基于APACHE Ⅱ评分探讨血液灌流联合低分子肝素治疗高脂血症性急性胰腺炎的临床疗效及对机体炎症反应的影响  

Clinical efficacy of hemoperfusion combined with low molecular weight heparin for HLAP based on APACHE Ⅱ score and its impact on inflammatory response

作　　者：蔡华忠[1] 李利毛 周峰[1] 苗振军[1] 魏法星[1] 贾珏[1] 徐美玲 CAI Huazhong;LI Limao;ZHOU Feng;MIAO Zhenjun;WEI Faxing;JIA Jue;XU Meiling(Department of Emergency Medicine,Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu,212001,China;School of Medicine,Jiangsu University;Department of General Zhenjiang Jingkou JianKang Road Community Health Service Center)

机构地区：[1]江苏大学附属医院急诊科,江苏镇江212001 [2]江苏大学医学院 [3]江市京口区健康路社区卫生服务中心全科

出　　处：《临床急诊杂志》2021年第5期305-308,共4页Journal of Clinical Emergency

基　　金：国家自然科学基金项目(No:81500351);镇江市重点研发计划-社会发展项目(No:SH2020067)。

摘　　要：目的:探讨血液灌流联合低分子肝素治疗高脂血症性急性胰腺炎(HLAP)的临床疗效以及对机体炎症反应的影响。方法:本研究为一项单中心、非盲、前瞻性研究,纳入2016年1月-2020年2月期间我院收治确诊的68例HLAP患者作为研究对象,入组患者按照随机数字法分为观察组与对照组,每组各34例。两组均接受常规治疗,在此基础上,对照组加用低分子肝素治疗,观察组接受低分子肝素治疗外加用血液灌流治疗。分别评估和检测两组患者治疗前、治疗后第1天、第3天及第7天APACHEⅡ评分、TNF-α、CRP、IL-6与血清三酰甘油(TG)水平变化。以及比较两组患者的临床疗效。结果:治疗前,观察组和对照组除了IL-6以外,其余指标均差异无统计学意义(P>0.05)。观察组和对照组的各指标在治疗后第1天、第3天和第7天,均呈下降趋势,组内比较均差异有统计学意义(P<0.05)。在组间比较中,观察组各指标均低于对照组,除TG外,均差异有统计学意义(P<0.05)。观察组患者的住院时间和并发MODS比例均低于对照组(P<0.05)。结论:血液灌流联合低分子肝素治疗HLAP患者可有效降低APACHEⅡ评分,减轻炎症反应,改善TG水平,提高了临床疗效。Objective: To explore the clinical efficacy of hemoperfusion combined with low molecular weight heparin for hyperlipidaemic acute pancreatitis based on APACHE Ⅱ, and impact of inflammatory response. Methods: This study was a single-center prospective study.A total of 68 patients with HLAP who admitted to our hospital from January 2016 to February 2020 were recruited in our study.They were randomly divided into observation group and control group, 34 cases in each group respectively.Both groups were treated with conventional therapy.In addition, The control group was treated with low molecular weight heparin, While observation group was treated with low molecualr weight heparin and hemoperfusion.We assessed and examined APACHE score, the level of TNF-a,CRP,IL-6 and triglyceride(TG) between two groups pre-treatment, 1 st day, 3 rd day and 7 th day of post-treatment. Results: There were no statistically significant differences between the observation group and the control group except for IL-6(P>0.05) before treatment. In the intra-group comparison, no matter the observation group or the control group, all indicators showed a downward trend on the 1 st, 3 rd and 7 th day after treatment, and the difference was statistically significant(P<0.05). In the comparison between groups, all indexes in the observation group were lower than those in the control group, with the exception of TG, the difference was statistically significant(P<0.05). Conclusion: Hemoperfusion combined with low molecular weight heparin was effective in reducing the APACHE Ⅱ scores, and its clinical efficacy significantly, and can alleviated inflammatory response, improved TG level.

关 键 词：高脂血症 急性胰腺炎 血液灌流 低分子肝素 炎症反应 

分 类 号：R657.51[医药卫生—外科学]