腹腔灌洗术联合高容量血液滤过对重症急性胰腺炎患者免疫细胞亚群的影响
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摘要
目的探讨腹腔灌洗术与高容量血液滤过联合治疗重症急性胰腺炎(SAP)的效果及对患者免疫细胞亚群的影响。方法选取SAP患者120例,随机分为对照组与观察组,各60例。所有患者均在常规治疗基础上给予连续静脉-高容量血液滤过治疗,观察组在此基础上联合实施腹腔灌洗术。治疗72h后,对比两组炎症因子水平与免疫细胞亚群水平变化情况,记录并发症发生率。结果治疗后,观察组炎症因子水平较对照组低(P<0.05);观察组CD4+、CD4+/CD8+水平较对照组高(P<0.05);两组CD8+水平比较差异无统计学意义(P>0.05)。治疗后观察组各并发症发生率均低于对照组(P<0.05)。结论腹腔灌洗术联合高容量血滤过治疗SAP疗效较单用高容量血滤过好,患者全身炎症反应明显减轻,机体免疫功能提高,并发症好转显著,联合治疗安全有效。
Objective To explore the efficacy of peritoneal lavage combined with high-volume hemofiltration on severe acute pancreatitis(SAP)and its effects on immune cell subsets.Methods 120 cases of patients with SAP who were admitted to our hospital from January in 2016 to January in 2018 were selected and divided into control group and observation group with 60 cases in each group according to the random number table method.All patients were given continuous venous high-volume hemofiltration on the basis of routine treatment,and observation group was combined with peritoneal lavage on this basis.After 72 hof treatment,the levels of inflammatory factors and immune cell subsets were compared between the two groups,and the incidence rate of complications was recorded.Results After treatment,the levels of inflammatory factors in observation group were lower than those in control group(P<0.05).The levels of CD4+and CD4+/CD8+in observation group were higher than those in control group(P<0.05).There were no statistical significantly differences in the level of CD8+(P>0.05).After treatment,the incidence rate of complications in observation group was lower than that in control group(P<0.05).Conclusion Peritoneal lavage combined with high-volume hemofiltration has better efficacy on severe acute pancreatitis than single high-volume hemofiltration alone,and the former one can significantly reduce systemic inflammatory response,and improve the immune function and the complications,therefore the combined therapy is safe and effective.
Objective To explore the efficacy of peritoneal lavage combined with high-volume hemofiltration on severe acute pancreatitis(SAP)and its effects on immune cell subsets.Methods 120 cases of patients with SAP who were admitted to our hospital from January in 2016 to January in 2018 were selected and divided into control group and observation group with 60 cases in each group according to the random number table method.All patients were given continuous venous high-volume hemofiltration on the basis of routine treatment,and observation group was combined with peritoneal lavage on this basis.After 72 hof treatment,the levels of inflammatory factors and immune cell subsets were compared between the two groups,and the incidence rate of complications was recorded.Results After treatment,the levels of inflammatory factors in observation group were lower than those in control group(P<0.05).The levels of CD4+and CD4+/CD8+in observation group were higher than those in control group(P<0.05).There were no statistical significantly differences in the level of CD8+(P>0.05).After treatment,the incidence rate of complications in observation group was lower than that in control group(P<0.05).Conclusion Peritoneal lavage combined with high-volume hemofiltration has better efficacy on severe acute pancreatitis than single high-volume hemofiltration alone,and the former one can significantly reduce systemic inflammatory response,and improve the immune function and the complications,therefore the combined therapy is safe and effective.
引文
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[8]余洪涛.早期腹腔灌洗对重症急性胰腺炎患者外周血中Th17/Treg细胞平衡的影响[J].临床和实验医学杂志,2016,15(4):370-372.
[9]马镇,苏彧.腹腔灌洗应用于重症急性胰腺炎患者的临床评价[J].中国急救医学,2016,36(9):829-833.
[10]原成英,李荣山.血液滤过对急性胰腺炎第3间隙积液的影响[J].中国药物与临床,2017,17(7):1060-1062.
[11]徐小彭.早期血液滤过对重症胰腺炎的疗效[J].内科急危重症杂志,2017,23(2):153,167.
[12]王健,李荣军,徐春霞,等.血液滤过联合动脉灌流对重症急性胰腺炎患者生化指标和T淋巴细胞亚群表达水平的影响[J].实用临床医药杂志,2017,21(13):206-208.
[2]陈伟明,闫刚风,陆铸今,等.高容量血液滤过对急性肺损伤幼猪肺功能的影响及其机制[J].中华儿科杂志,2017,55(5):343-348.
[3]段宏军,安媛,王峰,等.急性重症胰腺炎围手术期行持续腹腔灌洗和术后血液滤过的疗效观察[J].河北医药,2015,(22):3401-3403.
[4]中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J].中华消化杂志,2013,33(4):217-222.
[5]廖应英,孙泽群,陈俊,等.连续血液滤过对28例急性重症胰腺炎患者降钙素原的影响及细胞因子相关性分析[J].临床消化病杂志,2017,29(5):267-270.
[6]蒋文勇,杨静,吴欣.早期高容量血液滤过治疗重症急性胰腺炎伴急性呼吸窘迫综合征疗效观察[J].贵州医药,2015,39(4):317-318.
[7]程书立,柳彩侠.腹腔灌洗术联合高容量血液滤过治疗重症急性胰腺炎的临床效果及免疫功能观察[J].徐州医科大学学报,2017,37(10):653-657.
[8]余洪涛.早期腹腔灌洗对重症急性胰腺炎患者外周血中Th17/Treg细胞平衡的影响[J].临床和实验医学杂志,2016,15(4):370-372.
[9]马镇,苏彧.腹腔灌洗应用于重症急性胰腺炎患者的临床评价[J].中国急救医学,2016,36(9):829-833.
[10]原成英,李荣山.血液滤过对急性胰腺炎第3间隙积液的影响[J].中国药物与临床,2017,17(7):1060-1062.
[11]徐小彭.早期血液滤过对重症胰腺炎的疗效[J].内科急危重症杂志,2017,23(2):153,167.
[12]王健,李荣军,徐春霞,等.血液滤过联合动脉灌流对重症急性胰腺炎患者生化指标和T淋巴细胞亚群表达水平的影响[J].实用临床医药杂志,2017,21(13):206-208.