血浆置换联合连续性血液净化治疗妊娠合并高脂血症性急性重症胰腺炎

摘要

Objective To observe the effect of therapeutic plasma exchange (PE) combined with continuous renal re-placement therapy (CRRT) in treatment of gestational hyperlipidemia acute severe pancreatitis. Methods A total of 29 cases of gestational hyperlipidemia acute severe pancreatitis patients were divided into two groups. The control group with 11 cases accepted the traditional treatment while the treatment group with 18 cases accepted PE combined with CRRT based on the traditional treatment. The acute physiology and chronic health evaluation score, days of abrosia and hospital-ization, and the level of plasma triglyceride(TG) and total cholesterol(TC) at 48 hours after postoperative were compared. Results The score of APACHE, days of abrosia and hospitalization of the treatment group were significantly fewer than the control group (t=3.61,4.58,3.95,P<0.05). The levels of TG and TC of the treatment group were significantly lower than the control group at 6 days after postoperative (t=3.16, 4.16, P<0.05). The levels of TG and TC of two groups were significantly decreased after therapy (t=5.12, 6.02, 3.12, 3.02, P<0.05). One patient in the control group died of multi-ple organs failure induced by infection while none of treatment group was died. Conclusions PE combined with CRRT treatment can quickly reduce TG and TC levels. It’s a safe and effective way to cure gestational hyperlipidemia acute se-vere pancreatitis.%　　目的探讨血浆置换联合连续性血液净化治疗妊娠合并高脂血症性急性重症胰腺炎的疗效。方法回顾29例妊娠合并高脂血症性急性重症胰腺炎患者资料，按收治时间分组：对照组（n=11）行传统的胰腺炎治疗，治疗组（n=18）在传统治疗同时行血浆置换联合连续性血液净化治疗，观察两组患者治疗前后48 h急性生理和慢性健康评价指标Ⅱ（APACHEⅡ）评分、禁食天数、住院天数、治疗前后血清甘油三酯、总胆固醇水平。结果治疗组治疗48 h后APACHEⅡ评分明显低于对照组，禁食天数及住院天数明显少于对照组，差异均有统计学意义（t分别=3.61、4.58、3.95，P均＜0.05）；治疗组甘油三酯及总胆固醇水平治疗6 d后均明显低于对照组，差异均有统计学意义（t分别=3.16、4.16，P均＜0.05）；两组治疗后血清甘油三酯、总胆固醇水平较治疗前均降低，差异均有统计学意义（t分别=5.12、6.02、3.12、3.02，P均＜0.05）；治疗组无产妇死亡；对照组1例产妇死亡，死于感染并发多脏器功能衰竭。结论血浆置换联合连续性血液净化可以迅速降低甘油三酯及总胆固醇，是治疗妊娠并高脂血症性急性重症胰腺炎安全而有效的方法之一。