集成式血液净化治疗在高脂血症性急性胰腺炎患者中的临床应用

目的评价集成式血液净化治疗在高脂血症性急性胰腺炎（AHLP）患者的临床疗效。 方法采用前瞻性观察研究方法，选取2015年6月至2017年11月在山西医学科学院山西大医院重症医学科内行血液净化治疗的AHLP患者42例，按治疗过程中采用的血液净化方式，分为连续性血液滤过治疗（CVVH）组和血浆置换（PE）联用CVVH组，比较2组患者治疗前后白细胞计数（WBC）、C反应蛋白（CRP）、血清淀粉酶（AMY）、谷丙转氨酶（ALT）、血清肌酐（SCr）、三酰甘油（TG）、急性生理学与慢性健康状况评分（APACHE）Ⅱ评分的变化以及临床结局。采用t检验比较2组患者WBC、CRP、AMY、APACHEⅡ评分，采用χ²检验比较2组患者临床治疗有效率。 结果2组患者治疗前的WBC、CRP、AMY、ALT、SCr、TG比较，差异无统计学意义（P>0.05）。治疗7 d后，PE＋CVVH组WBC、CRP、AMY、ALT、SCr及TG均低于CVVH组［（9.6±3.5）×10⁹/L vs（12.6±3.7）×10⁹/L，（24.6±5.8）mg/L vs（34.7±2.2）mg/L，（242.1±28.9）IU/L vs（819.6±89.8）IU/L，（56.6±5.4）IU/L vs（78.9±18.）IU/L，（86.2±8.5）μmol/L vs（95.1±5.7）μmol/L，（4.1±1.6）mmol/L vs（8.9±2.1）mmol/L］，且差异具有统计学意义（t=-2.700，P=0.01；t=-7.317，P<0.001；t=-28.609，P<0.001；t=-5.521，P<0.001；t=3.943，P<0.001；t=-8.378，P<0.001）；同时，PE＋CVVH组患者的肠蠕动恢复时间、住院时间、腹痛及腹胀症状消失时间均短于CVVH组［（4.6±1.4）d vs（6.8±2.7）d，（13.6±3.2）d vs（16.8±2.6）d，（2.7±0.4）d vs（3.6±1.4）d］，且差异具有统计学意义（t=-3.36，P=0.002；t=-3.535，P=0.001；t=-2.891，P=0.006）。PE＋CVVH组患者临床有效率高于CVVH组（100.0% vs 85.0%），但差异无统计学意义（P=0.059）。 结论集成式血液净化技术能够有效降低患者的TG水平及炎症介质水平，对AHLP有较好的治疗效果。

Therapeutic effects of hybrid renal replacement therapy in patients with acute hyperlipidemic pancreatitis

ObjectiveTo evaluate the therapeutic effects of hybrid renal replacement therapy (HRRT) in patients with acute hyperlipidemic pancreatitis. MethodsForty-two patients with HLP treated in Shanxi Dayi Hospital were enrolled into this study From June 2015 to Nov 2017. The patients were randomly divided into two groups to receive either plasma exchange (PE)/continuous veno-venous hemofiltration (CVVH; 22 patients) or CVVH alone (20 patients) for 8-12 hours. Clinical signs and symptoms, white blood cell count (WBC), C-reactive protein (CRP), serum amylase (AMY), alanine transaminase (ALT), serum creatinine (SCr), triglyceride (TG), APACHE II score, and clinical outcome were compared by paired t test or χ²test. ResultsBefore treatment, WBC, CRP, AMY, ALT, SCr, and TG did not differ significantly between the two groups (P>0.05); after 7 days of treatment, WBC, CRP, AMY, ALT, SCr, and TG in the HP/CVVH group were significantly lower than those in the CVVH group [(12.6±3.7)×10⁹/L vs (9.6±3.5)×10⁹/L, t=-2.700, P=0.01; (34.7±2.2) mg/L vs (24.6±5.8) mg/L, t=-7.317, P<0.001; (819.6±89.8) IU/L vs (242.1±28.9) IU/L, t=-28.609, P<0.001; (78.9±18.) IU/L vs (56.6±5.4) IU/L, t=-5.521, P<0.001; (86.2±8.5) μmol/L vs (95.1±5.7) μmol/L, t=3.943, P<0.001; (4.1±1.6) mmol/L vs (8.9±2.1) mmol/L, t=-5.004, P<0.001]. Time to recovery of intestinal peristalsis, length of hospitalization duration, and time to disappearance of symptoms in the HP/CVVH group were significantly shorter than those in the CVVH group [(4.6±1.4) d vs (6.8±2.7) d, t=-3.36, P=0.002; (13.6±3.2) d vs (16.8±2.6) d, t=-3.535, P=0.001; (2.7±0.4) d vs (3.6±1.4) d, t=-2.891, P=0.006]. ConclusionHRRT can effectively reduce the levels of TG and inflammatory mediators and has a better therapeutic effect in patients with hyperlipidemic pancreatitis.