连续性血液净化治疗重症急性胰腺炎临床效果观察
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摘要
目的观察连续性血液净化治疗重症急性胰腺炎的临床效果。方法选取自2015年2月至2018年5月乐山市人民医院收治的98例重症急性胰腺炎患者为研究对象,将患者随机分入A组和B组,每组各49例。A组患者接受常规治疗,B组患者在常规治疗基础上联合连续性血液净化治疗。治疗7 d后,比较两组患者的腹胀和腹痛消失时间、体温恢复时间、肠蠕动恢复时间、住院时间,急性生理功能和慢性健康状况评分、改良CT严重指数评分,肿瘤坏死因子-α、白细胞介素-6、白细胞介素-10水平,以及全血比黏度高切、血浆比黏度、血小板黏附率。结果 B组患者腹胀和腹痛消失时间、体温恢复时间、肠蠕动恢复时间、住院时间均短于A组,差异有统计学意义(P<0.05)。治疗后,两组患者的急性生理功能和慢性健康状况评分、改良CT严重指数评分均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组患者的肿瘤坏死因子-α、白细胞介素-6、白细胞介素-10水平均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。治疗后,两组患者的全血比黏度高切、血浆比黏度、血小板黏附率均低于治疗前,且B组低于A组,差异有统计学意义(P<0.05)。结论连续性血液净化治疗重症急性胰腺炎疗效显著,可减轻患者炎症反应程度,改善血液流变学指标,有效缓解临床症状。
Objective To investigate the clinical effect of continuous blood purification(CBP)in the treatment of severe acute pancreatitis(SAP).Methods A retrospective study was performed on 98 cases of patients with SAP who were admitted from February 2015 to May 2018.Patients were randomly divided into the Group A and Group B,with 49 cases in each group.Patients of Group A were given conventional treatment,the others of Group B were added CBP on the basis of conventional treatment.Seven days after treatment,abdominal distension and abdominal pain disappear time,temperature,intestinal peristalsis recovery time,length of hospital stay,acute and chronic health evaluation,physiological function improvement of computed tomography(CT)severity index score,tumor necrosis factor alpha and interleukin-6 and interleukin-10 levels,as well as the whole blood high shear viscosity,plasma viscosity,platelet adhesion rate were compared between the two groups.Results The time of abdominal distension and pain disappearance,the time of temperature recovery,the time of bowel motility recovery and the time of hospitalization in Group B were all shorter than those in Group A,and the differences were statistically significant(P<0.05).After treatment,acute physiological function and chronic health status scores and modified CT severity index scores of both groups were lower than those before treatment,and Group B was lower than Group A(P<0.05).After treatment,the levels of tumor necrosis factor-alpha,interleukin-6 and interleukin-10 in both groups were lower than those before treatment,and those in Group B were lower than those in Group A(P<0.05).After treatment,the whole blood specific viscosity,plasma specific viscosity and platelet adhesion rate of the patients in the two groups were lower than those before treatment,and Group B was lower than Group A(P<0.05).Conclusion Continuous blood purification has a significant effect on the treatment of severe acute pancreatitis,which can reduce the degree of inflammation in patients,improve the hemorheology index,and effectively alleviate clinical symptoms.
Objective To investigate the clinical effect of continuous blood purification(CBP)in the treatment of severe acute pancreatitis(SAP).Methods A retrospective study was performed on 98 cases of patients with SAP who were admitted from February 2015 to May 2018.Patients were randomly divided into the Group A and Group B,with 49 cases in each group.Patients of Group A were given conventional treatment,the others of Group B were added CBP on the basis of conventional treatment.Seven days after treatment,abdominal distension and abdominal pain disappear time,temperature,intestinal peristalsis recovery time,length of hospital stay,acute and chronic health evaluation,physiological function improvement of computed tomography(CT)severity index score,tumor necrosis factor alpha and interleukin-6 and interleukin-10 levels,as well as the whole blood high shear viscosity,plasma viscosity,platelet adhesion rate were compared between the two groups.Results The time of abdominal distension and pain disappearance,the time of temperature recovery,the time of bowel motility recovery and the time of hospitalization in Group B were all shorter than those in Group A,and the differences were statistically significant(P<0.05).After treatment,acute physiological function and chronic health status scores and modified CT severity index scores of both groups were lower than those before treatment,and Group B was lower than Group A(P<0.05).After treatment,the levels of tumor necrosis factor-alpha,interleukin-6 and interleukin-10 in both groups were lower than those before treatment,and those in Group B were lower than those in Group A(P<0.05).After treatment,the whole blood specific viscosity,plasma specific viscosity and platelet adhesion rate of the patients in the two groups were lower than those before treatment,and Group B was lower than Group A(P<0.05).Conclusion Continuous blood purification has a significant effect on the treatment of severe acute pancreatitis,which can reduce the degree of inflammation in patients,improve the hemorheology index,and effectively alleviate clinical symptoms.
引文
[1] 悦云.早期肠内营养支持对重症急性胰腺炎患者临床预后的影响[J].解放军医学杂志,2015,40(10):853-854.
[2] 李敏利,张晓华,金鑫鑫,等.前列地尔对重症急性胰腺炎患者早期促炎因子的影响及疗效观察[J].解放军医学杂志,2017,42(2):140-143.
[3] 张勇,曾维政,王云侠,等.连续性血液净化治疗重症急性胰腺炎合并多器官功能障碍综合征的效果观察[J].临床肝胆病杂志,2016,32(2):320-323.
[4] 褚薇薇,闫爱丽,聂蕾,等.实验性大鼠轻型和重型急性胰腺炎的病理形态特点[J].重庆医学,2015,18:2454-2456.
[5] 刘振国,王婷.连续性血液净化治疗对重症肺炎患者血清降钙素原水平的影响[J].实用老年医学,2016,37(2):121-124.
[6] 席俊彦,杨莹,庾镇藩,等.中重症急性胰腺炎与重症急性胰腺炎的对比研究[J].中国现代医药杂志,2018,4(20):6-7.
[7] 张圣道,雷若庆.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[8] Hua Z,Su Y,Huang X,et al.Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis:a retrospective study of 344 cases in a single Chinese center[J].BMC Gastroenterology,2017,17(1):29-43.
[9] Wang G,Liu Y,Zhou SF,et al.Effect of somatostatin,ulinastatin and gabexate on the treatment of severe acute pancreatitis[J].Am J Med Sci,2016,351(5):506-512.
[10] 王顺,张丽,戴晨,等.连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效及对血清炎症因子的影响[J].标记免疫分析与临床,2016,23(7):727-730.
[11] 叶剑飞.生长抑素、丹参联合治疗对重症急性胰腺炎患者预后及血清水平因子影响的观察[J].临床急诊杂志,2016,17(11):848-851.
[12] Wang B,Wu XW,Guo MX,et al.Effects of ω-3 fatty acids on toll-like receptor 4 and nuclear factor-κB p56 in lungs of rats with severe acute pancreatitis[J].World J Gastroenterol,2016,22(44):9784-9793.
[13] 李虎年,何婷.重组人生长激素对重症急性胰腺炎肠黏膜屏障、肠道菌群及炎症因子的影响[J].胃肠病学和肝病学杂志,2017,26(3):331-334.
[14] 杨美荣,刘斌,张国顺,等.生长抑素联合早期血液灌流治疗急性重症胰腺炎临床分[J].中华实用诊断与治疗杂志,2017,31(2):145-147.
[15] 李科,刘明华,张雷,等.连续性血液净化治疗联乌司他丁对急性胰腺炎患者 TLR4、血浆炎症因子及白介素的影响[J].现代生物医学进展,2017,17(12):2260-2263.
[2] 李敏利,张晓华,金鑫鑫,等.前列地尔对重症急性胰腺炎患者早期促炎因子的影响及疗效观察[J].解放军医学杂志,2017,42(2):140-143.
[3] 张勇,曾维政,王云侠,等.连续性血液净化治疗重症急性胰腺炎合并多器官功能障碍综合征的效果观察[J].临床肝胆病杂志,2016,32(2):320-323.
[4] 褚薇薇,闫爱丽,聂蕾,等.实验性大鼠轻型和重型急性胰腺炎的病理形态特点[J].重庆医学,2015,18:2454-2456.
[5] 刘振国,王婷.连续性血液净化治疗对重症肺炎患者血清降钙素原水平的影响[J].实用老年医学,2016,37(2):121-124.
[6] 席俊彦,杨莹,庾镇藩,等.中重症急性胰腺炎与重症急性胰腺炎的对比研究[J].中国现代医药杂志,2018,4(20):6-7.
[7] 张圣道,雷若庆.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[8] Hua Z,Su Y,Huang X,et al.Analysis of risk factors related to gastrointestinal fistula in patients with severe acute pancreatitis:a retrospective study of 344 cases in a single Chinese center[J].BMC Gastroenterology,2017,17(1):29-43.
[9] Wang G,Liu Y,Zhou SF,et al.Effect of somatostatin,ulinastatin and gabexate on the treatment of severe acute pancreatitis[J].Am J Med Sci,2016,351(5):506-512.
[10] 王顺,张丽,戴晨,等.连续性血液净化治疗重症急性胰腺炎合并急性肾损伤的疗效及对血清炎症因子的影响[J].标记免疫分析与临床,2016,23(7):727-730.
[11] 叶剑飞.生长抑素、丹参联合治疗对重症急性胰腺炎患者预后及血清水平因子影响的观察[J].临床急诊杂志,2016,17(11):848-851.
[12] Wang B,Wu XW,Guo MX,et al.Effects of ω-3 fatty acids on toll-like receptor 4 and nuclear factor-κB p56 in lungs of rats with severe acute pancreatitis[J].World J Gastroenterol,2016,22(44):9784-9793.
[13] 李虎年,何婷.重组人生长激素对重症急性胰腺炎肠黏膜屏障、肠道菌群及炎症因子的影响[J].胃肠病学和肝病学杂志,2017,26(3):331-334.
[14] 杨美荣,刘斌,张国顺,等.生长抑素联合早期血液灌流治疗急性重症胰腺炎临床分[J].中华实用诊断与治疗杂志,2017,31(2):145-147.
[15] 李科,刘明华,张雷,等.连续性血液净化治疗联乌司他丁对急性胰腺炎患者 TLR4、血浆炎症因子及白介素的影响[J].现代生物医学进展,2017,17(12):2260-2263.