CVVH联合HP治疗重症急性胰腺炎并发多器官功能障碍综合征的临床效果  

Clinical Effect of CVVH Combined with HP in the Treatment of Severe Acute Pancreatitis Complicated with Multiple Organ Dysfunction Syndrome

作　　者：王丽晖 吴广礼 黄旭东[1] 杨新军 赵维[1] 陈云爽 张超[1] WANG Li-hui;WU Guang-li;HUANG Xu-dong;YANG Xin-jun;ZHAO Wei;CHEN Yun-shuang;ZHANG Chao(Department of Nephrology,the 980th Hospital of PLA Joint Logistics Support Forces,Shijiazhuang 050082,China)

机构地区：[1]中国人民解放军联勤保障部队第九八〇(白求恩国际和平)医院肾脏病科,石家庄050082

出　　处：《解放军医药杂志》2020年第9期53-57,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：河北省自然基金资助项目(H2016206578)。

摘　　要：目的探讨连续性静脉-静脉血液滤过(CVVH)联合血液灌流(HP)治疗重症急性胰腺炎(SAP)并发多器官功能障碍综合征(MODS)的临床效果。方法选择2010年1月—2019年12月收治的63例SAP并发MODS患者。根据治疗方法不同分为A组20例、B组22例、C组21例。A组给予常规内科综合治疗,B组在A组基础上行CVVH治疗,C组在A组基础上行CVVH联合HP治疗。比较3组的临床疗效,以及治疗前和治疗后5 d的急性生理及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、IL-1β、超敏C反应蛋白(hs-CPR)、尿素氮(BUN)、肌酐(Scr)、胆固醇(TC)、甘油三酯(TG)、淀粉酶(AMS)水平。结果B组和C组的临床总有效率明显高于A组(P<0.05)。C组临床总有效率与B组比较差异无统计学意义(P>0.05)。治疗后,B组和C组BUN、Scr、TC、TG、AMS、TNF-α、IL-6、IL-1β、hs-CRP及APACHEⅡ评分较治疗前和A组明显下降,且C组上述各指标下降较B组更明显(P<0.05)。结论与单用CVVH比较,CVVH联合HP可通过有效清除炎性介质,抑制SAP时过激的炎症反应,降低血脂及毒性物质,是治疗SAP并发MODS的有效方法。Objective To investigate the clinical effect of continuous veno-venous hemofiltration(CVVH)combined with hemoperfusion(HP)in the treatment of severe acute pancreatitis(SAP)complicated with multiple organ dysfunction syndrome(MODS).Methods Sixty-three patients with SAP complicated with MODS admitted from January 2010 to December 2019 were selected.According to different treatment methods,they were divided into group A(n=20)group B(n=22)and group C(n=21).Group A was given conventional medical comprehensive treatment.On the basis of group A,group B received CVVH treatment,and group C received CVVH combined with HP treatment.The clinical efficacy of the three groups was compared,and the acute physiology and chronic health evaluation systemⅡ(APACHEⅡ)score,tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)and IL-1β,hypersensitive C-reactive protein(hs-CPR),blood urea nitrogen(BUN),serum creatinine(Scr),cholesterol(TC),triglyceride(TG)and amylase(AMS)level before treatment and at 5 d after treatment were compared.Results The total clinical effective rate of group B and group C was significantly higher than that of group A(P<0.05).There was no significant difference in the total clinical effective rate between group C and group B(P>0.05).After treatment,BUN,Scr,TC,TG,AMS,TNF-α,IL-6,IL-1β,hs-CRP and APACHEⅡscore in group B and group C were significantly lower than those before treatment and those in group A,and the above-mentioned indexes of group C were decreased more than those of group B(P<0.05).Conclusion Compared with CVVH alone,CVVH combined with HP can effectively eliminate inflammatory mediators,inhibit the excessive inflammatory response during SAP,reduce blood lipids and toxic substances,and is an effective method for treating SAP with MODS.

关 键 词：血液灌流 连续性静脉-静脉血液滤过 胰腺炎 多器官功能障碍综合征 淀粉酶 白介素-6 

分 类 号：R576[医药卫生—消化系统]