血浆置换联合胰岛素强化降糖对高脂血症性胰腺炎患者相关指标的影响  

Effects of Plasma Exchange Combined with Intensive Insulin Glycemic Control on Related Indexes of Patients with Hyperlipidemic Pancreatitis

作　　者：田文彬 金康[2] 曹瑞旗[1] 李雪卿[1] 楚若鹏 TIAN Wenbin JIN Kang CAO Ruiqi LI Xueqing CHU Ruopeng(ICU of Anaesthesia, the Second Hospital of Hebei Medical University, Shijiazhuang 050001, China Dept. Two of Endocrinology, Shijiazhuang Mu- nicipal First Hospital, Shijiazhuang 050001, China)

机构地区：[1]河北医科大学第二医院麻醉ICU,石家庄050001 [2]石家庄市第一医院内分泌二科,石家庄050001

出　　处：《中国药房》2017年第30期4202-4205,共4页China Pharmacy

基　　金：河北省科技计划项目(No.152777133)

摘　　要：目的:探讨血浆置换联合胰岛素强化降糖对高脂血症性胰腺炎患者相关指标的影响。方法:120例高脂血症性胰腺炎患者随机分为对照组(60例)和观察组(60例)。两组患者在常规治疗的基础上,于入住重症监护病房(ICU)72 h内连续进行3次血浆置换+皮下注射注射用低分子肝素钙5 000单位+静脉推注注射用甲泼尼龙琥珀酸钠40 mg和葡萄糖酸钙注射液2 g。在此基础上,对照组患者随机血糖浓度≥12 mmol/L时,给予胰岛素注射液,微量泵泵入至随机血糖<12 mmol/L;观察组患者随机血糖浓度>8.3 mmol/L时,给予胰岛素注射液,微量泵持续静脉输注1周,维持随机血糖浓度在6.1~8.3 mmol/L。观察两组患者治疗前后血浆三酰甘油、淀粉酶、降钙素原水平和白细胞计数、全身评分系统研究评分(APACHEⅡ)、局部评分系统研究(Balthazar CT)评分、ICU住院时间及不良反应发生情况。结果:治疗后,两组患者血浆三酰甘油、淀粉酶、降钙素原水平和白细胞计数、APACHEⅡ评分、Balthazar CT评分均显著低于同组治疗前,且观察组显著低于对照组,差异均有统计学意义(P<0.05)。观察组患者ICU住院时间显著短于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论:血浆置换联合胰岛素强化降糖能有效降低高脂血症性胰腺炎患者血浆三酰甘油水平,缓解炎症反应,改善预后,且未增加不良反应的发生。OBJECTIVE：To investigate the effects of plasma exchange（PE）combined with intensive insulin glycemic control on related indexes of patients with HLP. METHODS：A total of 120 HLP patients were randomly divided into control group（60 cases）and observation group（60 cases）. Based on routine treatment,2 groups were given PE treatment for 3 times＋Low molecular weight heparin calcium for injection 5 000 U subcutaneously＋Methylprednisolone sodium succinate for injection 40 mg intravenously ＋ Calcium gluconate injection 2 g intravenously. Based on it,Insulin injection was pumped to random blood glucose 12 mmol/L with a micro-infusion pump in control group when random blood glucose concentration was equal to or more than 12 mmol/L. When random blood glucose of patients in observation group were higher than 8.3 mmol/L,Insulin injection was pumped with a micro-infusion pump for a week and random blood glucose concentration was maintained at 6.1-8.3 mmol/L. Plasma levels of triglyceride,PCT,WBC count,APACHEⅡ score,Balthazar CT score,length of hospitalization stay in ICU and the occurrence of ADR were observed in 2 groups before and after treatment. RESULTS：After treatment,plasma levels of triglyceride,amylase and PCT,WBC count,APACHEⅡ score and Balthazar CT score in 2 groups were significantly lower than before treatment,and the observation group was significantly lower than the control group,with statistical significance（P〈0.05）. Length of hospitalization stay in ICU observation group was significantly shorter than control group,with statistical significance（P〈0.05）. There was no statistical significance in the incidence of ADR between 2 groups（P〉0.05）. CONCLUSIONS：PE combined with intensive insulin gly-cemic control can effectively reduce the level of plasma triglyceride,relieve inflammatory reaction and improve prognosis without increasing the occurrence of ADR.

关 键 词：高脂血症性胰腺炎 血浆置换 胰岛素 强化降糖 三酰甘油 炎症反应 预后 

分 类 号：R589[医药卫生—内分泌]