连续性血液净化治疗重症急性胰腺炎合并多器官功能障碍综合征的效果观察  

Effect of continuous blood purification in treatment of patients with severe acute pancreatitis and multiple organ dysfunction syndrome

作　　者：张勇[1] 曾维政[1] 王云侠[1] 翁敏[1] 郑淑梅[1] 蒋明德[1] 

机构地区：[1]成都军区总医院消化内科,成都610083

出　　处：《临床肝胆病杂志》2016年第2期320-323,共4页Journal of Clinical Hepatology

摘　　要：目的观察连续性血液净化(CBP)对重症急性胰腺炎(SAP)合并多器官功能障碍综合征(MODS)患者血清炎症介质的影响。方法选取2008年4月-2013年12月成都军区总医院收治的SAP合并MODS患者65例,采用非随机同期对照试验方法按治疗方式不同分为两组,其中对照组(n=33)接受内科综合治疗,治疗组(n=32)在内科综合治疗基础上给予CBP治疗。监测患者CBP治疗前后APACHEⅡ评分、MODS评分以及血清肿瘤坏死因子(TNF)α、C-反应蛋白(CRP)、血小板衍化生长因子(PAF)、白细胞介素(IL)6、IL-18、一氧化氮(NO)水平变化。计量资料组间比较采用成组t检验,同组治疗前后比较采用配对t检验;计数资料组间比较采用χ2检验。结果两组患者治疗后,APACHEⅡ、MODS评分及血清TNFα、CRP、IL-6、IL-18、PAF、NO水平均较治疗前明显降低,差异均有统计学意义(P值均<0.05),且治疗组较对照组降低更为明显(P值均<0.001);治疗组患者存活率为90.6%(29/32),对照组患者存活率为78.8%(26/33),两组存活率比较差异无统计学意义(χ2=1.749,P=0.186)。结论 CBP能够有效清除SAP合并MODS患者血清中的炎症介质,从而阻断炎症反应,改善脏器功能,是治疗SAP的有效方法之一。Objective To observe the effect of continuous blood purification （CBP） on serum inflammatory mediators in patients with severe acute pancreatitis （SAP） and multiple organ dysfunction syndrome （MODS）. Methods Sixty - five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment, and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score, MODS score, and the serum levels of tumor necrosis factor α （TNFα） , C - reactive protein （CRP） , interleukin 6 （ IL - 6） , IL - 18, platelet - activating factor （ PAF）, and nitric ox- ide （NO） after treatment were observed. Independent - samples t test was applied for comparison of continuous data between the two groups, and paired t test was applied for before - after comparison within the same group ; chi - squared test was applied for comparison of categorical data between the two groups. Results In both groups, APACHE II score, MODS score, and the serum levels of TNFα, CRP, IL -6, IL - 18, PAF, and NO decreased significantly after treatment （ all P 〈 0.05 ） , and the treatment group had significantly greater decreases in these values than the control group （all P 〈 0. O01 ） ; the survival rates in the treatment group and the control group were 90.6% （29/32） and 78.8% （26/33）, respectively, with no significant difference between the two groups （X2 = 1. 749, P = 0. 186）. Conclusion In SAP patients with MODS, CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function, and, therefore, it is an effective method to treat SAP.

关 键 词：胰腺炎 多器官功能衰竭 血液滤过 治疗结果 

分 类 号：R576[医药卫生—消化系统] R459.7[医药卫生—内科学]