目的：观察早期血液灌流（HP）联合连续静脉-静脉血液滤过（CVVH）对高脂血症性重症急性胰腺炎（HLSAP）的治疗效果。方法39例HLSAP患者随机分为2组：HP+CVVH组（A组，n=19），对照组（B组，n=20）。在常规治疗基础上，A组加用HP联合CVVH治疗。观察治疗前后两组患者的心率（HR）、血压（BP）、氧合指数（PaO2/FiO2）、血清甘油三酯（TG）、白介素-6（IL-6）、C反应蛋白（CRP）等指标变化，并进行APECHA-Ⅱ动态评分，比较两组治愈率及ICU住院天数。结果经HP+CVVH治疗72h后，HR、BP趋于稳定，症状明显改善， APECHA-Ⅱ评分明显下降[（13.2±2.5）vs（18.5±2.7）,P＜0.05]，TG、IL-6、CRP亦明显下降[（6.4±3.5）vs （37.5±6.9）,（53.1±7.6）vs（97.5±11.2）,（31.3±6.3）vs（67.4±10.3）,均P＜0.05]。A组ICU平均住院时间明显缩短（13d vs 18d，P＜0.05），死亡率明显减少（0 vs 12.5%, P＜0.05）。结论早期经HP联合CVVH对治疗HLSAP有明显效果，能有效改善患者病情及预后，减少ICU住院时间，降低死亡率。%Objective To observe the treatment effect of Hemoperfusion(HP) combined continuous veno-venous hemofiltration(CVVH) in patients with hyperlipidemic severe acute pancreatitis(HLSAP). Methods Thirty-nine HLSAP patients were randomly divided into two groups:HP+CVVH group (A,n=19) and control group (B,n=20). Both groups underwent conventional therapy, and patients in group A additionally underwent HP+CVVH. Heart rate(HR), respiration, PO2/FiO2, triglyceride(TG), IL-6 and CRP were monitored. APACHEⅡscore was used to evaluate patients'condition. The survival rate and the avrage ICU hospitalization days were compared between the two groups. Results After treatment by HP+CVVH, HR, respiration, APACHE Ⅱ[(13.2±2.5) vs (18.5±2.7),P<0.05] as well as serum levels of TG, IL-6 and CRP[(6.4±3.5) vs (37.5±6.9), (53.1±7.6) vs (97.5±11.2), (31.3±6.3) vs (67.4±10.3), all P < 0.05] decreased significantly. In group A,the ICU length of hospital stay were significantly decreased (13 vs 18, P < 0.05). Compared to group B, group A had a lower mortality rate (0 vs 12.5%, P<0.05). Conclusion HP+CVVH is effective in treating HLSAP and is associated with a lower case fatality rate, also can reduce the ICU length of hospital stay.
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