持续血液净化联合糖皮质激素治疗重症胰腺炎并发呼吸窘迫综合征的临床效果研究

摘要

Objective:To study the clinical effect of blood purification and sustained glucocorticoid therapy on severe pancreatitis with respiratory distress syndrome,for providing clinical reference for such concomitant diseases.Methods:A total of 132 patients from April 2012 to June 2014in our hospital with severe pancreatitis and respiratory distress syndrome were studied,they were randomly divided into two groups,patients in the two groups were given conventional anti-infective,gastrointestinal decompression,rehydration therapy and other infrastructure,the control group were treated with continuous blood purification treatment,the observation group were treated with continuous blood purification and high-dose dexamethasone,the clinical symptoms,laboratory indicator in time,the levels of inflammatory cytokines,the APACHE Ⅱ scores and MODS scores and survival were compared.Results:The time of abdominal distention disappeared,blood amylase,urine amylase and pancreatic edema improvement in observation group was significantly improved than the control (P＜0.05);when compared with before,the CRP,IL-6,IL-8 and TNF-α of two groups were significantly decreased,and the index in observation group decreased more significantly,the difference was statistically significant (P＜0.05);when compared with before,the score of APACHE Ⅱ and MODS were significantly lower than control,the difference was statistically significant(P＜0.05);The final survival rate in observation group was 90.8％,which significantly higher than 61.5％ in control,the difference was statistically significant(P＜0.05).Conclusion:The effect of continuous blood purification combined with glucocorticoids (eg dexamethasone) in patients with severe pancreatitis and respiratory distress syndrome is remarkable,the clinical symptoms can significantly improved,the levels of inflammatory factors,effective recovery laboratory indicators,APACHE Ⅱ score and MODS score were decreased,the survival was higher,it was worthy of clinical use.%目的:探讨持续血液净化与糖皮质激素联合治疗重症胰腺炎并发呼吸窘迫综合征的临床效果.方法:对201 2年4月-2014年6月我院治疗的1 32例重症胰腺炎并发呼吸窘迫综合征患者随机分为两组,均给予常规抗感染、胃肠减压、补液等基础治疗.在此基础上,对照组患者采用持续血液净化进行治疗;观察组在持续血液净化的同时,给予大剂量地塞米松.比较两组患者临床表现、治疗前后炎症因子浓度变化、治疗前后APACHEⅡ评分和MODS评分以及两组患者的存活率.结果:治疗后,观察组腹痛腹胀消失时间、血液淀粉酶恢复时间、尿液淀粉酶恢复时间和胰腺水肿改善时间等均显著少于对照组(P＜0.05);与治疗前比较,两组患者的炎症因子如CRP、IL-6、IL-8和TNF-a水平均明显下降,且观察组下降的更多,两组差异有统计学意义(P＜0.05);与治疗前比较,治疗后两组患者的APACHEⅡ评分和MODS评分均明显降低,且观察组低于对照组(P＜0.05);观察组1年存活率为90.8％,对照组1年存活率为61.5％,两组比较差异有统计学意义(P＜0.05).结论:持续血液净化联合糖皮质激素治疗重症胰腺炎并发呼吸窘迫综合征可以明显改善患者的临床症状,降低炎症因子水平,有效恢复实验室检测指标,明显降低APACHE Ⅱ评分和MODS评分,患者存活率更高.