日间连续性血液净化联合血浆置换治疗非胆源性重症急性胰腺炎的疗效分析  

Therapeutic effect of daytime continuous blood purification combined with plasma exchange on non-biliary severe acute pancreatitis

作　　者：黎晓磊[1] 孔耀中[1] 肖观清[1] 李导 申伟[1] 陈德臻 黄雪芳[1] 李燕[1] Li Xiaolei;Kong Yaozhong;Xiao Guanqing;Li Dao;Shen Wei;Chen Dezhen;Huang Xuefang;Li Yan(Department of Nephrology,the First People's Foshan Hospital. Guangdong Foshan 528000,China)

机构地区：[1]广东佛山市第一人民医院肾内科,佛山528000

出　　处：《中华肾脏病杂志》2019年第9期670-675,共6页Chinese Journal of Nephrology

摘　　要：目的探讨日间连续性血液净化(DCRRT)联合血浆置换治疗重症急性胰腺炎的临床疗效。方法前瞻性分析2012年1月至2019年1月佛山市第一人民医院收治的非胆源性重症急性胰腺炎患者49例临床资料,用随机数字表法将入选者随机分为DCRRT联合血浆置换(联合治疗)组和单用DCRRT(单用)组。所有患者在诊断明确后立即行DCRRT,每次治疗8 h。联合治疗组在治疗过程中接受过至少1次血浆置换。比较两组患者治疗前后实验室检查和预后的差异。结果共入选49例患者,男29例,女20例,年龄(46.40±17.81)岁,其中联合治疗组24例,单用组25例。两组患者在年龄、性别、体重指数(BMI)、治疗前实验室检查结果等项目上的差异无统计学意义。两组患者治疗后血白细胞、超敏C反应蛋白(hs-CRP)、降钙素原(PCT-u)、淀粉酶、脂肪酶、三酰甘油、胆固醇、血肌酐等指标较治疗前显著降低(均P<0.05);治疗后联合治疗组的血hs-CPR、PCT-u、脂肪酶、三酰甘油等显著低于单用组(均P<0.05)。两组患者治疗后的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)均较治疗前显低,且联合治疗组较单用组下降更明显(均P<0.05)。联合治疗组死亡5例(20.83%),单用组死亡7例(28.00%),两组死亡率的差异无统计学意义。两组自发病至开始DCRRT时间和DCRRT持续时间上的差异无统计学意义。结论应用DCRRT或联合血浆置换治疗可有效治疗非胆源性重症急性胰腺炎,DCRRT联合血浆置换治疗能更有效地清除炎性反应因子及降低APACHE II评分。Objective To investigate the clinical efficacy of daytime continuous blood purification (DCRRT) combined with plasma exchange in the treatment of severe acute pancreatitis. Methods The clinical data of 49 patients with non-biliary severe acute pancreatitis admitted to the First People's Foshan Hospital from January 2012 to January 2019 were analysed respectively. The enrollees were randomized into DCRRT combined with plasma exchange (combination therapy) group and DCRR only (DCRR) group using a random number table method. All patients received DCRRT therapy [8 hours continuous venous-venous blood purification/day (CVVH/d)] immediately after the diagnosis of non-biliary severe acute pancreatitis was established. The combination group received at least one plasma exchange during the course of treatment. The differences of laboratory examination and prognosis between the two groups before and after treatment were compared. Results A total of49 patients were enrolled, including 29 males and 20 females, with age of (46.40±17.81) years. There were 24 patients in the combination therapy group and 25 patients in DCRR group. There were no significant differences in the age, gender, body mass index (BMI), and pre-treatment laboratory findings between the two groups. After treatment, the blood glucose, hypersensitive C-reactive protein (hs-CRP), procalcitonin (PCT-u), amylase, lipase, triglyceride, cholesterol, serum creatinine were lower than those before treatment (all P<0.05). The blood hs-CPR, PCT-u, lipase and triglyceride in the combination therapy group were significantly lower than those in the DCRR group (all P<0.05). The acute physiology and chronic health scores (APACHEⅡ) of the two groups were lower than those before treatment, and the combination therapy group was more significant than DCRR group (all P<0.05). There were 5 deaths (20.83%) in the combination therapy group and 7 deaths (28.00%) in DCRR group. There was no significant difference in mortality between the two groups. There was no significant diff

关 键 词：肾透析 血浆置换 胰腺炎 急性坏死性 

分 类 号：R576[医药卫生—消化系统]