血液灌流联合血液滤过治疗重症急性胰腺炎

摘要

Objective To study the clinical therapeutic effect of hemoperfusion (HP) combined with continuous veno-venous hemofiltration (CVVH) for treatment of patients with severe acute pancreatitis (SAP) and its possible mechanism. Methods Thirty patients with SAP were randomized to CVVH group (15 cases) or HP +CVVH group (15 cases). The two groups received the same symptomatic supportive therapies and CVVH. Patients in HP+CVVH group received HP combined with CVVH. The changes in vital signs and acute physiology and chronic health evaluation Ⅰ (APACHE Ⅰ ) score were observed before and after treatment. Serum levels of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) were measured by radioimmunity method. Results Both groups showed significant improvement in APACHE Ⅰ score after treatment, especially in HP+CVVH group (9.7±1.2 vs. 12.3±3.3, P＜0.05). There was no difference in TNF-α and IL-6 in two groups before treatment (both P ＞ 0.05). Compared with the results before treatment, the level of IL-6 (ng/L) in CVVH group was decreased after treatment (234± 33 vs. 506±64,P＜0.05), the levels of TNF-α and IL-6 were decreased in HP+CVVH group after treatment [TNF-α (ng/L): 312±24 vs. 835±68, IL-6 (ng/L): 157±26 vs. 533±71], the TNF-α (ng/L) level in HP±CVVH group was significantly lower than that in CVVH group (312±24 vs. 692±65,P＜0.05). Conclusion HP combined with CVVH in the treatment of SAP was more effective in reducing the levels of inflammatory factors and enhancing the therapeutic effects than CVVH performed alone.%目的 观察血液灌流(HP)联合连续性静-静脉血液滤过(CVVH)治疗重症急性胰腺炎(SAP)患者的临床疗效,并探讨其机制.方法 30例SAP患者按随机原则分为CVVH组和HP+CVVH组,每组15例.两组内科常规对症支持治疗及CVVH方法相同,HP+CVVH组采用HP联合CVVH治疗.观察治疗前后生命体征及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化,用放射免疫法检测肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平.结果 两组治疗后APACHEⅡ评分(分)均有下降趋势,且HP+CVVH组下降更明显(9.7±1.2比12.3±3.3,P＜0.05).两组治疗前血TNF-α、IL-6比较差异无统计学意义(均P>0.05).治疗后CVVH组仅IL-6(ng/L)较治疗前明显下降(234±33比506±64,P<0.05);HP+CVVH组TNF-α、IL-6均较治疗前明显下降(TNF-α(ng/L):312±24比835±68,IL-6(ng/L):157±26比533±71),且TNF-α(ng/L)明显低于CVVH组(312±24比692±65,P<0.05).结论 HP联合CVVH可有效降低炎症因子水平,提高患者治疗效果.