连续性血浆滤过吸附联合CVVH治疗重症急性胰腺炎并MODS患者效果研究  

Effects of Continuous Plasma Filtration Adsorption Combined with CVVH on Patients with Severe Acute Pancreatitis Complicated with MODS

作　　者：尹康[1] 朱秋平 赖纪英 薛正彪 王春丽[1] 邹志胜[1] 张宇珍[1] 许庆林[1] YIN Kang;ZHU Qiuping;LAI Jiying;XUE Zhengbiao;WANG Chunli;ZOU Zhisheng;ZHANG Yuzhen;XU Qinglin(The First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,China;不详)

机构地区：[1]赣南医学院第一附属医院,江西赣州341000

出　　处：《中国医学创新》2022年第21期32-36,共5页Medical Innovation of China

基　　金：江西省卫生健康委科技计划项目(20204454)。

摘　　要：目的:探讨连续性血浆滤过吸附(CPFA)+连续性静脉静脉血液滤过(CVVH)治疗重症急性胰腺炎(SAP)并多器官功能障碍综合征(MODS)的临床效果。方法:回顾性分析赣南医学院第一附属医院2019年12月-2022年3月收治的60例SAP并MODS患者临床资料,将接受CVVH治疗的30例患者设为对照组,将接受CPFA+CVVH治疗的30例患者设为观察组。比较治疗前及治疗3 d后两组生命体征变化、T淋巴细胞亚群、炎症因子水平、急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)、多器官功能障碍综合征(MODS)评分。结果:观察组治疗后心率(HR)[(94.25±7.37)次/min]低于对照组[(104.25±8.69)次/min],平均动脉压(MAP)[(88.96±7.45)mmHg]、氧合指数(OI)[(209.36±14.24)mmHg]高于对照组[(80.14±7.34)mmHg、(198.74±13.49)mmHg],差异均有统计学意义(P<0.05);观察组治疗后CD3[(62.57±6.05)%]、CD4[(35.54±4.12)%]、CD4/CD8[(1.65±0.26)]均高于对照组[(57.49±5.73)%、(32.29±3.89)%、(1.33±0.24)],CD8[(21.52±2.19)%]低于对照组[(24.28±2.34)%],差异均有统计学意义(P<0.05);观察组治疗后C反应蛋白(CRP)[(38.96±4.12)mg/L]、肿瘤坏死因子-α(TNF-α)[(67.52±6.17)ng/mL]、白介素-6(IL-6)[(70.74±7.25)ng/mL]水平均低于对照组[(45.71±4.39)mg/L、(74.58±6.34)ng/mL、(77.89±7.57)ng/mL],差异均有统计学意义(P<0.05);观察组治疗后APACHEⅡ评分[(14.32±2.04)分]、MODS评分[(6.13±1.02)分]均低于对照组[(16.86±2.13)、(7.23±1.16)分],差异均有统计学意义(P<0.05)。结论:CPFA+CVVH可提高SAP并MODS的治疗效果,纠正机体免疫功能异常,加快炎症消退,维持生命体征指标稳定,减轻多脏器功能损害,值得广泛应用。Objective:To investigate the clinical effect of continuous plasma filtration adsorption (CPFA) + continuous venous-venous hemofiltration (CVVH) in the treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction syndrome (MODS).Method:Clinical data of 60 patients with SAP complicated with MODS admitted to the First Affiliated Hospital of Gannan Medical College from December 2019 to March 2022 were retrospectively analyzed.30 patients receiving CVVH were enrolled as the control group,and 30 patients receiving CPFA+CVVH were enrolled as the observation group.The changes of vital signs,T lymphocyte subsets,levels of inflammatory factors,acute physiology and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) and Marshall multiple organ dysfunction score (MODS) were compared between the two groups before and 3 days after treatment.Result:After treatment,the heart rate (HR) of the observation group[(94.25±7.37) times /min]was lower than that of the control group[(104.25±8.69) times /min].The mean arterial pressure (MAP)[(88.96±7.45) mmHg]and oxygenation index (OI)[(209.36±14.24) mmHg]were higher than those in the control group[(80.14±7.34) mmHg,(198.74±13.49) mmHg],and the differences were statistically significant (P<0.05);after treatment,CD3[(62.57±6.05)%],CD4[(35.54±4.12)%],CD4/CD8[(1.65±0.26)]in the observation group were higher than those in the control group[(57.49±5.73)%,(32.29±3.89)%,(1.33±0.24)],and CD8[(21.52±2.19)%]was lower than that in the control group[(24.28±2.34)%],the differences were statistically significant (P<0.05);after treatment,the levels of C reactive protein (CRP)[(38.96±4.12) mg/L],TNF-α[(67.52±6.17) ng/mL]and interleukin-6 (IL-6)[(70.74±7.25) ng/mL]in observation group were lower than those in control group[(45.71±4.39) mg/L,(74.58±6.34) ng/mL,(77.89±7.57) ng/mL],the differences were statistically significant (P<0.05);after treatment,APACHE Ⅱ score[(14.32±2.04) points]and MODS score[(6.13±1.02) points]in the observation group were l

关 键 词：重症急性胰腺炎 多脏器功能障碍综合征 连续性血浆滤过吸附 血液滤过 炎症因子 

分 类 号：R459.7[医药卫生—急诊医学] R576[医药卫生—治疗学]