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血浆置换治疗妊娠合并高脂血症急性胰腺炎临床疗效观察
作者:徐文婷  李静  贾明旺  廖广园  倪淑媛 
单位:广州医科大学附属第三医院 重症医学科, 广东广州 510150
关键词:血浆置换 妊娠 高脂血症性胰腺炎 疗效 
分类号:R459.7;R459.4
出版年·卷·期(页码):2020·39·第一期(1-6)
摘要:

目的: 探讨血浆置换治疗妊娠合并高脂血症急性胰腺炎的临床效果。方法: 回顾性分析2015年1月-2017年12月广州医科大学附属第三医院收治的15例妊娠合并高脂血症急性胰腺炎经血浆置换治疗的住院患者的临床资料,观察患者治疗前和治疗24 h、48 h、72 h后的血清甘油三酯(TG)、总胆固醇(TC)、血淀粉酶(AMS)、肿瘤坏死因子-α(TNF-α)、白细胞计数(WBC)、C反应蛋白(CRP)、钙离子(Ca2+)以及TG下降至5.65 mmol·L-1所需要的时间、TG以及TC下降率情况、血浆置换的次数、生命体征变化、并发症、住院时间、孕产妇及胎儿结局、急性生理及慢性健康(APACHEⅡ)评分变化情况等。方法: 对于妊娠合并高脂血症胰腺炎,血浆置换可使TG、TC明显降低,治疗24 h后即可明显下降,与治疗前比较有统计学差异;随着治疗时间延长,两指标越接近正常水平,基本在治疗完成72 h后降至正常范围。治疗后各时间点TG、TC下降率不同,差异有统计学意义,以第1次治疗后下降率最大,且TG下降程度较TC更明显。平均 (2.5±1.19)次血浆置换即可使TG恢复安全水平(TG<5.65 mmol·L-1)。治疗前与治疗后TG恢复安全水平(TG<5.65 mmol·L-1),APACHEⅡ评分下降,治疗前后比较有统计学意义。炎症反应指标TNF-α,感染指标CRP 于治疗24 h后开始即较治疗前显著下降,差异有统计学意义,且TNF-a,CRP治疗后72 h与治疗后24 h比较,差异亦有统计学意义。WBC于治疗后72 h与治疗前比较有统计学意义。血淀粉酶、Ca2+ 于治疗后24 h与治疗前比较有统计学意义,且Ca2+在治疗后48 h,72 h与治疗后24 h比较差异也有统计学意义,治疗72 h后两指标降至正常参考值范围。血浆置换后48 h患者生命体征趋于平稳。方法: 血浆置换治疗能在短时间内快速有效清除血液中TG,同时减轻炎症反应,达到改善病情的效果。

Objective: To investigate the clinical effect of plasma exchange in the treatment of acute pancreatitis complicated with hyperlipidemia. Methods: The clinical data of 15 patients with acute pancreatitis complicated with acute pancreatitis treated with plasma exchange in the Third Affiliated Hospital of Guangzhou Medical University from January 2015 to December 2017 were retrospectively analyzed, including serum triacylglycerol (TG), total cholesterol (TC), blood amylase (AMS), tumor necrosis factor-α (TNF-α), white blood cell count (WBC), C-reactive protein (24 h, 48 h, 72 h after treatment) CRP), calcium ion (Ca2+) and the time required for TG to fall to 5.65 mmol·L-1, the number of plasma exchanges, changes of vital signs, and changes of observed complications,length of hospital stay, maternal and fetal outcomes,changes in acute physiology and chronic health (APACHE) II scores. Results: In pregnant women with hyperlipidemia pancreatitis, plasma exchange significantly reduced TG and TC after 24 hours of treatment, compared with the pre-treatment, the difference was statistical; along with the treatment time extending, TG and TC fell to the normal range after 72 hours of treatment; the rate of TG and TC decreased at each time point after treatment, the difference was statistically significant, after the first treatment the rate of decline was the biggest, and the degree of TG decreased more significantly than TC. After averaging (2.5±1.19) plasma exchange, TG could be restored to a safe level (TG<5.65 mmol·L-1),the safety level of TG recovered before and after treatment (TG<5.65 mmol·L-1), APPACHEII score decreased, and there was a statistical significance before and after treatment, the inflammatory response index TNF-α decreased significantly after treatment for 24 hours, and the difference was statistically significant. The infection index CRP and WBC decreased significantly 24 hours and 72 hours after treatment compared with before treatment, and the difference was statistically significant. The blood amylase and Ca2+ recovered to the normal range after 72 hours of treatment, and the vital signs of the patient stabilized 48 hours after plasma exchange. Conclusion: Plasma exchange therapy can quickly and effectively remove TG from the blood in a short period of time, and at the same time reduce the inflammatory response and improve the disease.

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