枸橼酸体外抗凝下血液灌流串联连续肾脏替代治疗一体化组合式血液净化治疗重症高甘油三酯血症性急性胰腺炎的疗效  

Efficacy of HP in series with CRRT integrated combined blood purification under extracorporeal citrate anticoagulation in the treatment of severe HTG⁃AP

作　　者：吴乐 耿润露 周京江 李丽 徐磊 康洁 卢斌 叶英 杨红宁 丁伟超 WU Le;GENG Runlu;ZHOU Jingjiang;LI Li;XU Lei;KANG Jie;LU Bin;YE Ying;YANG Hongning;DING Weichao(Department of Emergency Medicine,the Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu,China;Graduate School,Xuzhou Medical University,Xuzhou 221002,Jiangsu,China;Jiangsu Provincial Institute of Health Emergency,Xuzhou 221002,Jiangsu,China;不详)

机构地区：[1]徐州医科大学附属医院急诊医学科,江苏徐州221002 [2]徐州医科大学研究生院,江苏徐州221002 [3]江苏省卫生应急研究所,江苏徐州221002

出　　处：《实用医学杂志》2025年第4期561-568,共8页The Journal of Practical Medicine

基　　金：江苏省自然科学基金面上项目(编号:BK20211136);江苏省徐州市科技计划项目(编号:KC21215);徐州医科大学附属医院院级科研项目(编号:2024ZL10)。

摘　　要：目的研究枸橼酸体外抗凝下血液灌流(HP)串联连续肾脏替代治疗(CRRT)一体化组合式血液净化治疗在重症高甘油三酯血症性急性胰腺炎(HTG-AP)的疗效。方法选取徐州医科大学附属医院2022年6月至2024年5月收治的重症HTG-AP患者62例,随机分为对照组与观察组各31例。对照组使用常规内科治疗+HP联合CRRT分阶段组合式血液净化治疗,观察组使用常规内科治疗+枸橼酸体外抗凝下HP串联CRRT一体化组合式血液净化治疗。比较两组患者治疗前、治疗后7 d的各项指标与临床疗效。结果观察组单次CRRT时间大于对照组、CRRT次数少于对照组(P<0.05);两组患者CRRT总时间、单次HP时间、HP次数、HP总时间的差异无统计学意义(P>0.05)。两组患者治疗后的血常规、炎症因子、血生化、临床评分较治疗前改善(P<0.05);治疗后,观察组的血红蛋白(Hb)、血小板计数(Plt)高于对照组(P<0.05),两组患者的血常规其他指标、炎症因子、血生化、临床评分的差异无统计学意义(P>0.05)。两组患者的临床指标、预后及并发症的差异无统计学意义(P>0.05)。结论在不影响疗效的前提下,枸橼酸体外抗凝下HP串联CRRT一体化组合式血液净化治疗重症HTG-AP能够延长CRRT血滤器和管路使用时间,减少耗材使用,降低出血风险,还可以避免HP和CRRT分开操作的多次导管拆卸,减少相关感染风险,值得临床上推广应用。Objective To study the efficacy of hemoperfusion(HP)in series with continuous renal replace⁃ment therapy(CRRT)integrated combined blood purification under extracorporeal citrate anticoagulation in the treatment of severe hypertriglyceridemic acute pancreatitis(HTG-AP).Methods A total of 62 patients with severe HTG-AP admitted to the Affiliated Hospital of Xuzhou Medical University from June 2022 to May 2024 were selected and randomly divided into control group and observation group,with 31 cases in each group.The control group was treated with conventional medical treatment+HP combined with CRRT staged combined blood purifica⁃tion treatment,and the observation group was treated with conventional medical treatment+HP in series with CRRT integrated combined blood purification treatment under extracorporeal citrate anticoagulation.The indexes and clinical efficacy before and 7 days after treatment were compared between the two groups.Results The single CRRT time of the observation group was longer than that of the control group,and the frequency of CRRT was less than that of the control group(P<0.05).There were no significant differences in the total CRRT time,single HP time,HP frequency and total HP time between the two groups(P>0.05).The blood routine,inflammatory factors,blood biochemistry and clinical scores of the two groups after treatment were improved compared with those before treatment(P<0.05).After treatment,the hemoglobin(Hb)and platelet count(Plt)of the observation group were higher than those of the control group(P<0.05),and there were no significant differences in other indexes of blood routine,inflammatory factors,blood biochemistry and clinical scores between the two groups(P>0.05).There were no significant differences in clinical indexes,prognosis and complications between the two groups(P>0.05).Conclusions Without affecting the efficacy,HP in series with CRRT integrated combined blood purification under extracorporeal citrate anticoagulation in the treatment of severe HTG-AP can prolong the us

关 键 词：血液灌流 连续肾脏替代治疗 枸橼酸体外抗凝 重症高甘油三酯血症性急性胰腺炎(HTG-AP) 

分 类 号：R657.51[医药卫生—外科学]