excel database was established and professional terms were standardized,and data mining methods such as association rules and entropy clustering of complex systems were used to analyze medical patterns.Results:The main symbols of HLAP include abdominal pain,abdominal distinction,vomiting,fever,etc.The common used drags include Immature Orange Fruit,Baical Skullcap Root,Rhubarb and Chinese Thorowax Root,etc.The main drug pairs based on association rule analysis are"Baical Skullcap Root,Immature Orange Fruit","Rhubarb,Immature Orange Fruit","Baical Skullcap Root,Rhubarb,Immature Orange Fruit",etc,and 14 drug core combinations and 7 new formulations were extracted.Conclusion:The main synthesis of HLAP are solid-heat knots in the internal organs and dam-heat in the liver and gallbladder,and the formula is based on Da-chai-hu Decoction,the clinical treatment is based on attacking stagnation,activating blood circulation and removing dampness,which can offer reference for the clinical treatment of the disease.展开更多
With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcoho...With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol.There are many available therapies for HLAP,including oral lipid-lowering agents,intravenous insulin,heparin,and therapeutic plasmapheresis(TPE).It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides(TG),thus a rapid decrease in serum TG level is the key to the successful management of HLAP.TPE has emerged as an effective modality in rapidly reducing serum TG levels.However,due to its cost and accessibility,TPE remains poorly evaluated until now.Some studies revealed its efficacy in helping to treat and prevent the recurrence,while some studies suggested that TG levels were not correlated with disease severity,mortality,or length of hospital stay.Thus TPE might have no beneficial effect for the outcome.This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors,adverse effects of the procedure,and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis.Future direction of TPE research for HLAP is also discussed in this review.展开更多
背景 高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)需要早期识别其潜在的致命性并发症,研究已表明急性胰腺炎严重程度床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分与这些并发症相关.目的 ...背景 高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)需要早期识别其潜在的致命性并发症,研究已表明急性胰腺炎严重程度床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分与这些并发症相关.目的 通过Meta分析评估BISAP评分对HLAP严重性的预测价值.方法 检索国内外主要数据库,收集BISAP评分预测HLAP严重性的研究,用Stata及Meta-disc软件行Meta分析.结果 本Meta纳入10篇文章(n=1591).BISAP评分≥3分预测HLAP发生死亡的总敏感性、特异性、曲线下面积(area under curve,AUC)、诊断比值比(diagnostic odds ratio,DOR)分别为0.85(95%CI:0.65-0.96)、0.86(95%CI:0.82-0.88)、0.937、42.00(95%CI:12.86-139.12).BISAP评分升高预测HLAP发生重症急性胰腺炎(severe acute pancreatitis,SAP)的总敏感性、特异性、AUC、DOR分别为0.69(95%CI:0.61-0.76)、0.82(95%CI:0.78-0.85)、0.900、18.47(95%CI:6.82-42.03);预测中重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)+SAP的总敏感性、特异性、AUC、DOR分别为0.54(95%CI:0.50-0.63)、0.91(95%CI:0.89-0.93)、0.724、15.55(95%CI:6.91-34.99).BISAP评分与急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、Ranson评分相比,结合自身优点,预测HLAP严重性更具优势.结论 BISAP评分是预测HLAP严重性的有利工具,但预测SAP、MSAP+SAP的敏感性偏低.展开更多
目的通过系统分析方法评价双重滤过血浆置换(DFPP)治疗高脂血症性急性胰腺炎(HLAP)的临床疗效。方法通过计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMbase数据库、Cochrane图书馆数据库、科学网(Web of Science)、万方数...目的通过系统分析方法评价双重滤过血浆置换(DFPP)治疗高脂血症性急性胰腺炎(HLAP)的临床疗效。方法通过计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMbase数据库、Cochrane图书馆数据库、科学网(Web of Science)、万方数据、维普中文科技期刊全文数据库(VIP)和中国知网(CNKI)等中英文数据库中由建库至2022年9月发表的有关DFPP治疗HLAP的临床对照试验(CCT)或随机对照试验(RCT)。对照组给予药物治疗,DFPP组在药物治疗基础上加用DFPP;主要结局指标为:住院时间、重症监护病房(ICU)住院时间、总体病死率;次要结局指标为:三酰甘油(TG)、血淀粉酶、C-反应蛋白(CRP)。由2名研究者收集数据,依据Cochrane 5.1手册评价文献质量,采用RevMan 5.3软件进行Meta分析;Meta分析结果的稳定性用敏感性分析方法检验,用漏斗图分析文章的发表偏倚。结果最终纳入16篇中英文文献,共涉及835例患者,其中DFPP组450例,对照组385例。Meta分析结果显示,与对照组相比,DFPP组住院时间缩短〔均数差(MD)=-5.28,95%可信区间(95%CI)为-7.14~-3.15,P<0.00001〕、ICU住院时间缩短(MD=-3.90,95%CI为-5.71~-2.05,P<0.0001),TG(MD=-10.75,95%CI为-15.23~-6.27,P<0.00001)、血淀粉酶(MD=-219.01,95%CI为-320.05~-117.96,P<0.0001)、CRP(MD=-34.84,95%CI为-59.11~-10.57,P=0.005)均显著降低。但两组总体病死率比较差异无统计学意义〔相对危险度(RR)=0.77,95%CI为0.20~3.03,P=0.71〕。对纳入文献数量超过10篇的TG进行漏斗图分析,结果显示,本研究文献可能存在一定发表偏倚。结论在使用药物治疗的基础上应用DFPP能提高HLAP治疗的临床效果,改善预后。展开更多
基金Supported by Natural Science Foundation of Heilongjiang Province,China
文摘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.
基金Huang Bin Guangdong Famous Chinese Medicine Studio(Guangdong Chinese Medicine Office Letter[2020]No.1)。
文摘Objective:To excavate the medical pattern of hyperlipidemic acute pancreatitis based on Chinese Medicine Inheritance Assistant Platform software,hope to offer ideas for the treatment of the disease.Methods:Inpatient cases admitted to the Department of Gastroenterology of Shenzhen Hospital of Traditional Chinese Medicine for HLAP from September 2013 to June 2020 were collected,information on evidence patterns and formulations was extracted,an Excel database was established and professional terms were standardized,and data mining methods such as association rules and entropy clustering of complex systems were used to analyze medical patterns.Results:The main symbols of HLAP include abdominal pain,abdominal distinction,vomiting,fever,etc.The common used drags include Immature Orange Fruit,Baical Skullcap Root,Rhubarb and Chinese Thorowax Root,etc.The main drug pairs based on association rule analysis are"Baical Skullcap Root,Immature Orange Fruit","Rhubarb,Immature Orange Fruit","Baical Skullcap Root,Rhubarb,Immature Orange Fruit",etc,and 14 drug core combinations and 7 new formulations were extracted.Conclusion:The main synthesis of HLAP are solid-heat knots in the internal organs and dam-heat in the liver and gallbladder,and the formula is based on Da-chai-hu Decoction,the clinical treatment is based on attacking stagnation,activating blood circulation and removing dampness,which can offer reference for the clinical treatment of the disease.
文摘With changes in lifestyle and diet worldwide,the prevalence of hyperlipidemic acute pancreatitis(HLAP)has greatly increased,and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol.There are many available therapies for HLAP,including oral lipid-lowering agents,intravenous insulin,heparin,and therapeutic plasmapheresis(TPE).It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides(TG),thus a rapid decrease in serum TG level is the key to the successful management of HLAP.TPE has emerged as an effective modality in rapidly reducing serum TG levels.However,due to its cost and accessibility,TPE remains poorly evaluated until now.Some studies revealed its efficacy in helping to treat and prevent the recurrence,while some studies suggested that TG levels were not correlated with disease severity,mortality,or length of hospital stay.Thus TPE might have no beneficial effect for the outcome.This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors,adverse effects of the procedure,and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis.Future direction of TPE research for HLAP is also discussed in this review.
文摘背景 高脂血症性急性胰腺炎(hyperlipidemic acute pancreatitis,HLAP)需要早期识别其潜在的致命性并发症,研究已表明急性胰腺炎严重程度床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分与这些并发症相关.目的 通过Meta分析评估BISAP评分对HLAP严重性的预测价值.方法 检索国内外主要数据库,收集BISAP评分预测HLAP严重性的研究,用Stata及Meta-disc软件行Meta分析.结果 本Meta纳入10篇文章(n=1591).BISAP评分≥3分预测HLAP发生死亡的总敏感性、特异性、曲线下面积(area under curve,AUC)、诊断比值比(diagnostic odds ratio,DOR)分别为0.85(95%CI:0.65-0.96)、0.86(95%CI:0.82-0.88)、0.937、42.00(95%CI:12.86-139.12).BISAP评分升高预测HLAP发生重症急性胰腺炎(severe acute pancreatitis,SAP)的总敏感性、特异性、AUC、DOR分别为0.69(95%CI:0.61-0.76)、0.82(95%CI:0.78-0.85)、0.900、18.47(95%CI:6.82-42.03);预测中重症急性胰腺炎(moderately severe acute pancreatitis,MSAP)+SAP的总敏感性、特异性、AUC、DOR分别为0.54(95%CI:0.50-0.63)、0.91(95%CI:0.89-0.93)、0.724、15.55(95%CI:6.91-34.99).BISAP评分与急性生理与慢性健康评分(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、Ranson评分相比,结合自身优点,预测HLAP严重性更具优势.结论 BISAP评分是预测HLAP严重性的有利工具,但预测SAP、MSAP+SAP的敏感性偏低.
文摘目的通过系统分析方法评价双重滤过血浆置换(DFPP)治疗高脂血症性急性胰腺炎(HLAP)的临床疗效。方法通过计算机检索美国国立医学图书馆PubMed数据库、荷兰医学文摘EMbase数据库、Cochrane图书馆数据库、科学网(Web of Science)、万方数据、维普中文科技期刊全文数据库(VIP)和中国知网(CNKI)等中英文数据库中由建库至2022年9月发表的有关DFPP治疗HLAP的临床对照试验(CCT)或随机对照试验(RCT)。对照组给予药物治疗,DFPP组在药物治疗基础上加用DFPP;主要结局指标为:住院时间、重症监护病房(ICU)住院时间、总体病死率;次要结局指标为:三酰甘油(TG)、血淀粉酶、C-反应蛋白(CRP)。由2名研究者收集数据,依据Cochrane 5.1手册评价文献质量,采用RevMan 5.3软件进行Meta分析;Meta分析结果的稳定性用敏感性分析方法检验,用漏斗图分析文章的发表偏倚。结果最终纳入16篇中英文文献,共涉及835例患者,其中DFPP组450例,对照组385例。Meta分析结果显示,与对照组相比,DFPP组住院时间缩短〔均数差(MD)=-5.28,95%可信区间(95%CI)为-7.14~-3.15,P<0.00001〕、ICU住院时间缩短(MD=-3.90,95%CI为-5.71~-2.05,P<0.0001),TG(MD=-10.75,95%CI为-15.23~-6.27,P<0.00001)、血淀粉酶(MD=-219.01,95%CI为-320.05~-117.96,P<0.0001)、CRP(MD=-34.84,95%CI为-59.11~-10.57,P=0.005)均显著降低。但两组总体病死率比较差异无统计学意义〔相对危险度(RR)=0.77,95%CI为0.20~3.03,P=0.71〕。对纳入文献数量超过10篇的TG进行漏斗图分析,结果显示,本研究文献可能存在一定发表偏倚。结论在使用药物治疗的基础上应用DFPP能提高HLAP治疗的临床效果,改善预后。
