摘要
目的探讨早期血浆置换联合连续性肾脏替代疗法(CRRT)在重症急性胰腺炎(SAP)患者中的应用效果。方法选取2016年3月至2018年9月青岛大学附属医院ICU和急诊ICU收治的135例SAP患者,按住院号末位的奇偶数将其分为常规组(69例)和血浆置换组(66例),常规组入科后立即行CRRT治疗72 h,血浆置换组入科后立即行血浆置换联合CRRT治疗72 h。比较两组患者的治疗效果、住院时间、血清学相关指标、并发症发生率及平均滤器寿命。结果血浆置换组患者治疗有效率明显优于常规组[87.88%(58/66)vs.65.22%(45/69),χ^2=9.579,P=0.002]。血浆置换组患者住院时间明显短于常规组[(11.4±1.5)d vs.(21.3±2.8)d,t=2.979,P=0.004]。治疗后,血浆置换组患者血清学相关指标血清淀粉酶[(103±24)U/L vs.(267±60)U/L,t=2.419,P=0.021]、C反应蛋白[(51±8)mg/L vs.(129±19)mg/L,t=4.574,P<0.001]、白细胞计数水平[(8.9±0.5)×10^9/L vs.(11.5±1.0)×10^9/L,t=2.059,P=0.046],以及并发症急性呼吸窘迫综合征[6.06%(4/66)vs.34.78%(24/69),χ^2=16.930,P<0.001]、多器官功能障碍综合征[7.58%(5/66)vs.30.43%(21/69),χ^2=11.340,P<0.001]和胰性脑病的发生率[9.09%(6/66)vs.39.13%(27/69),χ^2=16.480,P=0.002]均明显低于常规组。同时,血浆置换组平均滤器寿命明显长于常规组[(24.7±2.3)h vs.(12.1±1.4)h,t=4.829,P<0.001]。结论血浆置换联合CRRT治疗SAP患者疗效显著,能够明显改善患者的临床症状及血清学相关指标,减少并发症的发生率,延长滤器寿命,提高体外循环治疗质量,值得临床推广应用。
Objective To investigate the effect of early plasma exchange combined with continuous renal replacement therapy(CRRT)in the treatment of patients with severe acute pancreatitis(SAP).Methods A total of 135 SAP patients admitted to the ICU and Emergency ICU of Affiliated Hospital of Qingdao University between March 2016 and September 2018 were randomly divided into the routine group(69 cases)and plasma exchange group(66 cases)according to their hospital numbers.Patients in the routine group were treated with CRRT immediately after admission for 72 h,and patients in the plasma exchange group were treated with plasma exchange and CRRT for 72 h.The therapeutic effect,hospitalization time,serological indicators,incidence of complications,and average filter life were compared between the two groups.Results The therapeutic effect was significantly better in the plasma exchange group than in the routine group[87.88%(58/66)vs.65.22%(45/69),χ^2=9.579,P=0.002].The hospitalization time was significantly shorter in the plasma exchange group than in the routine group[(11.4±1.5)d vs.(21.3±2.8)d,t=2.979,P=0.004].The levels of serum amylase[(103±24)U/L vs.(267±60)U/L,t=2.419,P=0.021],C-reactive protein[(51±8)mg/L vs.(129±19)mg/L,t=4.574,P<0.001]and white blood cell[(8.9±0.5)×10^9/L vs.(11.5±1.0)×10^9/L,t=2.059,P=0.046]after treatment and the incidence of acute respiratory distress syndrome[6.06%(4/66)vs.34.78%(24/69),χ^2=16.930,P<0.001],multiple organ dysfunction syndrome[7.58%(5/66)vs.30.43%(21/69),χ^2=11.340,P<0.001]and pancreatic encephalopathy[9.09%(6/66)vs.39.13%(27/69),χ^2=16.480,P=0.002]in the plasma exchange group were significantly lower than those in the routine group.The average filter life of the plasma exchange group was significantly longer than that of the routine group[(24.7±2.3)h vs.(12.1±1.4)h,t=4.829,P<0.001].Conclusions Plasma exchange combined with CRRT is effective in the treatment of SAP and worthy of clinical application.It can significantly improve patients'clinical symptoms and serum test results,reduce the incidence of complications and prolong the filter life,thereby improving the quality of extracorporeal circulation therapy.
作者
谢佩佩
杨富国
潘新亭
张成林
宋婧宇
Xie Peipei;Yang Fuguo;Pan Xinting;Zhang Chenglin;Song Jingyu(Department of Emergency Internal Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Qingdao University School of Nursing,Qingdao 266071,China;Department of Emergency Intensive Care Unit,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Transplantation Care Unit,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)
出处
《中华危重症医学杂志（电子版）》
CAS
CSCD
2019年第5期301-305,共5页
Chinese Journal of Critical Care Medicine:Electronic Edition
基金
国家自然科学基金面上项目（81870440）
关键词
重症急性胰腺炎
血浆置换
连续性肾脏替代疗法
Severe acute pancreatitis
Plasma Exchange
Continuous renal replacement therapy
