低分子肝素钙持续性区域动脉灌注治疗重症急性胰腺炎8例
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摘要
目的评价低分子肝素钙(LMWHC)持续性区域动脉灌注(CRAI)在重症急性胰腺炎(SAP治疗中的应用。方法收集2012年7月至2016年1月南京大学医学院附属金陵医院收治的16例SAP患者临床资料。8例接受LMWHC经CRAI治疗(CRAI组),8例接受非LMWHC常规治疗(对照组),比较两组治疗效果。结果两组患者入院时改良CT严重度指数(MCTSI)、急性胰腺炎严重度床旁指数(BISAP)、活化部分凝血活酶时间(APTT)和血小板(PLT)计数差异无统计学意义(P>0.05)。CRAI组、对照组住院期间感染发生率分别为0、100%(8/8)(P<0.01),腹腔出血率分别为0、100%(8/8)(P<0.01),中转手术率分别为0、62.5%(5/8)(P<0.01),病死率分别为0、25%(2/8)(P>0.01);住院时间分别为(11.0±2.8) d、(51.0±23.3) d(P<0.05)。CRAI组治疗前后APTT、PLT计数差异无统计学意义(P>0.05)。结论 CRAI途径LMWHC治疗可有效抑制SAP炎症改变和病情进展,明显降低患者住院感染发生率、腹腔出血率、中转手术率及住院时间。
Objective To discuss the application of continuous regional arterial infusion(CRAI) of low molecular weight heparin calcium(LMWHC) in treating severe acute pancreatitis(SAP). Methods The clinical data of 16 patients with SAP, who were admitted to the Affiliated Jinling Hospital of Medical College of Nanjing University, China, during the period from July 2012 to January 2016, were collected. Of the 16 patients, 8 received CRAI of LMWHC(CRAI group) and 8 received non-LMWHC routine therapy(control group). The therapeutic effects were compared between the two groups. Results On admission, no significant differences in modified CT severity index(MCTSI), bedside index of severe acute pancreatitis(BISAP)scores, activated partial thromboplastin time(APTT) and platelet(PLT) count existed between the two groups(P >0.05). In CRAI group and control group, the incidence of infection during hospitalization was 0 and100%(8/8) respectively(P<0.01), the intraperitoneal hemorrhage rate was 0 and 100%(8/8) respectively(P<0.01), transferring operation rate was 0 and 62.5%(5/8) respectively(P<0.01), the mortality rate was 0 and 25%(2/8) respectively(P>0.01), the hospitalization days were(11.0±2.8) days and(51.0±23.3) days respectively(P<0.05). In CRAI group, the postoperative APTT and PLT count were not significantly different from the preoperative ones(P>0.05). Conclusion CRAI of LMWHC can effectively inhibit the inflammatory reactions and progression of SAP, significantly reduce the incidences of infection, intraperitoneal hemorrhage and transferring operation, and obviously shorten the hospitalization duration.(J Intervent Radiol, 2019, 28:533-536)
Objective To discuss the application of continuous regional arterial infusion(CRAI) of low molecular weight heparin calcium(LMWHC) in treating severe acute pancreatitis(SAP). Methods The clinical data of 16 patients with SAP, who were admitted to the Affiliated Jinling Hospital of Medical College of Nanjing University, China, during the period from July 2012 to January 2016, were collected. Of the 16 patients, 8 received CRAI of LMWHC(CRAI group) and 8 received non-LMWHC routine therapy(control group). The therapeutic effects were compared between the two groups. Results On admission, no significant differences in modified CT severity index(MCTSI), bedside index of severe acute pancreatitis(BISAP)scores, activated partial thromboplastin time(APTT) and platelet(PLT) count existed between the two groups(P >0.05). In CRAI group and control group, the incidence of infection during hospitalization was 0 and100%(8/8) respectively(P<0.01), the intraperitoneal hemorrhage rate was 0 and 100%(8/8) respectively(P<0.01), transferring operation rate was 0 and 62.5%(5/8) respectively(P<0.01), the mortality rate was 0 and 25%(2/8) respectively(P>0.01), the hospitalization days were(11.0±2.8) days and(51.0±23.3) days respectively(P<0.05). In CRAI group, the postoperative APTT and PLT count were not significantly different from the preoperative ones(P>0.05). Conclusion CRAI of LMWHC can effectively inhibit the inflammatory reactions and progression of SAP, significantly reduce the incidences of infection, intraperitoneal hemorrhage and transferring operation, and obviously shorten the hospitalization duration.(J Intervent Radiol, 2019, 28:533-536)
引文
[1]杜奕奇,李维勤,毛恩强.中国急性胰腺炎多学科诊治共识意见[J].临床肝胆病杂志,2015,31:1770-1775.
[2]陆文彬,孙松,李忠学,等.重症急性胰腺炎的介入治疗[J].介入放射学杂志,2006,15:245-246.
[3]Yong FJ,Mao XY,Deng LH,et al.Continuous regional arterial infusion for the treatment of severe acute pancreatitis:a metaanalysis[J].Hepatobiliary Pancreat Dis Int,2015,14:10-17.
[4]Piascik M,Rydzewska G,Milewski J,et al.The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic:a randomized controlled study[J].Pancreas,2010,39:863-867.
[5]李龙辉,刘岩,李雪春,等.低分子肝素治疗重症急性胰腺炎对炎性因子及免疫功能的影响[J].临床合理用药杂志,2017,10:7-8.
[6]谢阳云,邹方,陈梅福,等.区域动脉灌注治疗重症急性胰腺炎的研究进展[J].中华实验外科杂志,2018,35:181-185.
[7]王馨,吴艳环.急性坏死性胰腺炎的介入治疗[J].介入放射学杂志,2001,10:177-178.
[8]卢义展,王湘英.微循环障碍在重症急性胰腺炎发病机制中的地位[J].中华胰腺病杂志,2010,10:144-146.
[9]田时静,周发春.低分子肝素治疗重症急性胰腺炎研究进展[J].重庆医学,2014,43:625-627.
[10]陈洁坤,宋青,王立金.低分子肝素治疗重症急性胰腺炎的Meta分析[J].中国综合临床,2014,30:58-62.
[11]张世龙,涂巧丽,石斌.低分子肝素区域动脉灌注治疗重症急性胰腺炎的实验研究[J].中国普通外科杂志,2012,21:290-294.
[12]袁涛,全冠民,石伟,等.急性胰腺炎新分类相关术语和并发症及MCTSI评分[J].放射学实践,2015,30:1005-1010.
[13]杨立新,杜丽川,刘欣,等.四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用[J].中华内科杂志,2016,55:695-699.
[2]陆文彬,孙松,李忠学,等.重症急性胰腺炎的介入治疗[J].介入放射学杂志,2006,15:245-246.
[3]Yong FJ,Mao XY,Deng LH,et al.Continuous regional arterial infusion for the treatment of severe acute pancreatitis:a metaanalysis[J].Hepatobiliary Pancreat Dis Int,2015,14:10-17.
[4]Piascik M,Rydzewska G,Milewski J,et al.The results of severe acute pancreatitis treatment with continuous regional arterial infusion of protease inhibitor and antibiotic:a randomized controlled study[J].Pancreas,2010,39:863-867.
[5]李龙辉,刘岩,李雪春,等.低分子肝素治疗重症急性胰腺炎对炎性因子及免疫功能的影响[J].临床合理用药杂志,2017,10:7-8.
[6]谢阳云,邹方,陈梅福,等.区域动脉灌注治疗重症急性胰腺炎的研究进展[J].中华实验外科杂志,2018,35:181-185.
[7]王馨,吴艳环.急性坏死性胰腺炎的介入治疗[J].介入放射学杂志,2001,10:177-178.
[8]卢义展,王湘英.微循环障碍在重症急性胰腺炎发病机制中的地位[J].中华胰腺病杂志,2010,10:144-146.
[9]田时静,周发春.低分子肝素治疗重症急性胰腺炎研究进展[J].重庆医学,2014,43:625-627.
[10]陈洁坤,宋青,王立金.低分子肝素治疗重症急性胰腺炎的Meta分析[J].中国综合临床,2014,30:58-62.
[11]张世龙,涂巧丽,石斌.低分子肝素区域动脉灌注治疗重症急性胰腺炎的实验研究[J].中国普通外科杂志,2012,21:290-294.
[12]袁涛,全冠民,石伟,等.急性胰腺炎新分类相关术语和并发症及MCTSI评分[J].放射学实践,2015,30:1005-1010.
[13]杨立新,杜丽川,刘欣,等.四种评分标准对高脂血症性急性胰腺炎病情和预后的评估作用[J].中华内科杂志,2016,55:695-699.