连续性血液净化对重症急性胰腺炎合并MODS患者血液流变学、血清炎症因子的影响

摘要

目的 探讨连续性血液净化(continuous blood purification,CBP)对重症急性胰腺炎(sever acute pancreatitis,SAP)合并MODS(多器官功能障碍综合征)患者血液流变学及血清炎症因子的影响.方法 以我院68例重症急性胰腺炎合并MODS患者为研究对象,根据是否使用CBP治疗分为对照组(30例)与观察组(38例),对照组予以常规维持水电解质及酸碱平衡、抗感染等治疗,治观察组在对照组常规治疗基础上使用CBP,检测治疗前后的血流动力学指标,包括血沉(ESR)、红细胞比容(HCT)、血浆粘度(ηp)、全血还原粘度(ηLr)并检测治疗前后肿瘤坏死因子(TNF-α)、IL-6(白介素-6)、IL-8、CRP(超敏C反应蛋白)等水平,同时观察两组肝肾、心肺等重要脏器功能变化.结果 对照组3例死亡,观察组1例死亡,两组血液流变学比较:两组ESR、HCT、ηp、ηLr较治疗前均显著下降,且观察组下降幅度均明显高于对照组,差异均具有统计学意义(P＜0.05);血清炎性指标比较:两组TNF-α、IL-6、IL-8及CRP较治疗前均显著下降,且观察组下降幅度明显高于对照组,差异均具有统计学意义(P＜0.05);肝、肾、心、肺等脏器功能指标比较:两组功能指标较治疗前均显著改善,观察组改善显著,差异均具有统计学意义(P＜0.05).两组发热恢复时间差异无统计学意义(P＞0.05),但观察组腹痛、恶心呕吐及淀粉酶恢复正常时间、APACHE Ⅱ评分均明显短于对照组,差异均具有统计学意义(P＜0.05).结果 连续血液净化可迅速改善重症急性胰腺炎合并MODS患者临床腹胀、腹痛及恶心呕吐等症状,并改善机体血液流变学,提高氧供,降低炎性反应,保护肝肾等重要脏器,提高患者预后.%Objective To investigate the effect of continuous blood purification (CBP) on hemorheology and serum inflammatory factors in patients with severe acute pancreatitis(SAP) complicated with multiple organ dysfunction syndrome (MODS).Methods 68 cases of patients with SAP complicated with MODS were enrolled in the study.According to the use of CBP,the patients were divided into the control group (30 cases) and the observation group(38 cases).The control group was given routine maintenance of water-electrolyte and acidbase balance,as well as anti-infection treatment.In addition,the observation group were treated with CBP.The hemodynamic indexes were detected before and after treatment,including erythrocyte sedimentation rate (ESR),hematocrit(HCT),plasma viscosity (ηp) and whole blood viscosity (ηLr).Levels of tumor necrosis factor(TNF-α),interleukin-6(IL-6),IL-8 and high sensitivity C reactive protein(CRP) were also detected before and after treatment.Changes of liver and kidney,heart and lung function in two groups were observed.Results There were 3 cases of death in the control group and 1 case in the observation group.After treatment,ESR,HCT,ηp and ηL rdecreased significantly in two groups,and the decrease was more significant in the observation group than in the control group(P ＜0.05).After treatment,levels of TNF-α,IL-6,IL-8 and CRP decreased significantly in two groups,and the decrease was more significant in the observation group than in the control group (P ＜ 0.05).After treatment,the liver,kidney,heart and lung function indexes in two groups were significantly improved,and the improvement was more significant in the observation group (P ＜ 0.05).There was no significant difference between the two groups in the recovery time from fever(P ＞ 0.05).The relief time of abdominal pain,nausea and vomiting,amylase recovery time and APACHE Ⅱ score in the observation group were significantly shorter or lower than those in the control group (P ＜ 0.05).Conclusion Continuous blood purification can rapidly relieve symptoms such as abdominal distension,abdominal pain,nausea and vomiting in patients with SAP complicated with MODS.It can also improve hemorheology and oxygen supply,reduce inflammatory reactions,protect important organs such as liver and kidney,and improve the prognosis of patients.