血浆置换联合血液灌流早期强化降脂对高脂血症性急性胰腺炎的作用  

Efficacy of early intensive triglyceride lowering therapy with combination of plasma exchange and hemoperfusion in treatment of hyperlipidemic acute pancreatitis

作　　者：王玉康 苏俊 胡炜 WANG Yukang;SU Jun;HU Wei(Department of Intensive Care Unit,Affiliated Hangzhou First People’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属杭州市第一人民医院重症医学科

出　　处：《浙江医学》2019年第16期1731-1735,共5页Zhejiang Medical Journal

基　　金：杭州市科技局科研项目（20160533B16）

摘　　要：目的探讨血浆置换(PE)联合血液灌流(HP)早期强化降脂在治疗高脂血症性急性胰腺炎(HLAP)中的作用。方法将60例HLAP患者按随机数字表法分为对照组和强化组,各30例。常规治疗基础上,对照组每日行1次PE;强化组在PE治疗结束后即复查血甘油三酯(TG)>5.65mmol/L时,则增加1次HP;两组治疗终点均为TG<5.65mmol/L。观察并比较两组患者入ICU治疗前及治疗24h、48h和7d后血TG、淀粉酶、超敏C反应蛋白(hs-CRP)、疾病严重程度及预后情况。结果治疗24h和48h后两组患者血TG水平均较治疗前均明显下降(均P<0.05),且强化组下降幅度显著高于对照组(均P<0.05)。治疗7d后两组患者的血淀粉酶水平较治疗前均明显下降(均P<0.05),但两组间相比差异无统计学意义(P>0.05)。治疗48h和7d后强化组患者的hs-CRP水平均明显低于对照组(均P<0.05)。治疗48h后强化组APACHEⅡ和Balthazar CT评分明显低于对照组(均P<0.05),但治疗7d后无统计学差异(P>0.05)。强化组患者住ICU时间和总住院时间明显低于对照组(均P<0.05)。两组患者进展为重症急性胰腺炎的比例及病死率比较均无统计学差异(均P>0.05)。结论PE联合HP早期强化降脂可减轻HLAP患者的炎症指标、降低住ICU时间及总住院时间,但对病死率无显著影响。Objective To investigate the clinical efficacy of combination of plasma exchange(PE)and hemoperfusion(HP)in treatment of hyperlipidemic acute pancreatitis(HLAP).Methods Sixty patients diagnosed with HLAP were randomized to control group(n=30)and study group(n=30).In addition to conventional treatment,control group received PE once per day,study group received PE and HP,if instant triglyceride(TG)>5.65mmol/L after PE.Serum TG,amylase,high-sensitivity C-reactive protein(hs-CRP),disease severity and prognosis were analyzed before and 24h,48h,7d after treatment.Results After treatment for 24h and 48h,serum TG level decreased significantly in both groups compared to baseline levels(P<0.05,respectively),while serumTG level of study group decreased more markedly than that of control group(P<0.05).After treatment for 7d,serum amylase level decreased significantly in both group compare with baseline levels(P<0.05,respectively),there was no significance difference between the two groups(P>0.05).After treatment for 48h and 7d,serumhs-CRP levels of study group were lower than those of control group,respectively(both P<0.05).After treatment for 48h,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)and Balthazar CT scores of study group were lower than those of control group(P<0.05,respectively).However,APACHEⅡand Balthazar CT showed no significance difference between the two group 7d after treatment(P>0.05).Compared with control group,study group showed shorter length of ICU stay and hospitalization time(P<0.05,respectively).Moreover,there was no difference in incidence of severe acute pancreatitis and mortality between the two groups(P>0.05).Conclusion Compared with using PE alone,early intensive TG lowering therapy with combination of PE and HP can reduce the inflammation status,shorten length of ICU and hospital stay for HLAP patients,but may have no mortality benefit.

关 键 词：高脂血症性急性胰腺炎 甘油三酯 血浆置换 血液灌流 降脂治疗 

分 类 号：R47[医药卫生—护理学]