配对血浆滤过吸附在重症急性胰腺炎患者治疗中对肠黏膜屏障功能的影响  

Effects of CPFA on inflammatory mediators and intestinal mucosal barrier function in patients with severe acute pancreatitis

作　　者：程仁洪 张伟[1] 廖达林[1] 薛建健[1] 林雪英[1] CHENG Renhong;ZHANG Wei;LIAO Dalin;XUE Jianjian;LIN Xueying(Emergency Medicine,900th Hospital of the Joint Service Support Force of Chinese People’s Liberation Army,Fuzhou FuJian 350000,China)

机构地区：[1]中国人民解放军联勤保障部队第900医院急诊医学科,福建福州350001

出　　处：《中国临床医生杂志》2022年第7期796-799,共4页Chinese Journal For Clinicians

摘　　要：目的探讨配对血浆滤过吸附(couple plasma filtration adsorption,CPFA)在重症急性胰腺炎患者治疗中对炎性介质、肠黏膜屏障功能的影响。方法选择2017年2月至2021年10月在中国人民解放军联勤保障部队第900医院急诊ICU接受治疗的重症急性胰腺炎患者63例,采用随机数字表法分为试验组(32例)和对照组(31例)。对照组给予高容量血液滤过治疗,试验组在对照组的基础上加用CPFA治疗。比较两组临床疗效、炎性介质、肠黏膜屏障功能水平变化情况、临床症状改善情况及不良反应发生情况。结果治疗后,两组总有效率比较差异有显著性(P<0.05);治疗前,试验组和对照组炎性介质水平比较差异无显著性;治疗后,试验组和对照组C-反应蛋白(C-reactive protein,CRP)、白细胞介素6(interleukin-6,IL-6)水平均随着时间的推移而降低,且试验组均低于对照组,差异有显著性(P<0.05);治疗前,试验组和对照组肠黏膜屏障功能水平比较差异无显著性;治疗后,试验组和对照组D-乳酸、二胺氧化酶(diamine oxidase,DAO)、内皮素(endothelin,ET)水平均随着时间的推移而降低,且试验组均低于对照组,差异有显著性(P<0.05);试验组腹痛、腹胀、肠鸣音恢复及住院时间显著低于对照组,差异有显著性(P<0.05);两组不良反应总发生率分别为3.13%、9.68%,差异无显著性(P>0.05)。结论在重症急性胰腺炎中应用CPFA治疗疗效显著,可有效改善患者炎性介质、肠黏膜屏障功能水平。Objective To study effects of paired plasma filtration adsorption(CPFA)on inflammatory mediators and intestinal mucosal barrier function in patients with severe acute pancreatitis.Method 63 patients with severe acute pancreatitis who were treated in the emergency ICU of our hospital from February 2017 to October 2021 were selected and divided into experimental group(n=32)and control group(n=31)by random number table method.The control group was treated with high volume hemofiltration,and the experimental group was treated with CPFA on the basis of the control group.Clinical efficacy,inflammatory mediators,changes in intestinal mucosal barrier function,improvement of clinical symptoms and occurrence of adverse reactions were compared between the two groups.Result After treatment,the total effective rate between the two groups was significantly different(P<0.05);Before treatment,there was no significant difference in the level of inflammatory mediators between the experimental group and the control group.After treatment,the levels of CRP,IL-6 in experimental group and control group decreased with time,and those in experimental group were lower than those in control group,the difference was significant(P<0.05).Before treatment,there was no significant difference in intestinal mucosal barrier function between experimental group and control group.After treatment,the levels of D-lactic acid,DAO and ET in experimental group and control group decreased with time,and those in experimental group were lower than those in control group,the difference was significant(P<0.05).Abdominal pain,abdominal distension,bowel sound recovery and hospital stay in experimental group were significantly lower than those in control group(P<0.05).The total incidence of adverse reactions was 3.13% and 9.68%(P>0.05).Conclusion CPFA had a significant therapeutic effect in severe acute pancreatitis,and could effectively improve inflammatory mediators and intestinal mucosal barrier function.

关 键 词：配对血浆滤过吸附 高容量血液滤过 重症急性胰腺炎 炎性介质 肠黏膜屏障功能 

分 类 号：R657.51[医药卫生—外科学]