日间连续性血液净化联合血浆置换对非胆源性重症急性胰腺炎患者的疗效观察

【目的】观察日间连续性血液净化联合血浆置换对非胆源性重症急性胰腺炎(SAP)患者炎症因子及肠黏膜屏障功能障碍的影响。【方法】本院收治的80例非胆源性SAP患者随机分为两组,各40例。血液净化组接受日间连续性血液净化治疗,联合组在血液净化组基础上接受至少1次的血浆置换治疗。比较两组治疗效果、炎症指标、肠黏膜屏障功能、并发症发生情况及死亡情况。【结果】联合组总有效率(87.5%)高于血液净化组(65.0%)(P<0.05)。治疗后,两组血淀粉酶及脂肪酶均较治疗前降低(均P<0.05),且联合组较血液净化组低(均P<0.05);两组CRP、TNF-α、降钙素原均较治疗前降低(均P<0.05),且联合组较血液净化组低(均P<0.05);两组内毒素、二胺氧化酶、D-乳酸均较治疗前降低(均P<0.05),且联合组较血液净化组低(均P<0.05)。联合组治疗期间新发总并发症发生率低于血液净化组(20.0%vs 35.0%),但差异无显著性(P>0.05),两组病死率(5.0%vs 7.5%)比较差异无显著性(P>0.05)。【结论】相比单独使用日间连续性血液净化,联合血浆置换可提高非胆源性SAP的疗效,改善患者胃肠功能及炎症水平,且安全性高。

Effect of Continuous Blood Purification Combined with Plasma Exchange on Patients with Non Biliary Severe Acute Pancreatitis

Objective]To observe the ffects of daytime conrinuous blood purification combined with plas-ma exchange on inflammatory factors and intestinal mucosal bar rier dysfunction in patients with non biliary se-vere acute pancreatitis(SAP).Methods]A total of 80 patients with non-biliary SAP treated in our hospital were random divided into two group.The blood purification group(groupA)received continuous daytime blood purification treatment.and the combination group(groupB)received at least one plasma exchange treat-ment based on the blood purification group.The therapeutic effects,inflammation indicators,intestinal muco-sal barrier function,complications and death were compared between the two groups.Results]The total ef-fective rate of combination group(87.5%)was higher than that of blood purification group(65.0%)(P<0.05).After treatment,the levels of serum amylase and lipase in the two groups were lower than those before treatment(all P<0.05),and those in the combined group were lower than those in the blood purification group(meanP<0.05).After treatment.CRP.TNF-α and procalcitonin in the two groups were lower than before treatment(all P<0.05),and the combined group was lower than the blood purification group(mean P<0.05).Afrer treatment,endotoxin,diamine oxidase and D lactate in the two groups were lower than before treatment(all P<0.05),and the combined group was lower than the blood purification group(mean P<0.05).The incidence of new complcations in the combined group was lower than that in the blood purification group(20.0%vs 35.0%).but the difference was not significant(P>0.05),and the mortality of the two groups(5.0%vs 7.5%)was not significant(P>0.05).Conclusion]Compared with daytime continuous blood purification alone.combined with plasma exchange can improve the curative effect of non biliary sap,improve gastrointestinal function and inflammatory level,and has high safety.