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目的:研究在对高脂血症性胰腺炎(hyperlipidemic pancreatitis,HLP)常规治疗基础上,采用联合血液灌流(hemoperfusion,HP)和持续静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)治疗的时机选择。方法:回顾性分析2011年1月至2014年3月符合HLP诊断的46例患者的临床资料,按从起病到接受血液净化治疗的时间分为3组:A组11例,从起病至开始行血液净化治疗时间在4 h之内;B组29例,时间在4~72 h内;C组6例,时间在72~120 h内。并记录治疗前后急性生理和慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、C-反应蛋白(C-reactive protein,CRP)、血细胞比容(haematocrit,Hct)、甘油三酯(triglyceride,TG)、总胆固醇(total cholesterol,TC)、血肌酐(serum creatinine,SCr)、血丙氨酸转氨酶(alanine aminotransferase,ALT)、氧合指数(Pa O2/Fi O2)以及各组平均住院时间。结果:A、B、C 3组性别、年龄构成均衡,差异均无统计学意义(P>0.05)。A、B组经治疗后APACHEⅡ评分、CRP、Hct、TG、TC、SCr、ALT均下降(P<0.05),Pa O2/Fi O2均升高(P<0.05),C组治疗前后指标的变化无统计学意义(P>0.05),其中B组APACHEⅡ评分、CRP、SCr、ALT及Pa O2/Fi O2变化尤为明显,而Hct、TG、TC治疗前后比较差异无统计学意义(P>0.05),提示早期HP联合CVVH能有效降低血脂浓度、减轻全身炎症反应及改善早期并发症,4~72 h是全身炎症的高峰时间段,是HP联合CVVH治疗的最佳时机。3组中B组平均住院时间最短(P<0.05)。结论:对于HLP的患者,除常规治疗外,应在起病后4~72 h内及时行HP+CVVH治疗。
Objective: To study the effects of hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH) on the routine therapy of hyperlipidemic pancreatitis (HLP) The timing of choice. Methods: The clinical data of 46 patients with HLP diagnosed from January 2011 to March 2014 were retrospectively analyzed. The time from onset to blood purification was divided into three groups: group A, 11 cases, from onset to Blood purification treatment began within 4 hours; B group 29 cases, the time within 4 ~ 72 h; C group 6 cases, the time in 72 ~ 120 h. The acute physiology and chronic health evaluationⅡ (APACHEⅡ) score, C-reactive protein (CRP), haematocrit (Hct), triglyceride (TG), total cholesterol (TC), serum creatinine (SCr), alanine aminotransferase (ALT), oxygenation index (Pa O2 / Fi O2) and average length of stay in each group. Results: There were no significant differences in gender and age between groups A, B and C (P> 0.05). APACHEⅡscore, CRP, Hct, TG, TC, SCr and ALT in group A and group B were decreased (P <0.05) and PaO2 / FiO2 were increased in group A and group B There was no significant difference in APACHEⅡscore, CRP, SCr, ALT and Pa O2 / Fi O2 in group B, but there was no significant difference between before and after treatment of Hct, TG and TC (P> 0.05) , Suggesting that early HP combined with CVVH can effectively reduce blood lipids, reduce the systemic inflammatory response and improve early complications, 4 to 72 h is the peak period of systemic inflammation, HP combined with CVVH the best time to treat. The average length of stay of group B in 3 groups was the shortest (P <0.05). Conclusion: For patients with HLP, HP + CVVH should be treated within 4 ~ 72 h after onset in addition to routine treatment.