摘要
目的 分析和比较血浆置换和胰岛素泵两种快速降脂方式在急性脂源性胰腺炎治疗中的优劣.方法 回顾性分析北京协和医院2014年1月到2016年12月收治的98例急性脂源性胰腺炎患者的病历资料,按照患者快速降脂的方式选择分为血浆置换组和胰岛素法组.共收集到血浆置换组患者42例,胰岛素法组56例.结果 血浆置换组和胰岛素法组在发病到开始治疗的时间、糖尿病患者所占比例、妊娠患者所占比例、初始三酰甘油水平、入室急性生理和慢性健康Ⅱ评分（APACHEⅡ）评分、改良CT严重程度指数评分（NCTSU评分）差异均无统计学意义（P均＞0.05）,另外,两组急性呼吸窘迫综合征发生比例、急性肾损伤发生比例、休克发生比例、胰腺脓肿发生比例、中度胰腺炎、重度胰腺炎所占比例、开始耐受经口/空肠营养的时间、住院时间、病死率差异均无统计学意义（P均＞0.05）,但血浆置换组三酰甘油达标时间和游离脂肪酸正常时间显著低于胰岛素法组[（13.09± 12.50）h比（46.92± 20.92）h,t=3.291,P=0.001;（15.75± 14.13）h比（73.21± 38.49）h,t=3.291,P=0.001],胰腺假囊肿发生比例显著低于胰岛素法组（7.14％比23.21％,t=2.120,P=0.034）,住院花费显著高于胰岛素法组[（81 794.92± 33 719.69）元比（56 042.43± 30 565.34）元,t=2.034,P=0.042）.结论 血浆置换和胰岛素均能快速降低血脂.血浆置换较胰岛素降脂有一定优势,其降脂速度更快,胰腺假囊肿的发生率更低,可以在患者经济情况允许时优先使用.
Objective To compare the efficacy of two rapid lipid lowering methods as plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis.Methods The clinical data of 98 patients with hyperlipidemic acute pancreatitis in Peking Union Medical College Hospital from January 2014 to December 2016 were retrospectively analyzed.All patients were divided into plasma exchange group （n =42） and insulin group （n=56） according to rapid lipid lowering method.Results There were no significant differences in the onset-to-treatment time,the proportion of patients with diabetes,the proportion of patients with pregnancy,the initial triglyceride level,Acute Physiology,Age and Chronic Health Evaluation l score and modified CT severity index score score and conditioning-test stimulus interval （CTSI） score between the plasma exchange group and the insulin group （P〉0.05）.In addition,there were also no significant differences in the incidences of acute respiratory distress syndrome,acute kidney injury,shock and pancreatic abscess,and the proportion of moderate pancreatitis and severe pancreatitis,oral / jejunum nutrition tolerating start time,hospitalization time and mortality between the two groups （P〉0.05）.The plasma exchange group had significantly less time to achieve the target triglyceride level and to reach normal free fatty acids level than the insulin group [（13.09±12.50） hvs.（46.92±20.92） h,t=3.291,P=0.001;（15.75±14.13） hvs.（73.21±38.49） h,t =3.291,P=0.001].The pancreatic pseudocyst incidence was significantly lower （7.14% vs.23.21%,t =2.120,P=0.034）,and the hospitalization cost was significantly higher [（81 794.92±33 719.69） yuan vs.（56 042.43±30 565.34） yuan,t =2.034,P =0.042] in the plasma exchange group than in the insulin group.Conclusions Both plasma exchange and insulin can rapidly lower blood lipids.Plasma exchange has certain advantages over insulin in lipid-lowering,for it is faster,and has lower incidence of pancreatic pseudocyst,thus can be
作者
刘业成
郭磊
齐志伟
徐军
朱华栋
于学忠
Liu Yecheng;Guo Lei;Qi Zhiwei;Xu Jun;Zhu Huadong;Yu Xuezhong(Department of Emergency Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中华临床营养杂志》
CAS
CSCD
2018年第4期202-206,共5页
Chinese Journal of Clinical Nutrition
