摘要
目的 探讨高脂血症性重症急性胰腺炎 (HL SAP)的规范化治疗方案。方法 将 2 0 0 0～ 2 0 0 3年 32例重症急性胰腺炎病人 ,分为重症胰腺炎组 (SAP ,2 2例 )和暴发性胰腺炎组 (FSAP ,10例 )。除常规治疗措施外 ,均加用“五联疗法”[血液净化 (血脂吸附与血液滤过 )、降血脂药物、低分子量肝素、胰岛素、全腹皮硝外敷 ]。测定血液净化前 (PF)、结束 (AFE)和发病后 7d(AF7)的甘油三酯、促炎及抗炎细胞因子和APACHEⅡ评分 ,且评估预后。结果 血液净化结束和发病后 7d ,31例病人血清甘油三酯和TNFα及APACHEⅡ评分较血液净化前显著降低 ,P <0 0 5 ;而IL 10浓度在血滤结束时显著升高 (P <0 0 0 1) ,发病后 7d则显著降低 (P <0 0 5 )。SAP组和FSAP组的第一次手术的时间、手术次数分别为 (5 5 8± 4 2 6 )dvs(12 2± 6 6 )d(P =0 0 2 ) ;(1 33± 0 5 )次vs(3 5± 1 2 )次 (P =0 0 0 37)。SAP组和FSAP组的非手术治愈率、假性囊肿吸收率及住院天数和存活率分别为10 0 % (2 2 / 2 2 )vs 11 1% (1/ 9) ;77 3% (17/ 2 2 )vs 11 1% (1/ 9) ;(5 4 2± 35 9)dvs(99 1± 4 9 5 )d(P =0 0 0 8) ;10 0 % (2 2 / 2 2 )vs 6 6 7% (6 / 9) (P =0 0 0 4 4 )。SAP组假性囊肿吸收时间 (135 1± 137 5 )d。结论?
Objective To investigate the formalized therapeutic strategies of hyperlipidemic severe acute pancreatitis (HL-SAP).Methods Thirty-two patients with severe acute pancreatitis were divided into severe acute pancreatitis group (SAP,22 cases) and fulminant severe acute pancreatitis group (FSAP,10 cases).In addition to the conventional therapeutic measures,'Pentad-therapy-strategies'below was also undergone in the two groups;①blood purification (adsorption of triglyceride and hemofiltration);②medications to decrease triglyceride;③low-molecular-weight heparin;④insulin;⑤the whole abdomen was covered with Pixiao(a traditional Chinese medicine).Serum levels of triglyceride,pro-inflammatory cytokines and anti-inflammatory cytokines were determined before blood purification (PF),at the end of blood purification (AFE) and 7th day(AF7) after onset of the disease,respectively.Simultaneously,the severity of the disease was observed through APACHE Ⅱ;and prognosis was evaluated.Results Serum levels of triglyceride (mmol/L),TNFα(U/mL) and APACHE Ⅱ scores were decreased significantly (P<0.05) at AFE and AF7,respectively compared with that of PF.However,serum concentration of IL-10 (pg/mL) was increased significantly (P<0.001) at AFE;and decreased significantly (P<0.05) at AF7 compared with that of PF.First operation time was (55.8±42.6)days in SAP group and (12.2±6.6)days in FSAP group (P=0.02);and operation times in the two groups were (1.33±0.5)vs(3.5±1.2)(P=0.0037),respectively.Non-operation rate,adsorption rate of pseudocyst,hospital stay and survival rate in SAP group and FSAP group were 100%(22/22) vs 11.1%(1/9);77.3%(17/22) vs 11.1%(1/9);(54.2±35.9) vs (99.1±49.5)days (P=0.008);100%(22/22) vs 66.7%(6/9) (P=0.0044).Time interval of adsorption of pseudocyst was (135.1±137.5)days in SAP group.Conclusion In addition to the conventional therapeutic strategies,'Pentad-therapy-strategies'is effective for treatment of hyperlipidemic severe acute pancreatitis.
出处
《中国实用外科杂志》
CSCD
北大核心
2003年第9期542-545,共4页
Chinese Journal of Practical Surgery
