摘要
目的探讨早期血液灌流(HP)联合连续性静脉-静脉血液滤过(CVVH)在高脂血症性重症急性胰腺炎(HLSAP)治疗中的疗效,以及不同血脂水平患者对该治疗的反应性。方法回顾性分析2016年1月至2021年1月信阳市中心医院重症医学科收治的68例HLSAP患者临床资料,按治疗方式分为两组。对照组给予常规治疗;观察组在常规治疗基础上给予HP联合CVVH治疗。比较两组患者腹痛缓解时间、生化指标、炎症指标、器官功能和预后。并根据治疗3 d后血脂下降程度〔血清三酰甘油(TG)下降幅度是否>60%〕将观察组再分为高效组和低效组,比较两组患者的疗效;将差异有统计学意义的变量纳入Logstic回归分析,进行多因素分析。结果68例HLSAP患者中观察组46例,对照组22例,两组患者治疗3 d后TG(mmol/L:4.6±1.4比7.9±1.7)、总胆固醇〔TC(mmol/L):6.4±1.6比8.2±1.9〕、血清淀粉酶〔AMY(mmol/L):242.3±23.6比367.1±32.7〕、白细胞介素-6〔IL-6(ng/L):67.3±11.4比87.6±16.3〕、肿瘤坏死因子-α〔TNF-α(ng/L):87.6±23.5比104.7±24.4〕、超敏C-反应蛋白〔hs-CRP(mg/L):36.2±22.7比55.3±27.6〕、腹痛缓解时间(h:47.2±10.3比56.4±11.6)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分(分:9.6±2.1比11.4±2.6)、机械通气时间(d:7.4±1.4比9.2±2.1)、ICU住院时间(d:14.5±2.6比17.7±3.2)、复发率〔4.3%(2/46)比13.6%(3/22)〕差异均有统计学意义(均P<0.05)。多因素Logistic回归分析显示,HLSAP经HP联合CVVH后血脂下降程度与性别〔优势比(OR)=7.231,95%可信区间(95%CI)为1.043~21.635〕、发病至HP开始时间(OR=1.064,95%CI为1.002~1.029)、红细胞比容(Hct:OR=1.035,95%CI为1.007~1.052)及治疗前血脂水平(TG:OR=1.276,95%CI为1.027~1.532;TC:OR=1.093,95%CI为1.004~1.037)呈显著相关性(均P<0.05)。结论HP联合CVVH较常规治疗能够快速清除HLSAP患者血清TG水平,从而快速缓解HLSAP的进展,对患者的病情控制、转归具有重要意义。性�
Objective To investigate the clinical effect and prognosis of hemoperfusion(HP)combined with continuous veno-venous hemofiltration(CVVH)in the treatment of hyperlipidemia severe acute pancreatitis(HLSAP),and the responsiveness of patients with different blood lipid levels to this treatment.Methods The clinical data of 68 patients with hyperlipidemia and severe acute pancreatitis admitted to the department of critical care medicine of Xinyang Central Hospital from January 2016 to January 2021 were retrospectively analyzed.The patients were divided into the observation group and the control group according to the treatment methods.The control group was given conventional treatment,the observation group was given HP combined with CVVH treatment based on conventional treatment.The abdominal pain relief time,biochemical parameters,inflammatory parameters,organ function,and prognosis were compared between the two groups.The observation group was subdivided into high efficiency group and low efficiency group according to the degree of blood lipid decrease[whether the decrease of serum triacylglycerol(TG)was more than 60%]after 3 days of treatment.The general data of the two groups were compared,and the variables with statistically significant differences between the two groups were included in Logistic regression analysis for multivariate analysis.Results Of the 68 patients with HLSAP,46 cases were in observation group and 22 cases were in control group.After treatment for 3 days,as for TG(mmol/L:4.6±1.4 vs.7.9±1.7),total cholesterol[TC(mmol/L):6.4±1.6 vs.8.2±1.9],serum amylase[AMY(mmol/L):242.3±23.6 vs.367.1±32.7],interleukin-6[IL-6(ng/L):67.3±11.4 vs.87.6±16.3],tumor necrosis factor-α[TNF-α(ng/L):87.6±23.5 vs.104.7±24.4],hypersensitivity C-reactive protein[hs-CRP(mg/L):36.2±22.7 vs.55.3±27.6],abdominal pain relief time(hours:47.2±10.3,56.4±11.6),acute physiology and chronic health evaluationⅡ(APACHEⅡscores:9.6±2.1 vs.11.4±2.6),duration of mechanical ventilation(days:7.4±1.4 vs.9.2±2.1),and the
作者
李梦蝶
许明
史新格
程小敏
吴旻
芦乙滨
Li Mengdie;Xu Ming;Shi Xinge;Cheng Xiaomin;Wu Min;Lu Yibin(Department of Critical Care Medicine,Xinyang Central Hospital,Xinyang 464000,Henan,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第6期662-667,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
河南省信阳市软科学研究项目(20190055)。
