Clinical efficacy of hemoperfusion combined with low molecular weight heparin for HLAP based on APACHE Ⅱ score and its impact on inflammatory response
-
摘要: 目的:探讨血液灌流联合低分子肝素治疗高脂血症性急性胰腺炎(HLAP)的临床疗效以及对机体炎症反应的影响。方法:本研究为一项单中心、非盲、前瞻性研究,纳入2016年1月-2020年2月期间我院收治确诊的68例HLAP患者作为研究对象,入组患者按照随机数字法分为观察组与对照组,每组各34例。两组均接受常规治疗,在此基础上,对照组加用低分子肝素治疗,观察组接受低分子肝素治疗外加用血液灌流治疗。分别评估和检测两组患者治疗前、治疗后第1天、第3天及第7天APACHEⅡ评分、TNF-α、CRP、IL-6与血清三酰甘油(TG)水平变化。以及比较两组患者的临床疗效。结果:治疗前,观察组和对照组除了IL-6以外,其余指标均差异无统计学意义(P>0.05)。观察组和对照组的各指标在治疗后第1天、第3天和第7天,均呈下降趋势,组内比较均差异有统计学意义(P<0.05)。在组间比较中,观察组各指标均低于对照组,除TG外,均差异有统计学意义(P<0.05)。观察组患者的住院时间和并发MODS比例均低于对照组(P<0.05)。结论:血液灌流联合低分子肝素治疗HLAP患者可有效降低APACHEⅡ评分,减轻炎症反应,改善TG水平,提高了临床疗效。Abstract: Objective: To explore the clinical efficacy of hemoperfusion combined with low molecular weight heparin for hyperlipidaemic acute pancreatitis based on APACHE Ⅱ, and impact of inflammatory response.Methods: This study was a single-center prospective study.A total of 68 patients with HLAP who admitted to our hospital from January 2016 to February 2020 were recruited in our study.They were randomly divided into observation group and control group, 34 cases in each group respectively.Both groups were treated with conventional therapy.In addition, The control group was treated with low molecular weight heparin, While observation group was treated with low molecualr weight heparin and hemoperfusion.We assessed and examined APACHE score, the level of TNF-a,CRP,IL-6 and triglyceride(TG) between two groups pre-treatment, 1 st day, 3 rd day and 7 th day of post-treatment.Results: There were no statistically significant differences between the observation group and the control group except for IL-6(P>0.05) before treatment. In the intra-group comparison, no matter the observation group or the control group, all indicators showed a downward trend on the 1 st, 3 rd and 7 th day after treatment, and the difference was statistically significant(P<0.05). In the comparison between groups, all indexes in the observation group were lower than those in the control group, with the exception of TG, the difference was statistically significant(P<0.05).Conclusion: Hemoperfusion combined with low molecular weight heparin was effective in reducing the APACHE Ⅱ scores, and its clinical efficacy significantly, and can alleviated inflammatory response, improved TG level.
-
-
[1] 徐震林.低分子肝素联合乌司他丁治疗急性胰腺炎的效果观察[J].西南国防医药,2017,27(12):1262-1265.
[2] 王琦,卢光新,胡俊华,等.床旁血浆置换联合血液滤过治疗高脂血症性重症急性胰腺炎的临床分析[J].中华胰腺病杂志,2018,18(5):343-345.
[3] 中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中华外科杂志,2015,53(1):50-53.
[4] 张晓飞,李亚斌,王塬.血液灌流联合血液滤过对高脂血症胰腺炎患者生命体征的恢复效果评价[J].河北医药,2017,39(3):425-427.
[5] Adiamah A,Psaltis E,Crook M,et al.A systematic review of the epidemiology,pathophysiology and current management of hyperlipidaemic pancreatitis[J].Clin Nutr,2018,37(6 Pt A):1810-1822.
[6] 张文凯,李长罗,柴湘平.高脂血症性急性胰腺炎的研究进展[J].中国急救复苏与灾害医学杂志,2018,13(2):189-192.
[7] 郑丹,蒋永泼,张胜,等.高脂血症重症急性胰腺炎的临床特征分析[J].浙江医学,2017,39(22):2002-2004.
[8] 马江辰,保志军.高脂血症性急性胰腺炎发病机制的研究进展[J].国际消化病杂志,2017,37(1):24-27.
[9] 李龙辉,刘岩,李学春,等.低分子肝素治疗高脂血症性重症急性胰腺炎对血脂和血液流变学的影响[J].解放军医药杂志,2017,29(9):75-77,102.
[10] 戴琳琳,崔颖.低分子肝素抗凝治疗对ICU脓毒症患者凝血功能和炎症反应的影响[J].河北医科大学学报,2018,39(1):100-104.
[11] 黄书哲,郭应军,李安.低分子肝素联合床旁持续血液滤过对高脂血症性胰腺炎的临床效果观察[J].吉林医学,2020,41(2):304-306.
[12] 韩莉,康焰.急性生理功能和慢性健康状况评分系统Ⅱ和Ⅳ对192例重度急性胰腺炎死亡风险预测的比较[J].中华消化杂志,2016,36(3):177-181.
[13] 蒋晓岚,杨帆,王春晖,等.高脂血症性急性胰腺炎血清细胞因子水平与病情严重程度的相关性[J].西部医学,2017,29(4):489-493,498.
[14] Gao N,Yan C,Zhang G.Changes of Serum Procalcitonin (PCT),C-Reactive Protein (CRP),Interleukin-17 (IL-17),Interleukin-6 (IL-6),High Mobility Group Protein-B1 (HMGB1) and D-Dimer in Patients with Severe Acute Pancreatitis Treated with Continuous Renal Replacement Therapy (CRRT) and Its Clinical Significance[J].Med Sci Monit,2018,24:5881-5886.
[15] 于涛,陈雁林.低分子肝素联合血液灌流治疗高脂血症性胰腺炎的效果观察[J].医学理论与实践,2016,29(12):1598-1599.
[16] 朱亚男,刘玲,王娟,等.高脂血症性胰腺炎炎性指标的特点分析[J].中国中西医结合消化杂志,2017,25(11):51-54.
[17] 陈俞兵,周宇,申屠刚.胰岛素联合低分子肝素治疗高脂血症性急性胰腺炎的临床效果及安全性分析[J].中国中西医结合消化杂志,2020,28(5):52-55.
-
计量
- 文章访问数: 271
- PDF下载数: 68
- 施引文献: 0
下载: