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

张勇; 曾维政; 王云侠; 翁敏; 郑淑梅; 蒋明德

doi:10.3969/j.issn.1001-5256.2016.02.025

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

DOI: 10.3969/j.issn.1001-5256.2016.02.025

成都军区总医院消化内科

详细信息

中图分类号: R576;R459.7
计量
- 文章访问数: 2206
- HTML全文浏览量: 51
- PDF下载量: 440
- 被引次数: 0
出版历程
- 收稿日期: 2015-07-20
- 出版日期: 2016-02-20

Effect of continuous blood purification in treatment of patients with severe acute pancreatitis and multiple organ dysfunction syndrome

Department of Gastroenterology,General Hospital of Chengdu Command Area of Chinese PLA

摘要

摘要:
目的观察连续性血液净化（CBP）对重症急性胰腺炎（SAP）合并多器官功能障碍综合征（MODS）患者血清炎症介质的影响。方法选取2008年4月-2013年12月成都军区总医院收治的SAP合并MODS患者65例,采用非随机同期对照试验方法按治疗方式不同分为两组,其中对照组（n=33）接受内科综合治疗,治疗组（n=32）在内科综合治疗基础上给予CBP治疗。监测患者CBP治疗前后APACHEⅡ评分、MODS评分以及血清肿瘤坏死因子（TNF）α、C-反应蛋白（CRP）、血小板衍化生长因子（PAF）、白细胞介素（IL）6、IL-18、一氧化氮（NO）水平变化。计量资料组间比较采用成组t检验,同组治疗前后比较采用配对t检验;计数资料组间比较采用χ2检验。结果两组患者治疗后,APACHEⅡ、MODS评分及血清TNFα、CRP、IL-6、IL-18、PAF、NO水平均较治疗前明显降低,差异均有统计学意义（P值均<0.05）,且治疗组较对照组降低更为明显（P值均<0.001）;治疗组患者存活率为90.6%（29/32）,对照组患者存活率为78.8%（26/33）,两组存活率比较差异无统计学意义...
- 胰腺炎 /
- 多器官功能衰竭 /
- 血液滤过 /
- 治疗结果
Abstract:
Objective To observe the effect of continuous blood purification( CBP) on serum inflammatory mediators in patients with severe acute pancreatitis( SAP) and multiple organ dysfunction syndrome( MODS). Methods Sixty- five SAP patients with MODS who were treated in General Hospital of Chengdu Command Area of Chinese PLA from April 2008 to December 2013 were enrolled and divided into two groups. The 33 patients in the control group received comprehensive internal medicine treatment,and the 32 patients in the treatment group received comprehensive internal medicine treatment and CBP. Changes in APACHE II score,MODS score,and the serum levels of tumor necrosis factor α( TNFα),C- reactive protein( CRP),interleukin 6( IL- 6),IL- 18,platelet- activating factor( PAF),and nitric oxide( NO) after treatment were observed. Independent- samples t test was applied for comparison of continuous data between the two groups,and paired t test was applied for before- after comparison within the same group; chi- squared test was applied for comparison of categorical data between the two groups. Results In both groups,APACHE II score,MODS score,and the serum levels of TNFα,CRP,IL- 6,IL- 18,PAF,and NO decreased significantly after treatment( all P < 0. 05),and the treatment group had significantly greater decreases in these values than the control group( all P < 0. 001); the survival rates in the treatment group and the control group were 90. 6%( 29 /32)and 78. 8%( 26 /33),respectively,with no significant difference between the two groups( χ2= 1. 749,P = 0. 186). Conclusion In SAP patients with MODS,CBP can effectively clear the serum inflammatory mediators to block systemic inflammatory response and improve organ function,and,therefore,it is an effective method to treat SAP.
- pancreatitis /
- multiple organ failure /
- hemofiltration /
- treatment outcome

HTML全文

参考文献(13)

[1]MALMSTRM ML,HANSEN MB,ANDERSEN AM,et al.Cytokines and organ failure in acute pancreatitis:inflammatory response in acute pancreatitis[J].Pancreas,2012,41(2):271-277.

[2]ZHANG NN,GUO XZ,LI HY,et al.A meta-analysis of blood purification in severe acute pancreatitis in chinese clinical trials[J].Trauma Crit Care Med,2014,2(1):42-47.(in Chinese)张宁宁,郭晓钟,李宏宇,等.血液净化治疗急性重症胰腺炎疗效Meta分析[J].创伤与急危重病医学,2014,2(1):42-47.

[3]Pancreatic Disease Group of Digestive Disease Branch of Chinese Association.Recommendation of standardized treatment of internal medicine for severe acute pancreatitis[J].Chin J Dig,2009,29(2):75-78.(in Chinese)中华医学会消化病学分会胰腺病学组.重症急性胰腺炎内科规范治疗建议[J].中华消化杂志,2009,29(2):75-78.

[4]WANG JD,WANG BE.Staging diagnosis and severity score criteria for multiple organ dysfunction syndrome(MODS)[J].Chin Critical Care Med,1995,7(6):346-347.(in Chinese)王今达,王宝恩.多脏器功能失常综合征(MODS)病情分期诊断及严重程度评分标准[J].中国危重病急救医学,1995,7(6):346-347.

[5]LU SY,PAN XZ.Recent progress in understanding the pathogenesis of severe acute pancreatitis[J].World Chin J Dig,2011,19(23):2421-2425.(in Chinese)卢世云,潘秀珍.重症急性胰腺炎发病机制研究现状[J].世界华人消化杂志,2011,19(23):2421-2425.

[6] ZHANG J,NIU J,YANG J.Interleukin-6,interleukin-8 and interleukin-10 in estimating the severity of acute pancreatitis:an updated meta-analysis[J].Hepatogastroenterology,2014,61(129):215-220.

[7]CHEN C,XIA SH,CHEN H,et al.Therapy for acute pancreatitis with platelet-activating factor receptor antagonists[J].World J Gastroenterol,2008,14(30):4735-4738.

[8]XIA SH,HU CX,ZHAO ZL,et al.Significance of platelet activating factor receptor expression in pancreatic tissues of rats with severe acute pancreatitis and effects of BN52021[J].World J Gastroenterol,2007,13(21):2992-2998.

[9]LIANG J,ZHOU Y,WANG Z,et al.Relationship between liver damage and serum levels of IL-8,TNF-αand NO in patients with acute pancreatitis[J].J South Med Univ,2010,30(8):1912-1914.(in Chinese)梁坚,周宇,王壮,等.急性胰腺炎肝损害与血清IL-18、TNF-α、NO的关系[J].南方医科大学学报,2010,30(8):1912-1914.

[10]HEINRICH S,SCHFER M,ROUSSON V,et al.Evidencebased treatment of acute pancreatitis:a look at established paradigms[J].Ann Surg,2006,243(2):154-168.

[11]HE C,ZHANG L,SHI W,et al.Coupled plasma filtration adsorption combined with continuous veno-venous hemofiltration treatment in patients with severe acute pancreatitis[J].J Clin Gastroenterol,2013,47(1):62-68.

[12]CHU LP,ZHOU JJ,YU YF,et al.Clinical effects of pulse highvolume hemofiltration on severe acute pancreatitis complicated with multiple organ dysfunction syndrome[J].Ther Apher Dial,2013,17(1):78-83.

[13]XU J,TIAN X,ZHANG C,et al.Management of abdominal compartment syndrome in severe acute pancreatitis patients with early continuous veno-venous hemofiltration[J].Hepatogastroenterology,2013,60(127):1749-1752.

施引文献

资源附件(0)

访问统计