不同时机启动连续性血液净化治疗重症急性胰腺炎的临床效果研究  

Study on the clinical effect of initiating continuous blood purification at different times for severe acute pancreatitis

作　　者：陈飞扬 谢若愚 韩小彤[1,3,4,5] 宁凤玲 陈云 刘慧敏 刘丽蕾 李想[1,3,4,5] Chen Feiyang;Xie Ruoyu;Han Xiaotong;Ning Fengling;Chen Yun;Liu Huimin;Liu Lilei;Li Xiang(Department of Emergency Medicine,People's Hospital of Hunan Province(the First Affiliated Hospital of Hunan Normal University),Changsha 410002,Hunan,China;Hunan Normal University,Changsha 410081,Hunan,China;Hunan Acute and Critical Care Clinical Medical Research Center,Changsha 410209,Hunan,China;Hunan Institute of Emergency Medicine,Changsha 410209,Hunan,China;Hunan Key Laboratory of Acute and Critical Metabolomics,Changsha 410005,Hunan,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)急诊医学科,长沙410002 [2]湖南师范大学,长沙410081 [3]湖南省急危重症临床医学研究中心,长沙410209 [4]湖南省急救医学研究所,长沙410209 [5]急危重症代谢组学湖南省重点实验室,长沙410005

出　　处：《中华危重病急救医学》2024年第9期937-942,共6页Chinese Critical Care Medicine

基　　金：湖南省自然科学基金(2021JJ70018,2023JJ60308);湖南省急危重症临床医学研究中心项目(2021SK4011)。

摘　　要：目的观察在不同时机下启动连续性血液净化(CBP)治疗重症急性胰腺炎(SAP)患者的临床效果,探讨CBP治疗SAP的最佳启动时机,为临床医师启动CBP治疗提供依据。方法采用回顾性队列研究方法,选择2020年1月至2023年12月在湖南省人民医院住院的接受CBP治疗的SAP患者作为研究对象。根据CBP启动时机将患者分为早期启动组(确诊SAP至首次CBP治疗时间<24 h)和晚期启动组(确诊SAP至首次CBP治疗时间为24~48 h)。收集并比较两组患者的一般资料、治疗前后急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、急性胰腺炎严重程度床旁指数(BISAP)评分及实验室检查指标、局部并发症和全身并发症发生情况、重症监护病房(ICU)治疗时间、住院时间、治疗费用、临床结局。结果共纳入130例接受CBP治疗的SAP患者,其中早期启动组90例,晚期启动组40例。治疗前,早期启动组与晚期启动组患者的性别、年龄、APACHEⅡ评分、BISAP评分、病因和实验室检查指标比较差异均无统计学意义。治疗后48、72、96 h,两组患者的血钙水平较治疗前明显升高,白细胞计数(WBC)、C-反应蛋白(CRP)、乳酸、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平及APACHEⅡ评分和BISAP评分均较治疗前明显降低,其中晚期启动组治疗后72 h和96 h WBC水平、APACHEⅡ评分、BISAP评分均较早期启动组明显降低〔WBC(×10^(9)/L):治疗后72 h为10.96(8.68,13.04)比12.45(8.93,16.30),治疗后96 h为10.18(8.68,12.42)比11.96(8.81,16.87);APACHEⅡ评分(分):治疗后72 h为9.50(5.75,12.00)比11.00(6.25,14.00),治疗后96 h为10.00(4.00,12.00)比12.00(7.00,14.75);BISAP评分(分):治疗后72 h为2.35±1.03比2.76±1.10,治疗后96 h为2.08±1.21比2.70±1.11〕,差异均有统计学意义(均P<0.05)。并发症方面,晚期启动组胰腺脓肿发生率明显低于早期启动组〔5.00%(2/40)比20.00%(18/90)〕,但腹腔间隔室综合征发生率明显高于早期启动组〔42Objective To observe the clinical effect of initiating continuous blood purification(CBP)treatment at different times for patients with severe acute pancreatitis(SAP),and to explore the optimal timing for starting CBP treatment for SAP,so as to provide evidence for clinicians to start CBP treatment.Methods A retrospective cohort study was used to select patients with SAP who received CBP treatment in People's Hospital of Hunan Province from January 2020 to December 2023.According to the timing of CBP initiation,the patients were divided into early initiation group(diagnosis of SAP to the first CBP treatment time<24 hours)and late initiation group(diagnosis of SAP to the first CBP treatment time of 24-48 hours).The general data,acute physiology and chronic health evaluationⅡ(APACHEⅡ),bedside index for severity in acute pancreatitis(BISAP)score and laboratory indicators,local complications and systemic complications,intensive care unit(ICU)treatment time,hospital stay,treatment cost,and clinical outcome of the two groups were collected and compared.Results A total of 130 patients with SAP who received CBP treatment were enrolled,including 90 patients in the early initiation group and 40 patients in the late initiation group.Before treatment,there were no significant differences in gender,age,APACHEⅡscore,BISAP score,etiology and laboratory examination indexes between the early initiation group and late initiation group.At 48,72,96 hours after treatment,the blood calcium level of the two groups was significantly higher than that before treatment,and the levels of white blood cell count(WBC),C-reactive protein(CRP),lactic acid,interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),APACHEⅡscore and BISAP score were significantly lower than those before treatment.The WBC level,APACHEⅡscore and BISAP score of the late initiation group were significantly lower than those of the early initiation group at 72 hours and 96 hours after treatment[WBC(×10^(9)/L):10.96(8.68,13.04)vs.12.45(8.93,16.30)at 72 hours after tr

关 键 词：重症急性胰腺炎 连续性血液净化 时机 治疗效果 炎症因子 

分 类 号：R576[医药卫生—消化系统]