血必净联合血液净化治疗重症急性胰腺炎合并MODS的疗效及对炎症反应、脏器功能的影响  

Efficacy of Xuebijing combined with blood purification in the treatment of severe acute pancreatitis complicated with MODS and its effect on inflammatory response and organ function

作　　者：张英[1] 梁瑞景 张建茹 张雨[4] 汪敬杰 ZHANG Ying;LIANG Rui-jing;ZHANG Jian-ru(Department of Gastroenterology,the Second Hospital of Qinhuangdao City,Qinhuangdao Hebei 066600,China;Department of Geriatrics,the First Hospital of Hebei Medical University,Shijiazhuang Hebei 050000,China;Department of Hemodialysis,the Second Hospital of Qinhuangdao City,Qinhuangdao Hebei 066600,China)

机构地区：[1]秦皇岛市第二医院消化科,河北秦皇岛066600 [2]河北医科大学第一医院老年病科,河北石家庄050000 [3]秦皇岛市第二医院血液透析科,河北秦皇岛066600 [4]秦皇岛市第二医院肾内科,河北秦皇岛066600 [5]秦皇岛市第二医院感染科,河北秦皇岛066600

出　　处：《临床和实验医学杂志》2022年第12期1262-1266,共5页Journal of Clinical and Experimental Medicine

基　　金：2016年度秦皇岛市市级科技计划项目(编号:201602A236);河北省中医药管理局支持项目(编号:2019102)。

摘　　要：目的探究血必净联合血液净化(CBP)治疗重症急性胰腺炎(SAP)合并多器官功能障碍(MODS)的疗效及对炎症反应、脏器功能的影响。方法前瞻性选取2016年4月至2020年4月秦皇岛市第二医院收治的60例SAP合并MODS患者为研究对象,按数字表法随机分为对照组和观察组,每组30例。对照组予以常规综合治疗,观察组在对照组基础上增加血必净联合CBP治疗。比较两组临床疗效及治疗前后中医证候积分、急性胰腺炎严重度床边指数(BISAP)评分、改良CT严重程度指数(MCTSI)评分、血清炎症因子[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平及脏器功能[呼吸功能:动脉血氧分压(PaO_(2))、动脉氧合指数(PaO 2/FiO_(2))、肝功能[天门冬氨酸氨基转移酶(AST)、谷氨酸-丙酮酸氨基转移酶(ALT)、肾功能[血清肌酐、血清尿素、心肌酶[肌酸激酶、乳酸脱氢酶(LDH)]。结果观察组临床总有效率为90.00%,明显高于对照组(70.00%),差异有统计学意义(P<0.05)。观察组治疗后中医证候积分、BISAP评分及MCTSI评分均显著低于对照组,差异均有统计学意义(P<0.05)。观察组治疗后血清CRP、TNF-α、IL-6水平均显著低于对照组,差异均有统计学意义(P<0.05)。与对照组相比,观察组治疗后PaO_(2)、PaO_(2)/FiO_(2)均明显更高,血清AST、ALT、肌酐、尿素、肌酸激酶、LDH水平则明显更低,差异均有统计学意义(P<0.05)。结论血必净联合CBP治疗SAP合并MODS的疗效显著,可有效改善患者临床症状,减轻炎症反应,保护脏器功能。Objective To explore the efficacy of Xuebijing combined with blood purification(CBP)in the treatment of severe acute pancreatitis(SAP)complicated with multiple organ dysfunction(MODS)and its effect on inflammatory response and organ function.Methods From April 2016 to April 2020,60 patients with SAP combined with MODS who were treated in the Second Hospital of Qinhuangdao City were prospectively selected as the research objects,and were randomly divided into the control group and the observation group according to the random number table method,with 30 cases in each group.The control group received conventional comprehensive treatment,and the observation group received Xuebijing combined with CBP treatment on the basis of the control group.The clinical efficacy,TCM syndrome scores,bedside index of severity acute pancreatitis(BISAP)score,modified CT severity index(MCTSI score),serum inflammatory factor levels[C-reactive protein(CRP),tumor necrosis score],and serum inflammatory factors were compared between the two groups before and after treatment factor-α(TNF-α),interleukin-6(IL-6)]and organ function[respiratory function:arterial partial pressure of oxygen(PaO_(2)),arterial oxygenation index(PaO_(2)/FiO_(2))],liver function[aspartate aminotransferase(AST),glutamate-pyruvate aminotransferase(ALT)],renal function(serum creatinine,serum urea),cardiac enzymes[creatine kinase,lactate dehydrogenase(LDH)].Results The clinical total effective rate in the observation group was 90.00%,which was significantly higher than that in the control group(70.00%),the difference was statistically significant(P<0.05).After treatment,the TCM syndrome score,BISAP score and MCTSI score of the observation group were significantly lower than those of the control group,the differences were statistically significant(P<0.05).After treatment,the levels of serum CRP,TNF-αand IL-6 in the observation group were significantly lower than those in the control group,the differences were statistically significant(P<0.05).Compared with the control g

关 键 词：重症急性胰腺炎 多器官功能障碍 血必净 血液净化治疗 炎症反应 脏器功能 

分 类 号：R576[医药卫生—消化系统] R459.7[医药卫生—内科学]