配对血浆滤过吸附治疗在高脂血症性急性重症胰腺炎中的临床观察.docVIP

配对血浆滤过吸附治疗在高脂血症性急性重症胰腺炎中的临床观察 　　[摘要] 目的 观察配对血浆滤过吸附（CPFA）治疗高脂血症性急性重症胰腺炎（HLAP）患者的临床效果。 方法 选取2014年1月～2016年2月在梅州市人民医院重症医学科住院治疗的32例HLAP患者，按随机数字表法分为治疗组（16例）和对照组（16例）。治疗组采用CPFA治疗，对照组采用血浆置换（PEX）治疗。比较治疗前与治疗5 d后两组患者临床症状改善情况、临床急性生理学及慢性健康状况评分（Apache Ⅱ）、生化指标（三酰甘油、脂肪酶、血淀粉酶）及C反应蛋白等指标变化；比较两种治疗方法对血细胞和凝血酶原时间的影响以及高热、皮疹的发生率。 结果 两组治疗前及治疗5 d心率、呼吸频率、平均动脉压的改善情况及腹痛消失时间、压痛消失时间比较，差异无统计学意义（均P 0.05）；而同组患者治疗5 d与治疗前比较，心率、呼吸频率、平均动脉压差异均有统计学意义（均P 0.05），而同组患者治疗5 d与治疗前比较，上述指标差异均有统计学意义（均P 0.05）；而治疗5 d后，两组血小板、血红蛋白水平均较治疗前下降，凝血酶原时间较治疗前延长，差异均有统计学意义（均P 0.05）。治疗组并发症发生率明显低于对照组，差异有统计学意义（P 0.05）。 结论 CPFA与PEX均可很好地改善HLAP患者的临床症状和实验室检验指标，但CPFA比PEX血细胞破坏少，减少输注血液制品的风险，值得在临床上推广应用。 　　[关键词] 配对血浆滤过吸附；血浆置换；高脂血症；急性重症胰腺炎 　　[中图分类号] R576 [文献标识码] A [文章编号] 1674-4721（2016）09（a）-0051-04 　　[Abstract] Objective To observe the clinical effect of coupled plasma filtration adsorption （CPFA） in the treatment of patients with hyperlipidemic acute pancreatitis （HLAP）. Methods A total of 32 patients with HLAP treated in Intensive Care Unit of Meizhou People′s Hospital were enrolled in this study from January 2014 to February 2016. The patients were randomly divided into the treatment group （n=16） and the control group （n=16）. Treatment group was treated with CPFA and control group was treated with plasma exchange （PEX）. Clinical symptoms improved conditions， clinical acute physiology and chronic health evaluation （Apache Ⅱ）， biochemical indicators including levels of triglycerides， lipase and serum amylase and C-reactive protein level were compared between the two groups before and after 5 days treatment. Furthermore， blood cell counts， prothrombin time and incidence of hyperpyrexia and skin rash of patients in the two gorups were also compared. Results There were no statistically significant differences in clinical symptoms such as heart rate， breathing rate， mean arterial pressure， abdominal pain disappear time and abdominal tenderness disappear time beween the two groups before treatment and 5 d after treatment （P 0.05）； b