摘要
目的 探讨持续性血液净化治疗联合清胰汤对重症急性胰腺炎（SAP）细胞因子浓度的影响.方法 本研究采取前瞻性双盲随机对照试验.收集本院的57例重症急性胰腺炎患者作为研究对象.入选患者按随机数字法分为对照组（清胰汤干预组,n=27）与实验组（持续血液净化与清胰汤干预组,n=30）.对照组每日给予清胰汤经鼻肠管灌注,50 mL/次,每6 h 1次.实验组在对照组基础上给予持续的血液净化治疗,模式为CVVH,采用肝素抗凝,剂量为35 mL/（kg·h）,采用改良的南京军区总医院配方.两组患者分别于入院第1、7天采集静脉血检测AMY、BUN、 Cr、TBIL、TNF-α、IL-1、IL-6、IL-8;同时动脉采血,行血气分析监测,分别记录PaO2 、HCO-3,根据吸氧浓度,计算氧合指数.所测数据应用SPSS 21.0统计软件处理.结果 两组患者入选时AMY（U/L：818±172 vs.813±111）、BUN（mmol/L：18.8±2.4 vs.18.4±2.1）、Cr（μmol/L：250±42 vs.244±59）、TBIL（μmol/L：41.1±9.3 vs.43.5±5.4）、HCO-3（mmol/L：18.7±1.6 vs.18.5±1.7）、TNF-α（pg/L：177.3±12.9 vs.171.56±10.5）、IL-1（pg/L：31.8±2.8 vs.32.6±3.8）、IL-6（pg/L：111.3±22.8 vs.119.4±10.6）、IL-8（pg/L：90.3±16.0 vs.97.6±17.1）、PaO2 /FiO2（mm Hg：269.7±61.7 vs.283.5±53.4）,差异无统计学意义（P〉0.05）;治疗7 d后再次检测发现：对照组各项生化指标[AMY（735±164）U/L、BUN（17.1±2.1）mmol/L、Cr（213±80）μmol/L、TBIL（36.8±5.5）μmol/L、HCO-3（20.1±1.8）mmol/L、TNF-α（167.7±11.1）pg/L、IL-1（27.7±5.4）pg/L、IL-6（92.7±29.2）pg/L、IL-8（75.9±14.6）pg/L、PaO2 /FiO2（304.6±38.3）mm Hg]治疗后下降（P〈0.05）;实验组各项生化指标[AMY（649±149）U/L、BUN（14.9±1.7）mmol/L、Cr（127±50）μmol/L、TBIL（32.1±4.7）μmol/L、HCO-3（21.3±1.7）mmol/L、TNF-α（120.4±7.9）pg/L、IL-1（16.8±2.0）pg/L、IL-6（66.0±15.9）pg/L、IL-8（64.9±11.8）pg/L、PaO2 /FiO2（330.2±50.5�
Objective To explore the effect of cytokines Qingyi decoction combining with continuous blood purification therapy on severe acute pancreatitis.Methods Aprospective double-blinded randomized controlled trial was conducted.Fifty-seven patients of severe acute pancreatitis admitted to department of critical care medicine of the second hospital of Lanzhou University were enrolled.They were randomly divided into control group（Qingyi decoction group, n=27）and study group（continuous blood purification therapy combining with Qingyi decoction group, n=30）.Routine treatments were executed in bothgroups.50 mLQingyi decoction was given thoughnasointestinal tube, and that was repeated every six hours in control group.Except Qingyi decoction, continuous blood purification therapy was executedin study group.While heparin used for anticoagulation,mode of that was continuous veno-veno hemofiltraion（CVVH）.Using the improved formula of the General Hospital of Nanjing Military Region,dose of CVVH was 35 mL/（kg·h）.Serum levels of creatinine（Scr）, amylase（AMY）, tumor necrosis factor-α（TNF-α）, total bilirubin（TBIL）, interleukin-1（IL-1）, interleukin-6（IL-6）, interleukin-8（IL-8）were assayed during the first and the seventh day of the treatment.At the same time nurses collected artery blood and monitored blood gas analysis and record arterial oxygen partial pressure（PaO2）, bicarbonate ion（HCO-3）,fraction of inspired oxygen（FiO2）and oxygenation index（PaO2 /FiO2）.The test data were processed with SPSS 21.0 statistical software.Results The indicators of the first day [AMY：（818±172）U/L vs.（813±111）U/L;BUN：（18.8±2.4）mmol/L vs.（18.4±2.1）mmol/L;Cr：（250±42）μmol/L vs.（244±59）μmol/L;TBIL：（41.1±9.3）μmol/L vs.（43.5±5.4）μmol/L;HCO-3：（18.7±1.6）mmol/L vs.（18.5±1.7）mmol/L;TNF-α：（177.3±12.9）pg/L vs.（171.56±10.5）pg/L;IL-1（31.8±2.8）pg/L vs.（32.6±3.8）pg/L;IL-6：（111.3±22.8）pg/L vs.（119.4±10.6）pg/L;I
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第6期506-510,共5页
Chinese Journal of Critical Care Medicine
基金
甘肃省兰州市城关区科技计划项目（2015-3-7）
