[目的]探讨床边血浆置换治疗重症高脂血症性急性胰腺炎 (HLAP)的临床疗效.[方法]本院确诊为重症HLAP患者44例,随机分为观察组和对照组,每组各22例;对照组采用常规综合治疗,观察组在常规综合治疗的基础上行床边血浆置换,观察血浆置换的安全性,对两组患者治疗前后血清甘油三酯(TG)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、血气氧合指数、Balthazar CT评分、急性生理和慢性健康状况评分(APACHEⅡ)、住院时间等指标进行比较.[结果]观察组患者血浆置换后发生轻微并发症3例,无严重并发症;观察组治疗后d3、d7 的TG、TNF-α和IL-6水平明显低于对照组,氧合指数、胸腔积液量和APACHEⅡ评分比较观察组优于对照组,且差异均有显著性(P<0.05);治疗d7观察组Balthazar CT评分明显低于对照组,且差异有显著性(P<0.05);观察组机械通气时间和住院时间均少于对照组(P<0.05).[结论]床边血浆置换治疗重症HLAP具有良好的安全性,其疗效显著.%[Objective]To explore the clinical efficacy of bedside plasma exchange in the treatment of severe hyperlipidemic acute pancreatitis(HLAP). [Methods] Forty-four patients confirmed as severe HLAP were randomly divided into observation group and control group with 22 cases in each group. The control group was treated with conventional therapy, while the observation group was given bedside plasma exchange based on conventional therapy. The safety of plasma exchange was observed. Serum triglyceride(TG) , tumor necrosis factor alpha(TNF-α) , inter-leukin-6(IL-6) , blood gas, Balthazar CT score, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and length of hospital stay in two groups were compared between before and after treatment. [Results] There was no serious complication besides 3 cases of minor complications in the observation group. The levels of TG, TNF-α and IL-6 in the observation group were significantly lower than those in the control group on the 3rd and 7th day of treatment ( P <0. 05). Oxygenation index, pleural effusion volume and APACHE Ⅱ score in the observation group were better than those in the control group, and there were significant differences( P <0. 05). Balthazar CT score in the observation group was significantly lower than that in the control group on the 7th day of treatment( P <0. 05). Mechanical ventilation time and length of hospital stay in the observation group were less than those in the control group ( P < 0. 05). [Conclusion] Bedside plasma exchange for the treatment of severe HLAP has good safety and significant efficacy.
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