不同血液净化对重症急性胰腺炎全身炎症综合征的临床疗效评价  

Effect of different blood purification on severe acute pancreatitis complicated with systemic inflammatory response syndrome

作　　者：胥清蓉[1] 陈晓梅[1] 石宝春[1] 曾颖[1] 

机构地区：[1]成都医学院第一附属医院门诊部,四川成都610500

出　　处：《西部医学》2018年第2期238-241,共4页Medical Journal of West China

基　　金：四川省教育厅科研课题(12ZB208)

摘　　要：目的评价血液灌流(hemoperfusion,HP)与持续性血液净化(Continuous Blood Purification)治疗对急性重症胰腺炎(severe acute pancreatitis,SAP)全身炎症反应综合征(SIRS)的临床疗效。方法 66例SAP伴全身炎症反应综合征的患者随机分为3组:治疗组1(20例),治疗组2(20例)和对照组(26例),对照组采取常规治疗,治疗组1在采用常规治疗的基础上进行血液灌流;治疗组2血液灌流联合持续性血液净化治疗。在治疗前和治疗后12、24、48h,对患者进行C反应蛋白、血清中白细胞介素6(Interleukin-6,IL-6)、白细胞介素8(IL-8),同时进行MODS及APACHEⅡ评分。结果治疗后12和24、48h患者C反应蛋白、IL-6,IL-8水平均明显低于治疗前(P<0.05),多器官功能障碍综合征(MODS)与APACHEⅡ评分降低(P<0.05)。治疗组1与治疗组2总存活率明显高于对照组(P<0.05)。结论持续性血液净化联合血液灌流治疗较单纯血液灌流和常规治疗对急性重症胰腺炎伴全身炎症反应综合征炎性介质清除有明显的效果,能有效纠正内环境紊乱及脏器功能衰竭,降低病死率。Objective To evaluate the effect of hemoperfusion or continuous blood purification on severe acute pan- creatitis complicated with systemic inflammatory response syndrome. Methods 40 patients with SAP were randomly divided into treatment group 1 and treatment group 2（n=20）and control group （n= 26）. The control group was received routine treatment. Group 1 was received hemoperfusion treatment. Group 2 were received hemoperfusion and continuous blood purification. C-reactive protein, IL-6, IL-8 were detected with before hemoperfusion or continuous blood purification on 12, 24, 48 hours after treatment. At the same time, APACHE Ⅱ score and MODS were assessed. Results In the treatment group, C-reactive protein, IL-6, IL-8, APACHE Ⅱ score and MODS were significantly lower than that in the control group on 12, 24 and 48 hours after therapy （P〈0.05）. The survival rate was significantly higher in the treatment group than in the control group （82.5% VS 57. 69%, P〈0.05）. Conclusion Continuous blood purification can effectively reduce the inflammatory mediators of patients with SAP complicated with systemic inflammatory response syndrome. It can obviously improved internal environment disturbances and viscera function failure.

关 键 词：重症急性胰腺炎 全身炎症反应综合征 血液灌流 持续性血液净化 

分 类 号：R576[医药卫生—消化系统]