早期CRRT联合前列地尔治疗高脂血症性急性重症胰腺炎  

Prospective study of early CRRT combined with alprostadil in the treatment of hyperlipidemic acute severe pancreatitis

作　　者：吴林[1] 孔晓霞 郑桂贞[1] 郭俊雄[1] 刘燕钗[1] 庄怡哲 WU Lin;KONG Xiaoxia;ZHENG Guizhen;GUO Junxiong;LIU Yanchai;ZHUANG Yizhe(Department of Gastroenterology, Shantou Central Hospital, Shantou 515031, Guangdong, China;Department of Oncology, Cancer Hospital Affiliated to Shantou University School of Medicine, Shantou 515031, Guangdong, China)

机构地区：[1]汕头市中心医院消化内科,广东汕头515031 [2]汕头大学医学院附属肿瘤医院妇科肿瘤科,广东汕头515031

出　　处：《西部医学》2022年第2期270-275,共6页Medical Journal of West China

基　　金：汕头市科技计划医疗卫生类别项目[汕府科(2017)119号-24]。

摘　　要：目的探讨早期连续性肾脏替代治疗(CRRT)联合前列地尔治疗高脂血症性急性重症胰腺炎(HLSAP)的临床疗效,旨在为临床治疗HLSAP提供理论依据。方法选取汕头市中心医院2017年10月1日~2019年9月30日收治的100例HLSAP患者进行前瞻性研究,纳入者按随机数字法分为治疗组(50例)和对照组(50例),两组入院后给予重症急性胰腺炎(SAP)常规治疗,在此基础上,对照组给予前列地尔治疗,治疗组在对照组治疗基础上给予早期CRRT治疗,比较两组治疗后临床疗效、临床症状及体征缓解时间、实验室指标、APACHEⅡ评分、Ranson评分、并发症发生率、住院时间、治疗费用、病死率及复发率。结果治疗组治疗后临床总有效率显著高于对照组(P<0.05),治疗组腹痛、腹胀、恶心呕吐缓解时间及血清TG下降时间显著早于对照组(P<0.001),治疗前,两组TG、CRP、WBC、AMY、ALT及SCr水平比较差异无统计学意义(P>0.05),治疗72 h后,两组TG、CRP、WBC、ALT及SCr较治疗前明显降低,治疗组各指标水平显著低于对照组(均P<0.001),而两组治疗前后AMY水平比较差异无统计学意义(P>0.05);治疗前,两组APACHEⅡ评分、Ranson评分比较差异无统计学意义(P>0.05),治疗72 h后,两组APACHEⅡ评分、Ranson评分较治疗前明显降低,治疗组显著低于对照组(均P<0.001);治疗组并发症发生率分显著低于对照组(P<0.05);治疗组住院时间显著短于对照组,住院期间病死率显著低于对照组(P<0.05),而治疗组住院费用明显高于对照组(P<0.001);两组出院后均经随访1年,治疗组复发率显著低于对照组(P<0.05)。结论采取早期CRRT联合前列地尔治疗HLSAP患者能有效提高临床疗效,促进患者症状缓解,迅速降低血清甘油三酯水平,改善实验室指标,减少并发症的发生,缩短住院时间和降低病死率,改善患者预后,可在临床推广应用。Objective To study the clinical efficacy of early continuous renal replacement therapy(CRRT)combined with alprostadil in the treatment of hyperlipidemic severe acute pancreatitis(hlsap)and provide theoretical basis for clinical treatment of hlsap.Methods 100 HLSAP patients admitted to Shantou Central Hospital from October 1,2017 to September 30,2019 were divided into a treatment group(50 cases)and a control group(50 cases)according to the random number method.The two groups were given severe cases after admission Acute pancreatitis(SAP)who were conventionally treated.On this basis,the control group was given alprostadil treatment,and the treatment group was given early CRRT treatment on the basis of the control group treatment.The clinical efficacy,clinical symptoms and signs relief time of the two groups after treatment are compared.Laboratory indicators,APACHEⅡscore,Ranson score,complication rate,length of hospital stay,treatment cost,fatality rate and recurrence rate.Results The clinical total effective rate of the treatment group was significantly higher than that of the control group(P<0.05).The remission time of abdominal pain,abdominal distension,nausea and vomiting in the treatment group was significantly earlier than that in the control group(P<0.001).Before treatment,there was no significant difference in the levels of laboratory indexes(TG,CRP,WBC,Amy,ALT and SCR)between the two groups(P>0.05).After 72 hours of treatment,the levels of serum TG,CRP,WBC,Amy,ALT and SCR were not significantly different between the two groups(P>0.05).The levels of TG,CRP,WBC,ALT and SCR in the two groups were significantly lower than those before treatment(P<0.001),while the levels of Amy were not significantly different between the two groups before and after treatment(P>0.05).Before treatment,there was no significant difference in ApacheⅡscore and Ranson score between the two groups(P>0.05).After 72 hours of treatment,ApacheⅡscore and Ranson score of the two groups were significantly lower than those before treatme

关 键 词：急性重症胰腺炎 高脂血症 连续性肾脏替代疗法 前列地尔 

分 类 号：R576[医药卫生—消化系统]