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目的:探讨双重血液滤过治疗高脂血症性重症急性胰腺炎(HL-SAP)的效果。方法:51例HL-SAP患者随机分为观察组(26例)和对照组(25例),对照组接受常规治疗,观察组在常规治疗的基础上加用双重血液滤过治疗,比较两组第2、7天的相关疗效指标及并发症发生情况。结果:与治疗前比较,治疗第2天,观察组血甘油三酯(TG)及血、尿淀粉酶水平较治疗前明显降低,大部分血液流变学指标明显改善,炎症因子水平明显降低,前白蛋白明显升高,SIRS评分、APACHE II评分、Ranson评分明显降低(均P<0.05);而对照组除Ranson评分明显降低外,其余指标无明显改善(均P>0.05)。治疗第7天,观察组以上指标均进一步改善,对照组大部分指标也较治疗前明显改善(均P<0.05)。治疗后同时间点比较,观察组以上指标改善程度均优于对照组(均P<0.05)。观察组的并发症发生率明显低于对照组(P<0.05)。结论:双重血液滤过能有效降低TG水平,改善微循环障碍,维持机体促抗炎细胞因子平衡,改善HL-SAP患者预后。
Objective: To investigate the effect of double hemofiltration on hyperlipidemic severe acute pancreatitis (HL-SAP). Methods: Fifty-one patients with HL-SAP were randomly divided into observation group (n = 26) and control group (n = 25). The control group received routine treatment. The observation group was treated with double hemofiltration on the basis of routine treatment. The 2nd and 7th day related curative index and complication occurred. Results: Compared with those before treatment, the levels of triglyceride (TG), blood and urine amylase in the observation group were significantly lower than those before treatment, most of the indexes of hemorheology were significantly improved and the levels of inflammatory cytokines were significantly decreased. Pre-albumin was significantly increased, SIRS score, APACHE II score and Ranson score were significantly decreased (all P <0.05), while the control group had no significant improvement except Ranson score (all P> 0.05). On the 7th day of treatment, the above indexes in the observation group were further improved, and most of the indexes in the control group were also significantly improved (all P <0.05). After treatment at the same time point, the observation group above indicators were better than the control group (P <0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P <0.05). Conclusion: Double hemofiltration can effectively reduce TG levels, improve microcirculation, maintain the balance of pro-inflammatory cytokines, and improve the prognosis of patients with HL-SAP.