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目的探讨连续性血液净化(CBP)治疗对高脂血症性胰腺炎(HLP)中的治疗作用。方法选择2015年7月至2016年12月华中科技大学同济医学院附属武汉中心医院住院HLP患者48例,其中男性30例,女性18例,年龄21~52岁。按治疗方法分观察组(CPB治疗)和对照组(常规治疗)。对照组23例,其中男性14例,女性9例;年龄25~52岁,平均年龄35.3岁。观察组25例,其中男性16例,女性9例;年龄21~51岁,平均年龄34.4岁。两组患者均按照诊疗规范予以常规治疗,观察组再连续24 h行CBP治疗3~5 d,待临床症状好转后改为间断性血液净化治疗或停止CBP治疗。比较两组血液净化前、血液净化治疗72 h后生命体征、氧合指数、血清甘油三酯、C-反应蛋白和血浆炎性介质及细胞因子(TNF-α、IL-6、IL-8)水平变化;比较两组机械通气时间、重症监护病房(ICU)住院时间及死亡率。结果两组患者治疗后生命体征明显趋于稳定,血清甘油三酯、C-反应蛋白及血浆炎性介质水平均较治疗前下降[观察组(2.7±0.6)mmol/L vs(23.8±7.6)mmol/L,(12.7±4.6)mg/L vs(34.2±11.6)mg/L,TNF-α(320.5±35.5)ng/L vs(405.2±39.4)ng/L,IL-6(382.3±42.2)ng/L vs(578.7±62.6)ng/L,IL-8(456.3±34.4)ng/L vs(635.1±59.7)ng/L;对照组(5.6±0.4)mmol/L vs(24.2±8.5)mmol/L,(18.9±7.6)mg/L vs(35.3±12.6)mg/L,TNF-α(380.9±26.6)ng/L vs(412.7±40.2)ng/L,IL-6(450.8±36.7)ng/L vs(563.5±52.4)ng/L,IL-8(507.7±46.7)ng/L vs(655.2±58.8)ng/L;P<0.05]。观察组患者血清甘油三酯、C-反应蛋白及血浆炎性介质水平在相同时间点明显低于对照组(P<0.05)。观察组患者机械通气时间、ICU住院时间、死亡率明显低于对照组,临床转归优于对照组(P<0.05)。结论 HLP患者在内科综合治疗的基础上,联合CBP治疗能有效清除甘油三酯及炎性介质,缓解临床症状,缩短病程,显著改善预后。
Objective To investigate the therapeutic effect of continuous blood purification (CBP) on hyperlipidemic pancreatitis (HLP). Methods From July 2015 to December 2016, 48 patients with HLP were enrolled in Wuhan Central Hospital, Tongji Medical College, Huazhong University of Science and Technology. There were 30 males and 18 females, aged from 21 to 52 years. According to the treatment method, the observation group (CPB treatment) and the control group (conventional treatment). The control group of 23 patients, including 14 males and 9 females; aged 25 to 52 years, mean age 35.3 years. The observation group of 25 cases, including 16 males and 9 females; aged 21 to 51 years, mean age 34.4 years. The two groups of patients were routinely treated according to the treatment guidelines. The observation group was treated with CBP for another 24 hours for 3 ~ 5 days. After the clinical symptoms improved, the observation group switched to intermittent blood purification treatment or stopped CBP treatment. The vital signs, oxygenation index, serum triglycerides, C-reactive protein, plasma inflammatory mediators and cytokines (TNF-α, IL-6 and IL-8) were compared between the two groups before blood purification 72 hours after blood purification. The mechanical ventilation time, intensive care unit (ICU) hospital stay and mortality were compared between the two groups. Results The vital signs of the two groups were obviously stabilized after treatment. The levels of serum triglyceride, C-reactive protein and plasma inflammatory mediators decreased compared with those before treatment in the two groups [(2.7 ± 0.6) mmol / L vs (23.8 ± 7.6) (12.2 ± 4.6) mg / L vs (34.2 ± 11.6) mg / L, 320.5 ± 35.5 ng / L vs 405.2 ± 39.4 ng / L and 382.3 ± 42.2 (5.66 ± 0.4) mmol / L vs. (24.2 ± 8.5) ng / L vs (578.7 ± 62.6) ng / L vs 456.3 ± 34.4 ng / L vs L, (18.9 ± 7.6) mg / L vs (35.3 ± 12.6) mg / L and (380.9 ± 26.6) ng / L vs 36.7) ng / L vs (563.5 ± 52.4) ng / L, IL-8 (507.7 ± 46.7) ng / L vs (655.2 ± 58.8) ng / L, respectively; P <0.05]. The levels of serum triglyceride, C-reactive protein and plasma inflammatory mediators in the observation group were significantly lower than those in the control group at the same time point (P <0.05). The observation group patients with mechanical ventilation time, ICU hospital stay, mortality was significantly lower than the control group, the clinical outcome was better than the control group (P <0.05). Conclusion On the basis of comprehensive medical treatment, combined with CBP can effectively remove triglyceride and inflammatory mediators, relieve clinical symptoms, shorten the course of disease and significantly improve the prognosis of HLP patients.