早期血浆置换治疗高脂血症性急性胰腺炎的临床意义

目的探讨早期血浆置换（plasma exchange,PE）对高脂血症性急性胰腺炎（acute hyperlipidemic pancreatitis,HLP）的治疗作用。方法将42例HLP患者随机分为两组,治疗组22例（常规治疗＋早期PE）,对照组20例采用常规治疗。比较PE两组患者血清甘油三酯（TG）浓度、急性生理和慢性健康评价指标Ⅱ（APACHEⅡ）评分、C-反应蛋白（CRP）浓度变化,并观察两组患者的临床表现和预后。结果入院24h,两组患者血清TG浓度较入院时均降低,且治疗组血清TG浓度明显低于对照组（P〈0.01）;入院48h,治疗组APACHEⅡ评分、CRP浓度均低于对照组（P=0.032;P=0.017）;治疗组患者腹痛、腹胀缓解时间,禁食水时间,住院时间均较对照组缩短（P〈0.01）;治疗组及对照组的病死率分别为9.1%、25.0%,两者比较差异无统计学意义（P=0.333）。结论早期PE可显著降低患者血清TG浓度,改善患者的临床症状,是治疗HLP的安全、有效的手段之一。

The clinical effects of the earlier plasma exchange in the treatment of hyperlipidemic acute pancreatitis

Objective To evaluate the effect of earlier plasma exchange in the treatment of patients with The hyperlipidemic acute panercatitis （HLP）. Methods 42 patients with HLP were divided into 2 groups： the treatment group（22cases）was given the conventional therapy and the plasma exchange; the control group （20 cases）was given the only conventional therapy, and then The triglyceride levels in serum,the sorces of acute physiology and chronic health evaluation ]l as well as the C - reactive protein levels in serum were compared be- fore and after the plasma exchange respectively, their clinical features and prognosis were also observed. Results After 24 hours in hospital, triglyceride serum levels reduced in both grouds, and decreased more distinctly in the treatment group （P 〈0. 01 ）. After 48 hours, both the sorces of acute physiology and chronic health evaluation II and the C - reactive protein levels in serum in the control group were sinifidantly increased than those of the treatment group（P =0. 032;P =0. 017）. The release time of abodominal pain and distention,the time of fasting and hospital stay of the treatment group .were significantly shorter than that of the control group（ P 〈 0. 01 ）, the mortality of the two groups were 9. 1% and 25, 0% respectively, had no statistical significance for their （ P = 0. 333 ）. Conclusion The earlier plasma exchange could quickly and obviously deduces the triglyceride serum levels as well as improves patients＇ clinical features, which is one of the safely and available tools.