连续性肾脏替代治疗联合血浆置换对高脂血症性重症急性胰腺炎病人炎性因子水平和多器官功能的影响  

Effects of continuous renal replacement therapy combined with plasma exchange on inflammation and organ function in patients with severe hyperlipidemic acute pancreatitis

作　　者：邹军[1] 张毅[1] 王平[1] ZOU Jun;ZHANG Yi;WANG Ping(Department of ICU,Chengdu Fifth People’s Hospital,Chengdu,Sichuan 611130,China)

机构地区：[1]成都市第五人民医院重症医学科

出　　处：《安徽医药》2020年第1期95-98,共4页Anhui Medical and Pharmaceutical Journal

基　　金：四川省卫生和计划生育委员会科研重点课题（18PJ450)

摘　　要：目的探讨连续性肾脏替代治疗联合血浆置换对高脂血症性重症急性胰腺炎病人炎症和多器官功能的保护作用。方法回顾性收集2013年1月至2018年1月成都市第五人民医院收治的高脂血症性重症急性胰腺炎90例,根据病人早期采用的治疗方法,分为观察组41例和对照组49例,观察组给予连续性肾脏替代治疗联合血浆置换治疗,对照组仅给予连续性肾脏替代治疗,观察两组炎症水平、器官功能和预后。结果两组病人入院时C反应蛋白(CRP)和肿瘤坏死因子α(TNF⁃α)等比较差异无统计学意义(P>0.05)。24 h后与对照组比较,观察组CRP显著降低[(13.82±3.88)比(15.72±4.04)mg/L,P=0.026],TNF⁃α降低[(90.77±26.42)比(105.81±28.35)ng/L,P=0.011]。与照组比较,观察组持续肾脏替代治疗时间缩短[(6.72±2.28)比(8.73±1.98)d,P=0.000];新发脏器功能障碍发生率明显降低(51.22%比77.55%,P=0.009);住院时间缩短[(43.29±6.38)比(46.92±7.22)d,P=0.014]。两组病人腹腔感染、胰腺假性囊肿、胰腺无菌性坏死、死亡率等差异未见统计学意义(P>0.05)。两组病人入院时三酰甘油水平差异无统计学意义(P>0.05)。与对照组比较,24 h后观察组病人三酰甘油水平明显降低[(3.86±1.82)比(5.71±2.16)mmol/L,P=0.000]。结论连续性肾脏替代治疗联合血浆置换有助于降低高脂血症性重症急性胰腺炎病人炎症水平,保护器官功能,改善预后。Objective To investigate the protective effects of continuous renal replacement therapy combined with plasma exchange on inflammation and organ function in patients with severe hyperlipidemic acute pancreatitis.Methods From January 2013 to Jan⁃uary 2018,90 patients with hyperlipidemic severe acute pancreatitis admitted to Chengdu Fifth People’s Hospital were retrospec⁃tively collected.According to the early treatment methods,the patients were divided into observation group(41 cases)and control group(49 cases).The observation group was treated with continuous renal replacement therapy combined with plasma replacement therapy,while the control group was treated with continuous renal replacement therapy only.The inflammation levels,organ function and prognosis of the two groups were observed.Results There was no significant difference in the CRP and TNF⁃αbetween the two groups at admission(P>0.05).When compared with the control group,the CRP and TNF⁃αin the observation group decreased sig⁃nificantly[(13.82±3.88 vs.15.72±4.04 mg/L,P=0.026)and(90.77±26.42 vs.105.81±28.35 ng/L,P=0.011)].When compared with the control group,the duration of continuous renal replacement therapy in the observation group was shortened(6.72±2.28 vs.8.73±1.98 d,P=0.000);the incidence of new organ dysfunction was significantly reduced(51.22%vs.77.55%,P=0.009);and the length of hospitalization was shortened(43.29±6.38 vs.46.92±7.22 d,P=0.014).There were no significant differences in ab⁃dominal infection,pancreatic pseudocyst,pancreatic aseptic necrosis and mortality between the two groups(P>0.05).There was no significant difference in triglyceride level between the two groups on admission(P>0.05).When compared with the control group,the level of triglyceride in the observation group decreased significantly after 24 hours(3.86±1.82 vs.5.71±2.16 mmol/L,P=0.000).Conclusion Continuous renal replacement therapy combined with plasma exchange is helpful to reduce inflammation level,pro⁃tect organ function and improve progno

关 键 词：胰腺炎 肾替代治疗 血液透析滤过 血浆置换 高脂血症 肿瘤坏死因子α C反应蛋白质 炎症 器官功能 

分 类 号：R47[医药卫生—护理学]