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目的探讨血液灌流联合血液滤过对高脂血症性重症急性胰腺炎(hyperlipidemic severe acute pancreatitis,HLSAP)的临床疗效以及对炎症反应的保护作用。方法选取2012年1月—2014年12月收治的HLSAP患者37例,根据患者治疗方式的不同分成3组,其中血液灌流联合连续性静脉-静脉血液滤过(hemoperfusion combined continuous veno-venous hemofiltration,HP+CVVH)组13例患者给予血液灌流联合血液滤过治疗,连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)组11例患者给予血液滤过治疗,对照组13例患者给予一般治疗。观察对比治疗前后3组患者血清三酰甘油、C反应蛋白以及炎性细胞因子肿瘤坏死因子-α、白细胞介素-6、白细胞介素-8水平及急性生理学与慢性健康状况(acute physiology and chronic health evaluation,APACHE)Ⅱ评分的变化,统计3组患者的住院时间、并发症发生率、病死率。结果与对照组相比,治疗后72 h HP+CVVH组与CVVH组患者三酰甘油、C反应蛋白、炎性细胞因子以及APACHEⅡ评分明显下降,差异有统计学意义(P<0.05);而HP+CVVH组患者的三酰甘油、C反应蛋白、炎性细胞因子以及APACHEⅡ评分在相同时间点低于CVVH组(P<0.05)。与对照组相比,HP+CVVH组与CVVH组患者的住院时间明显减少,差异有统计学意义(P<0.05);与CVVH组相比,HP+CVVH组患者的住院时间明显减少,差异有统计学意义(P<0.05)。3组患者的并发症发生率、病死率差异无统计学意义(P>0.05)。结论血液灌流联合血液滤过是治疗HLSAP的有效方法,其可通过有效清除炎性介质,抑制HLSAP时存在过激的炎症反应。
Objective To investigate the clinical efficacy of hemoperfusion combined with hemofiltration in hyperlipidemic severe acute pancreatitis (HLSAP) and its protective effect on inflammatory reaction. Methods Thirty-seven patients with HLSAP who were admitted from January 2012 to December 2014 were divided into three groups according to their treatment methods. Hemoperfusion combined with continuous veno-venous hemofiltration (HP) + CVVH). Thirteen patients were given hemoperfusion combined with hemofiltration, 11 patients in continuous veno-venous hemofiltration (CVVH) group were given hemofiltration, and 13 in control group were given general treatment. The levels of serum triglyceride, C-reactive protein and inflammatory cytokines TNF-α, IL-6, IL-8 and acute physiology and chronic health evaluation, APACHE) Ⅱ score changes, the three groups of patients hospitalized for statistics, the incidence of complications, mortality. Results Compared with the control group, the levels of triglyceride, C-reactive protein, inflammatory cytokines and APACHEⅡ in HP + CVVH group and CVVH group were significantly decreased at 72 h after treatment (P <0.05), and HP Patients in the CVVH group had lower triglyceride, C-reactive protein, inflammatory cytokines and APACHE II scores at the same time point than those in the CVVH group (P <0.05). Compared with the control group, the hospitalization time of HP + CVVH group and CVVH group decreased significantly, the difference was statistically significant (P <0.05); compared with CVVH group, hospitalization time of HP + CVVH group decreased significantly, the difference was Statistical significance (P <0.05). There was no significant difference in the incidence of complication and mortality between the three groups (P> 0.05). Conclusion Hemoperfusion combined with hemofiltration is an effective method for the treatment of HLSAP. It can excrete hyperactive inflammation by effectively clearing inflammatory mediators and inhibiting HLSAP.