中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (08): 509-512.doi: 10.3969/j.issn.1671-4091.2020.08.002

• 临床研究 • 上一篇    下一篇

早期血浆置换对非轻症高三酰甘油血症性胰腺炎患者临床结局的影响

占凌辉1,陆程翔1,王萍萍1,郭雪玲1,罗雁1,苏文松1   

  1. 1厦门大学附属中山医院重症医学科
  • 收稿日期:2020-03-10 修回日期:2020-05-08 出版日期:2020-08-12 发布日期:2020-08-12
  • 通讯作者: 占凌辉 oriental_power00@163.com E-mail:oriental_power00@163.com

The effect of plasma exchange at early disease stage on clinical outcome of the patients with non-mild hypertriglyceridemic pancreatitis

  1. 1Department of Critical Medicine, Zhongshan Hospital, Xiamen University, Xiamen 361004, China
  • Received:2020-03-10 Revised:2020-05-08 Online:2020-08-12 Published:2020-08-12

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摘要： 【摘要】目的观察早期血浆置换对非轻症高三酰甘油血症性胰腺炎患者临床结局的影响。方法选择2013 年8 月～2019 年8 月于厦门大学附属中山医院重症医学科收治行血浆置换(plasma exchange，PE)治疗的非轻症高三酰甘油血症性胰腺炎患者67 例，根据患者腹痛后48h 以内是否行接受PE治疗，分为早期PE 组(n=33)和晚期PE 组(n=34)。收集所有患者病史、检查和治疗资料，观察并记录患
者住院期间是否存在死亡、器官功能衰竭、腹腔内高压、急性胰周液体积聚、急性胰腺坏死、胰腺假性囊肿、感染性胰腺坏死、外科手术干预,统计患者ICU 住院时间、总住院时间和住院费用。采用SPSS 19.0软件对结果进行统计学分析。结果与晚期PE 组相比，早期PE 组患者的急性胰腺坏死、胰腺假性囊肿、手术干预、短暂性器官衰竭、持续呼吸衰竭、持续肾衰竭发生率更低(c2 值分别为7.923，7.403，5.518，4.377，4.750，3.945；P 值分别为0.005，0.007，0.019，0.036，0.029，0.047)。早期PE 组患者的ICU 住院时间、总住院时间更短，住院费用明显低于晚期PE 组(Z 值分别为-2.243，-2.426，-2.982；P 值分别为0.019，0.015，0.003)。2 组在住院病死率(3.0%比2.9%，P＝1.000)、感染性胰腺坏死(6.1%比23.5%，c2＝2.766，P＝0.096)方面差异无统计学意义。结论早期血浆置换在降低非轻症高三酰甘油血症性胰腺炎患者的一部分局部并发症和器官衰竭的发生发挥一定的作用。

关键词: 胰腺炎, 高三酰甘油血症, 血浆置换, 临床结局

Abstract: 【Abstract】Objective To observe the effect of plasma exchange (PE) at early disease stage on clinical outcome of the patients with non-mild hypertriglyceridemic pancreatitis (HTGP). Methods A total of 67 non-mild HTGP patients treated in the ICU of our hospital from August 2013 to August 2019 were recruited. The patients were divided into early PE group (PE after abdominal pain for <48hours; n=33) and late PE group (PE after abdominal pain for >48hours; n=34). Clinical data of the patients were collected. The main outcomes including in-hospital mortality, organ failure, intra-abdominal hypertension (IAH), acute peri-pancreatic fluid accumulation, acute pancreatic necrosis, pancreatic pseudocyst, infected pancreatic necrosis, and surgical intervention were recorded during hospitalization. The period of staying in ICU, total length of staying in hospital and medical expenses were calculated. Results were analyzed using SPSS 19.0 statistical software. Results Compared to the patients in late PE group, patients in early PE group had lower rates of acute pancreatic necrosis, pancreatic pseudocyst, surgical interventions, transient organ failure, persistent respiratory failure and persistent renal failure (χ2＝7.923, 7.403, 5.518, 4.377, 4.750 and 3.945 respectively;
P＝0.005, 0.007, 0.019, 0.036, 0.029 and 0.047 respectively), shorter period of staying in ICU and total length of staying in hospital (Z＝-2.243 and -2.426 respectively, P＝0.019 and 0.015 respectively), and lower medical expenses (Z＝- 2.982, P＝0.003). However, there were no significant differences in in- hospital mortality rate (3.0% vs. 2.9%, P＝1.000) and incidence of infectious pancreatic necrosis (6.1% vs. 23.5%, χ2＝2.766, P＝0.096) between the two groups. Conclusion Early PE may be useful in reducing local complications and organ failure in patients with non-mild hypertriglyceridemic pancreatitis.

Key words: Pancreatitis, Hypertriglyceridemia, Plasma exchange, Clinical outcome

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