连续性静脉-静脉血液透析滤过治疗在重症急性胰腺炎中的效果及对炎性因子表达的影响观察

张静 孟娟

【摘要】 目的：探讨连续性静脉-静脉血液透析滤过治疗在重症急性胰腺炎中的临床效果以及对炎性因子表达的影响。方法：选取2018年2月-2021年4月本院收治的82例重症急性胰腺炎患者，采取电脑随机抽签的方式将其分为对照组和研究组，每组41例。对照组患者行常规治疗方案，研究组患者在对照组治疗基础上加用连续性静脉-静脉血液透析滤过治疗。比较两组疗效、并发症发生情况、治疗前后的炎性因子[肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）]和生化指标[C反应蛋白（CRP）、血肌酐（Scr）、淀粉酶（AMY）和降钙素原（PCT）]。结果：研究组总有效率为92.68%，高于对照组的63.41%，差异有统计学意义（P<0.05）。治疗前，两组TNF-α、IL-6、IL-8、CRP、PCT、Scr、AMY比较，差异均无统计学意义（P>0.05）;治疗后，两组TNF-α、IL-6、IL-8、CRP、PCT、Scr、AMY均低于治疗前，且研究組均低于对照组，差异均有统计学意义（P<0.05）。研究组并发症发生率为7.32%，低于对照组患者的26.83%，差异有统计学意义（P<0.05）。结论：连续性静脉-静脉血液透析滤过治疗重症急性胰腺炎可以清除体内炎性因子，维持机体内环境稳态，降低并发症发生率，提高临床疗效。

【关键词】 连续性静脉-静脉血液透析滤过 重症急性胰腺炎 炎性因子

[Abstract] Objective： To investigate the clinical effect of continuous veno-venous hemodiafiltration in the treatment of severe acute pancreatitis and its effect on the expression of inflammatory factors. Method： A total of 82 patients with severe acute pancreatitis admitted to our hospital from February 2018 to April 2021 were selected， they were randomly divided into control group and study group according to computer lottery， 41 cases in each group. The control group was treated with routine treatment， and the study group was treated with continuous veno-venous hemodiafiltration on the basis of the control group. The therapeutic effect and the incidence of complications were compared between two groups， and the inflammatory factors [tumor necrosis factor-α （TNF-α）， interleukin-6 （IL-6） and interleukin-8 （IL-8）] and biochemical indexes [C-reactive protein （CRP）， serum creatinine （Scr）， amylase （AMY） and procalcitonin （PCT）] before and after treatment were compared between two groups. Result： The total effective rate of the study group was 92.68%， which was higher than 63.41% of the control group， the difference was statistically significant （P<0.05）. Before treatment， there were no significant differences in TNF-α， IL-6， IL-8， CRP， PCT， Scr and AMY between two groups （P>0.05）; after treatment， TNF-α， IL-6， IL-8， CRP， PCT， Scr and AMY of both groups were lower than those before treatment， and those of the study group were lower than those of the control group， the differences were statistically significant（P<0.05）. The incidence of complications of the study group was 7.32%， which was lower than 26.83% of the control group， the difference was statistically significant （P<0.05）. Conclusion： Continuous veno-venous hemodiafiltration in the treatment of severe acute pancreatitis can clear inflammatory factors in the body， maintain the homeostasis of the body， reduce the incidence of complications， and improve the clinical efficacy.

[Key words] Continuous veno-venous hemodiafiltration Severe acute pancreatitis Inflammatory factors

First-author’s address： Weifang Central Blood Station， Weifang 261041， China

doi：10.3969/j.issn.1674-4985.2021.25.008

重癥急性胰腺炎（severe acute pancreatitis，SAP）是临床上极其危重的外科急腹症之一，该病病情发展迅速，并发症发生率高，且死亡率也高。据统计，SAP的发病率约占胰腺炎总发病率的五分之一，而病死率可高达三分之一，并发症发生率高达二分之一[1]。SAP的发病机理主要是指受饮食结构不合理、胆道结石等多种因素导致的胰酶激活并消化自身组织，引起炎症反应[2-3]。……