摘要
目的探讨血糖目标管理联合早期血液灌流对高脂血症性急性胰腺炎(HL-AP)患者机体炎性反应和应激的影响。方法采用前瞻性研究的方法,选取新乡医学院附属周口市中心医院2019年9月至2022年9月HL-AP患者159例,按随机数字表法将患者分为A、B、C三组,每组53例。三组均给予常规治疗,在此基础上A组采用血糖目标管理治疗,B组采用早期血液灌流治疗,C组采用血糖目标管理联合早期血液灌流治疗。分别于治疗前和治疗7 d后检测炎性因子,包括白细胞介素-10(IL-10)、白细胞介素-18(IL-18)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)、降钙素原(PCT)、高迁移率族蛋白B1(HMGB1)和测核因子-κB p65(NF-κB p65);应激指标,包括脂质过氧化氢(LHP)、晚期蛋白氧化产物(AOPPs)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、肾上腺素(E)和皮质醇;肠黏膜屏障指标,包括D-乳酸、二胺氧化酶(DAO)和内毒素;血液流变学指标,包括血小板黏附率、血浆比黏度、全血比黏度高切和血栓长度。记录恢复指标(尿淀粉酶恢复时间、肠鸣音恢复时间、排气恢复时间、腹痛缓解时间和住院时间)、不良反应和疗效。结果三组治疗前各检测指标比较差异无统计学意义(P>0.05)。治疗7 d后,C组IL-10、CAT和GSH-Px明显高于A组和B组,IL-18、NF-κB p65、TNF-α、sICAM-1、PCT、HMGB1、LHP、AOPPs、E、皮质醇、D-乳酸、DAO和内毒素明显低于A组和B组,差异有统计学意义(P<0.05);各指标A组和B组比较差异无统计学意义(P>0.05)。治疗7 d后,C组血小板黏附率、血浆比黏度、全血比黏度高切和血栓长度明显低于A组和B组,B组明显低于A组,差异有统计学意义(P<0.05)。C组尿淀粉酶恢复时间、肠鸣音恢复时间、排气恢复时间、腹痛缓解时间和住院时间明显短于A组和B组[(5.73±0.64)d比(7.49±0.89)和(7.26±0.85)d、(2.45±0.31)d比(5.76±0.73)和(5.83±0.79)d、(2
Objective To investigate the effects of blood glucose target management combined with early hemoperfusion on inflammatory reaction and stress in patients with hyperlipidemic acute pancreatitis(HL-AP).Methods A prospective cohort study was used.One hundred and fifty-nine patients with HL-AP from September 2019 to September 2022 in Zhoukou Central Hospital Affiliated to Xinxiang Medical University were selected.The patients were divided into group A,B and C by random number table method with 53 cases in each group.All patients were given routine treatment.On this basis,the patients in group A were given blood glucose target management,the patients in group B were given early hemoperfusion,and the patients in group C were given blood glucose target management combined with early hemoperfusion.Before treatment and 7 d after treatment,the inflammatory factors(including interleukin-10,IL-10;interleukin-18,IL-18;tumor necrosis factor-α,TNF-α;soluble intercellular adhesion molecule-1,sICAM-1;procalcitonin,PCT;high mobility group protein B1,HMGB1;nuclear factor-κB p65,NF-κB p65),stress indexes(including lipid hydrogen peroxide,LHP;advanced protein oxidation products,AOPPs;catalase,CAT;glutathione peroxidase,GSH-Px;epinephrine,E and cortisol),intestinal mucosal barrier indexes(including D-lactate;diamine oxidase,DAO;endotoxin)and hemorheological indexes(including platelet adhesion rate,plasma specific viscosity,whole blood specific viscosity high shear and thrombus length)were detected.The recovery indexes(urinary amylase recovery time,bowel sound recovery time,exhaust recovery time,abdominal pain relief time and hospitalization time),adverse reactions and curative effect were recorded.Results There were no statistical differences in the detection indexes before treatment among three groups(P>0.05).Seven days after treatment,the IL-10,CAT and GSH-Px in group C were significantly higher than those in group A and group B.The IL-18,NF-κB p65,TNF-α,sICAM-1,PCT,HMGB1,LHP,AOPPs,E,cortisol,D-lactic acid,DAO and endotoxin we
作者
李畅
刘学进
于彦章
Li Chang;Liu Xuejin;Yu Yanzhang(Graduate School,Xinxiang Medical University,Xinxiang 453003,China;Department of Gastroenterology,Zhoukou Central Hospital Affiliated to Xinxiang Medical University,Zhoukou 466000,China;Department of Hepatobiliary Surgery,Zhoukou Central Hospital Affiliated to Xinxiang Medical University,Zhoukou 466000,China)
出处
《中国医师进修杂志》
2023年第11期990-997,共8页
Chinese Journal of Postgraduates of Medicine
关键词
胰腺炎
高脂血症
血液灌流
血糖目标管理
炎性反应
应激反应
Pancreatitis
Hyperlipidemias
Hemoperfusion
Blood glucose target management
Inflammatory reaction
Stress reaction
