连续性血浆滤过吸附治疗妊娠期急性胰腺炎的病例系列报道  

Continuous plasma filtration adsorption for treatment of acute pancreatitis in pregnancy: analysis of 18 cases

作　　者：邓雨峰[1] 陈翔 何月 张海燕[1] 黄金园 DENG Yufeng;CHEN Xiang;HE Yue;ZHANG Haiyan;HUANG Jinyuan(Department of Women's Healthcare,Chongqing Maternal and Child Health Hospital,Chongqing,400021;Department of Hepatobiliary Surgery,Chongqing Emergency Center,Chongqing,400001;Department of Critical Care Medicine,First Affiliated Hospital,Army Medical University (Third Military Medical University),Chongqing,400038,China)

机构地区：[1]重庆市妇幼保健院妇女保健科,重庆400021 [2]重庆市急救中心肝胆外科,重庆400001 [3]陆军军医大学(第三军医大学)第一附属医院重症医学科,重庆400038

出　　处：《第三军医大学学报》2019年第14期1381-1386,共6页Journal of Third Military Medical University

摘　　要：目的描述性分析连续性血浆滤过吸附(continuous plasma filtration adsorption, CPFA)治疗妊娠期急性胰腺炎(acute pancreatitis in pregnancy, APIP)的效果。方法收集2010年1月至2016年11月重庆市妇幼保健院、重庆市急救中心和陆军军医大学第一附属医院3家医院收治的18例APIP患者的临床资料,记录、评价对治疗前后、血液吸附前后及血液滤过前后血浆中细胞因子水平、APACHEⅡ评分、血清淀粉酶活性以及患者预后、妊娠结局等指标。结果本组病例治疗后血浆中TNF-α、IL-1β、IL-6、IL-10水平明显下降,其余细胞因子水平无明显变化;吸附后血浆中TNF-α、IL-1β、IL-6水平明显下降;IL-10、IL-1ra、sTNFR-Ⅰ、sTNFR-Ⅱ水平无明显变化。治疗后患者sTNFR/TNF-α以及HLA-DR表达率均明显改善,APACHEⅡ评分由治疗前的(18.0±3.8)分降至(6.8±1.4)分,血清淀粉酶明显下降,治疗期间无不良反应。出院后随访半年,妊娠结局良好,均为足月分娩,无1例窒息或早产发生。结论妊娠期急性胰腺炎患者采用2次CPFA治疗可使患者充分获益,其妊娠结局良好。Objective To assess the efficacy and safety of continuous plasma filtration adsorption(CPFA) for management of acute pancreatitis in pregnancy(APIP). Methods We collected the clinical data from 18 patients with APIP treated in Chongqing Maternal and Child Health Hospital, Chongqing Emergency Center and the First Affiliated Hospital of Army Medical University between January, 2010 and November, 2016. The plasma levels of cytokines, APACHE II score and serum amylase activity before and after CPFA, and the pregnancy outcomes of the patients were analyzed. Results The plasma levels of TNF-α, IL-1β, IL-6 and IL-10 of the patients were obviously decreased after CPFA, and no obvious changes in other cytokines were found after CPFA. The levels of TNF-α, IL-1β, and IL-6 were obviously decreased while the levels of IL-10, IL-1 ra, sTNFR-I and sTNFR-Ⅱ showed no significant changes after absorption. Treatment with CPFA significantly improved the sTNFR/TNF-α ratio, increased the expression level of HLA-DR, decreased APACHE Ⅱ scores from 18.0±3.8 before treatment to 6.8±1.4, and lowered serum amylase levels. No adverse events occurred in these patients during the treatment. Follow-up for 6 months after discharge showed favorable pregnancy outcomes in all the patients, who had uneventful full-term delivery without fetal asphyxia or premature delivery. Conclusion The patients with APIP can benefit from 2 sessions of CPFA treatment, which does not adversely affect the pregnancy outcomes.

关 键 词：妊娠 急性胰腺炎 血液滤过 血液吸附 细胞因子 

分 类 号：R459.5[医药卫生—治疗学] R576.05[医药卫生—临床医学]