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连续性血液净化治疗重症急性胰腺炎的临床观察

作者:张贺川 王玉东

所属单位:河南省驻马店市中心医院急诊科 (河南 驻马店 463000)

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摘要

目的 观察连续性血液净化(CBP)对重症急性胰腺炎(SAP)患者肠道屏障功能的影响。方法 选取我院收治的60例SAP 患者为研究对象,随机分为CBP治疗组和对照组,每组各30例,对照组予以常规治疗,CBP治疗组在对照组的基础 上给予CBP治疗,两组均治疗1周。比较两组的临床疗效,采用分光光度法检测二胺氧化酶(DAO)、D-乳酸和内毒素 水平,比较两组的肠道屏障功能,采用酶联免疫法检测血清肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)、白介 素-8(IL-8)D等炎性因子水平。结果 CBP治疗组治疗总有效率为90.00%,对照组的治疗总有效率为83.33%,差异 具有统计学意义(P<0.05);治疗后,两组的DAO、D-乳酸、内毒素水平与炎性因子水平均有下降,且CBP治疗组的 DAO、D-乳酸、内毒素水平与TNF-α、IL-6、IL-8水平低于对照组,差异具有统计学意义(P<0.05)。结论 CBP可通 过降低SAP患者体内炎性因子水平,改善肠道屏障功能,显著提高治疗SAP的疗效,具有一定的临床意义。

Objective To observe the effects of continuous blood purification (CBP) on intestinal barrier function in patients with severe acute pancreatitis (SAP). Methods 60 patients with SAP admitted to our hospital were selected for the study and were randomly divided into CBP treatment group and control group, with 30 cases in each group. Control group was given routine treatment, and CBP treatment group was given CBP treatment on the basis of control group, and the two groups were treated for 1 w. The clinical efficacy of the two groups was compared. The levels of diamine oxidase (DAO), D-lactic acid and endotoxin were measured by spectrophotometry. The intestinal barrier function of the two groups was compared. The levels of inflammatory factors of serum tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and interleukin-8 (IL-8) were detected by enzyme-linked immunosorbent assay. Results The total effective rate of treatment was 90.00% in CBP treatment group and 83.33% in control group (P<0.05). After treatment, the levels of DAO, D-lactic acid and endotoxin and the levels of inflammatory factors in the two groups were decreased, and the levels of DAO, D-lactic acid, endotoxin and TNF-α, IL-6 and IL-8 in CBP treatment group were lower than those in control group (P<0.05). Conclusion CBP can improve the intestinal barrier function by reducing the levels of inflammatory factors in SAP patients, and it can significantly improve the efficacy of SAP, and it has certain clinical significance.

【关键词】重症急性胰腺炎;连续性血液净化;肠道屏障功能;影响

【中图分类号】R657.5+1;R459.5

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2019.01.026

前言

胰腺炎是指胰腺因胰蛋白酶的消化作用而引起的 水肿、充血、出血的疾病,临床以腹痛、腹胀、恶 心、呕吐、发热等为典型症状,且血尿中淀粉酶含 量会显著升高。SAP是该病的急性发病加重期,发病 急、病情凶险、并发症多,严重威胁人类的生命健 康。SAP患者在发病的早期阶段及时运用CBP治疗,可 有效控制病情发展,清除多种有害介质,避免了患者 心、肝、肾等重要器官的持续性伤害,王顺等[1]采用CBP治疗重症急性胰腺炎合并急性肾损伤,取得满意 效果。本研究采用早期CBP治疗SAP患者,并观察血清 DAO、D-乳酸和内毒素水平,以探讨CBP治疗对SAP患 者肠道屏障功能的影响,现报告如下。