CVVH与血浆置换治疗妊娠期高脂血症性胰腺炎的疗效观察

摘要

目的 探讨并比较连续性血液滤过(continuous veno-venous hemofiltration,CVVH)与CVVH联合血浆置换(plasma exchange,PE)2种治疗方式在治疗妊娠期高脂血症性胰腺炎(hyperlipid-emic acute pancreatitis in pregnancy,HLAPIA)中的临床疗效. 方法 郑州大学附属洛阳市中心医院2011年5月到2017年5月被收治入院的妊娠期高脂血症性胰腺炎30例病例,随机分为2组,均给予常规内科治疗.CVVH组另予持续血液滤过,疗程5d;CVVH+PE组另予持续血液滤过,疗程5d,同时予以血浆置换3次.比较2组患者治疗有效率、症状缓解时间、禁食时间、住院时间及相关实验室血液指标之间的差异. 结果 CVVH+PE组的治疗有效率为93.33％,高于CVVH组53.33％,且2组间有统计学差异(P=0.035).CVVH+PE组症状缓解时间(t=3.850,P＜0.001)、禁食时间(t=5.290,P＜0.001)与住院时间(t=4.890,P＜0.001)均显著低于CVVH组,差异有统计学意义.治疗后,CVVH+PE组的白细胞(t=4.870,P＜0.001)、C反应蛋白(t=10.390,P＜0.001)、三酰甘油(t=5.230,P＜0.001)、总胆固醇(t=-5.370,P＜0.001)明显低于CVVH组,而2组之间的淀粉酶(amylase AMY)、脂肪酶(lipase LPS)则无明显差异.%Objective To study the prognosis of hyperlipidemic acute pancreatitis in pregnancy (HLAPIP) patients treated by continuous veno-venous hemofiltration (CVVH) or CVVH plus plasma exchange (PE).Methods We recruited 30 patients diagnosed with HLAPIP in Luoyang Central Hospital,Zhengzhou University and randomly divided them into 2 groups.The CVVH group received CVVH for 5 days,and the CVVH+PE group received plasma exchange 3 times in addition to CVVH5 for 5 days.We then compared treatment efficiency,symptom alleviating time,fasting time,hospitalization days and laboratory blood indices between the two groups.Results The treatment efficiency is 93.33％ in CVVH + PE group,higher than 53.33％ (P=0.035) in CVVH group.The symptom alleviating time (t =3.850,P＜0.001),fasting time (t =5.290,P＜0.001),hospitalization days (t =4.890,P＜0.001) are shorter in CVVH+PE group than in CVVH group.After the treatment,white blood cell (t =4.870,P＜0.001),C response protein (t=10.390,P＜0.001),triglyceride (t =5.230,P＜0.001) and total cholesterol (t =5.370,P＜0.001) are lower in CVVH+PE group than in CVVH group;while amylase and lipase have no significant differences between the two groups.