连续性血液净化联合清胰利胆颗粒治疗重症急性胰腺炎的应用价值
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摘要
目的观察在重症急性胰腺炎患者中应用连续性血液净化联合清胰利胆颗粒方案,对其生化指标、炎性指标及治疗效果的影响.方法回顾性分析2012-04/2017-04浙江绍兴第二医院收治的150例重症急性胰腺炎患者的临床资料,其中70例患者给予在常规治疗基础上给予连续性血液净化方案,将其作为对照组,80例患者在常规治疗基础上给予连续性血液净化联合清胰利胆颗粒方案,将其作为观察组.然后将两组患者的生化指标、炎性指标、APACHEⅡ评分、CTSI评分及治疗效果等进行比较.结果在治疗后,观察组患者的APACHEⅡ评分明显低于对照组(10.22分±2.58分vs 14.03分±2.91分),差异均具有统计学意义(P<0.05);在治疗后,观察组患者的腹胀消失时间、腹痛消失时间、住院时间明显低于对照组,差异均具有统计学意义(P<0.05);在治疗后,观察组患者的血清淀粉酶、血清脂肪酶、肌酐、谷草转氨酶、谷丙转氨酶、降钙素原明显低于对照组,差异均具有统计学意义(P<0.05);在治疗后,观察组患者的白介素(interleukin,IL)-8、IL-6、肿瘤坏死因子-α、热休克蛋白70、HSP72、高迁移率族蛋白1值明显低于对照组,差异均具有统计学意义(P<0.05);经过治疗后,观察组患者的治疗总有效率明显高于对照组(93.75%vs 71.43%),差异有统计学意义(P<0.05);对照组患者的死亡率为8.57%,观察组患者的死亡率为6.25%,差异无统计学意义;对照组患者的并发症发生率明显高于对照组(28.57%vs12.5%),差异具有统计学意义(P<0.05).结论在重症急性胰腺炎患者中应用连续性血液净化联合清胰利胆颗粒的治疗方案,能够显著减轻患者的炎性反应,改善患者的生化指标,提高治疗效果.
AIM To observe the effect of continuous blood purificationcombined with Qingyi Lidan granules in patients with severe acute pancreatitis with regard to biochemical indexes, inflammatory indexes, and therapeutic effects.METHODS The clinical data of 150 patients with severe acute pancreatitis treated at Shaoxing Second Hospital from April 2012 to April 2017 were retrospectively analyzed. Among them, 70 patients were given continuous blood purification therapy as a control group, and the other 80 patients were given continuous blood purification combined with Qingyi Lidan granules based on conventional therapy, as an observation group. Biochemical indicators, inflammatory indicators, APACHE Ⅱ score, CTSI score, and therapeutic effects were compared between the two groups. RESULTS After treatment, APACHE II score was significantly lower in the observation group than in the control group(10.22 ± 2.58 vs 14.03 ± 2.91, P < 0.05). The time to disappearance of abdominal distension and abdominal pain and hospital stay were significantly shorter in the observation group than in the control group(P < 0.05). AMS, LPS, Cr, AST, ALT, and PCT in the observation group were significantly lower than those in the control group(P < 0.05). The levels of IL-8, IL-6, TNF-α, HSP70, HSP72, and HMGB1 in the observation group were also significantly lower than those in the control group(P < 0.05). The total effective rate was significantly higher in the observation group than in the control group(93.75% vs 71.43%, P < 0.05). The mortality rate did not differ significantly between the control group and observation group(8.57% vs 6.25%). The incidence of complications in the control group was significantly higher than that of the observation group(28.57% vs 12.5%, P < 0.05).CONCLUSION Continuous blood purification combined with Qingyi Lidan granules in patients with severe acute pancreatitis can significantly reduce the inflammatory response and improve biochemical indexes and therapeutic effects.
AIM To observe the effect of continuous blood purificationcombined with Qingyi Lidan granules in patients with severe acute pancreatitis with regard to biochemical indexes, inflammatory indexes, and therapeutic effects.METHODS The clinical data of 150 patients with severe acute pancreatitis treated at Shaoxing Second Hospital from April 2012 to April 2017 were retrospectively analyzed. Among them, 70 patients were given continuous blood purification therapy as a control group, and the other 80 patients were given continuous blood purification combined with Qingyi Lidan granules based on conventional therapy, as an observation group. Biochemical indicators, inflammatory indicators, APACHE Ⅱ score, CTSI score, and therapeutic effects were compared between the two groups. RESULTS After treatment, APACHE II score was significantly lower in the observation group than in the control group(10.22 ± 2.58 vs 14.03 ± 2.91, P < 0.05). The time to disappearance of abdominal distension and abdominal pain and hospital stay were significantly shorter in the observation group than in the control group(P < 0.05). AMS, LPS, Cr, AST, ALT, and PCT in the observation group were significantly lower than those in the control group(P < 0.05). The levels of IL-8, IL-6, TNF-α, HSP70, HSP72, and HMGB1 in the observation group were also significantly lower than those in the control group(P < 0.05). The total effective rate was significantly higher in the observation group than in the control group(93.75% vs 71.43%, P < 0.05). The mortality rate did not differ significantly between the control group and observation group(8.57% vs 6.25%). The incidence of complications in the control group was significantly higher than that of the observation group(28.57% vs 12.5%, P < 0.05).CONCLUSION Continuous blood purification combined with Qingyi Lidan granules in patients with severe acute pancreatitis can significantly reduce the inflammatory response and improve biochemical indexes and therapeutic effects.
引文
1王瑞,黄志寅,王默进,唐承薇.防治重症急性胰腺炎临床研究进展.中华内科杂志2016;55:490-493[DOI:10.3760/cma.j.issn.0578-1426.2016.06.020]
2孙备,冀亮.重症急性胰腺炎外科干预应重视的问题.中华消化外科杂志2017;16:987-990[DOI:10.3760/cma.j.issn.1673-9752.2017.10.003]
3王俊,金钧,黄坚,李东蓉,郝艳,孔金丹,储珍玉,付建红,黄芳.早期使用乌司他丁对中重症/重症急性胰腺炎患者疗效的影响.中华医学杂志2017;97:1252-1255[DOI:10.3760/cma.j.issn.0376-2491.2017.16.015]
4曾雪云,毛兴龙,钱军,余春,朱郎萍.重症急性胰腺炎伴腹腔感染患者易感因素分析.中华医院感染学杂志2016;26:4173-4175[DOI:10.11816/cn.ni.2016-161644]
5马莉,韩宝艳,鹿梦溪.连续性血液净化联合大承气汤治疗重症急性胰腺炎对患者炎性因子、免疫功能和生化指标的影响.河北医药2017;39:1457-1460[DOI:10.3969/j.issn.1002-7386.2017.10.004]
6王春友,赵玉沛.重症急性胰腺炎诊治进展及国内外指南解读.中华外科杂志2013;51:198-200[DOI:10.3760/cma.j.issn.0529-5815.2013.03.002]
7陈先强,姚义,黄鹤光.白细胞介素-10对大鼠重症急性胰腺炎血清肿瘤坏死因子-α及胰腺组织的影响.中华肝胆外科杂志2016;22:562-565[DOI:10.3760/cma.j.issn.1007-8118.2016.08.016]
8郝一鸣,王士琪,冯全新,冯向英,余鹏飞,白槟,邱兆岩,王谦,赵青川.脂肪肝诊断联合APACHE-Ⅱ评分提高预测重症急性胰腺炎的能力.中华普通外科杂志2016;31:23-26[DOI:10.3760/cma.j.issn.1007-631X.2016.01.008]
9符宜龙,舒艾娅,罗艳,王金龙,曹家军,孙兵,简万均,唐中建.限制性液体复苏联合连续性肾脏替代治疗在重症急性胰腺炎并发腹腔间隔室综合征治疗中的应用价值.中华消化外科杂志2017;16:1042-1047[DOI:10.3760/cma.j.issn.1673-9752.2017.10.012]
10梁新文,徐星莉,徐星榕.重症急性胰腺炎患者继发胰腺感染的危险因素研究.中华医院感染学杂志2015;10:2080-2082[DOI:10.11816/cn.ni.2015-141587]
11钟朝辉,周迈,王达庆,焦岗军,邓五一,冷希圣.生长激素对重症急性胰腺炎肝脏损伤的保护作用.中华普通外科杂志2016;31:121-125[DOI:10.3760/cma.j.issn.1007-631X.2016.02.011]
12李梦秋,余红菊,李良海.连续性血液净化对重症急性胰腺炎患者肾素-血管紧张素-醛固酮系统及炎性因子的影响.中国老年学杂志2015;10:630-632[DOI:10.3969/j.issn.1005-9202.2015.03.026]
13程汝兰,张洪福.连续性血液净化对重症急性胰腺炎患者血清疾病相关指标的影响.西部医学2015;27:221-223[DOI:10.3969/j.issn.1672-3511.2015.02.019]
14张勇,曾维政,王云侠,翁敏,郑淑梅,蒋明德.连续性血液净化治疗重症急性胰腺炎合并多器官功能障碍综合征的效果观察.临床肝胆病杂志2016;32:320-323[DOI:10.3969/j.issn.1001-5256.2016.02.025]
15朱艳,崔云,张育才,缪惠洁,王斐,陈容欣,戎群芳.连续性血液净化辅助救治儿童重症急性胰腺炎.中华儿科杂志2017;55:338-342[DOI:10.3760/cma.j.issn.0578-1310.2017.05.006]
16谢锋伟,冼倩,庞浩文,吴旭.连续性血液净化联合腹腔镜腹腔置管灌洗引流术治疗重症急性胰腺炎的临床疗效.齐齐哈尔医学院学报2017;38:394-396[DOI:10.3969/j.issn.1002-1256.2017.04.009]
17贾楠,何茵,赵海颖,张清叶,金晔.清胰利胆颗粒对重症急性胰腺炎患者血清HMGB1,HSP70,HSP27,IL-8水平的影响.现代生物医学进展2017;17:4650-4652,4675[DOI:10.13241/j.cnki.pmb.2017.24.011]
18程开,王为光,遇常虹.清胰利胆颗粒对胰腺炎大鼠TNF-α的影响.黑龙江医药科学2011;34:10-11[DOI:10.3969/j.issn.1008-0104.2011.02.005]
19程开,王卓,吴文婷,卓越.清胰利胆颗粒对胰腺炎大鼠AMS的影响.中国民康医学2011;23:1070-1071[DOI:10.3969/j.issn.1672-0369.2011.09.010]
20王军.清胰利胆颗粒联合乌司他丁和生长抑素治疗急性重症胰腺炎的临床研究.现代药物与临床2016;31:1477-1481[DOI:10.7501/j.issn.1674-5515.2016.09.037]
21林洋.清胰利胆颗粒联合五水头孢唑林钠用于ERCP术后并发胰腺炎的疗效观察.河北医药2017;39:2903-2905,2909[DOI:10.3969/j.issn.1002-7386.2017.19.005]
2孙备,冀亮.重症急性胰腺炎外科干预应重视的问题.中华消化外科杂志2017;16:987-990[DOI:10.3760/cma.j.issn.1673-9752.2017.10.003]
3王俊,金钧,黄坚,李东蓉,郝艳,孔金丹,储珍玉,付建红,黄芳.早期使用乌司他丁对中重症/重症急性胰腺炎患者疗效的影响.中华医学杂志2017;97:1252-1255[DOI:10.3760/cma.j.issn.0376-2491.2017.16.015]
4曾雪云,毛兴龙,钱军,余春,朱郎萍.重症急性胰腺炎伴腹腔感染患者易感因素分析.中华医院感染学杂志2016;26:4173-4175[DOI:10.11816/cn.ni.2016-161644]
5马莉,韩宝艳,鹿梦溪.连续性血液净化联合大承气汤治疗重症急性胰腺炎对患者炎性因子、免疫功能和生化指标的影响.河北医药2017;39:1457-1460[DOI:10.3969/j.issn.1002-7386.2017.10.004]
6王春友,赵玉沛.重症急性胰腺炎诊治进展及国内外指南解读.中华外科杂志2013;51:198-200[DOI:10.3760/cma.j.issn.0529-5815.2013.03.002]
7陈先强,姚义,黄鹤光.白细胞介素-10对大鼠重症急性胰腺炎血清肿瘤坏死因子-α及胰腺组织的影响.中华肝胆外科杂志2016;22:562-565[DOI:10.3760/cma.j.issn.1007-8118.2016.08.016]
8郝一鸣,王士琪,冯全新,冯向英,余鹏飞,白槟,邱兆岩,王谦,赵青川.脂肪肝诊断联合APACHE-Ⅱ评分提高预测重症急性胰腺炎的能力.中华普通外科杂志2016;31:23-26[DOI:10.3760/cma.j.issn.1007-631X.2016.01.008]
9符宜龙,舒艾娅,罗艳,王金龙,曹家军,孙兵,简万均,唐中建.限制性液体复苏联合连续性肾脏替代治疗在重症急性胰腺炎并发腹腔间隔室综合征治疗中的应用价值.中华消化外科杂志2017;16:1042-1047[DOI:10.3760/cma.j.issn.1673-9752.2017.10.012]
10梁新文,徐星莉,徐星榕.重症急性胰腺炎患者继发胰腺感染的危险因素研究.中华医院感染学杂志2015;10:2080-2082[DOI:10.11816/cn.ni.2015-141587]
11钟朝辉,周迈,王达庆,焦岗军,邓五一,冷希圣.生长激素对重症急性胰腺炎肝脏损伤的保护作用.中华普通外科杂志2016;31:121-125[DOI:10.3760/cma.j.issn.1007-631X.2016.02.011]
12李梦秋,余红菊,李良海.连续性血液净化对重症急性胰腺炎患者肾素-血管紧张素-醛固酮系统及炎性因子的影响.中国老年学杂志2015;10:630-632[DOI:10.3969/j.issn.1005-9202.2015.03.026]
13程汝兰,张洪福.连续性血液净化对重症急性胰腺炎患者血清疾病相关指标的影响.西部医学2015;27:221-223[DOI:10.3969/j.issn.1672-3511.2015.02.019]
14张勇,曾维政,王云侠,翁敏,郑淑梅,蒋明德.连续性血液净化治疗重症急性胰腺炎合并多器官功能障碍综合征的效果观察.临床肝胆病杂志2016;32:320-323[DOI:10.3969/j.issn.1001-5256.2016.02.025]
15朱艳,崔云,张育才,缪惠洁,王斐,陈容欣,戎群芳.连续性血液净化辅助救治儿童重症急性胰腺炎.中华儿科杂志2017;55:338-342[DOI:10.3760/cma.j.issn.0578-1310.2017.05.006]
16谢锋伟,冼倩,庞浩文,吴旭.连续性血液净化联合腹腔镜腹腔置管灌洗引流术治疗重症急性胰腺炎的临床疗效.齐齐哈尔医学院学报2017;38:394-396[DOI:10.3969/j.issn.1002-1256.2017.04.009]
17贾楠,何茵,赵海颖,张清叶,金晔.清胰利胆颗粒对重症急性胰腺炎患者血清HMGB1,HSP70,HSP27,IL-8水平的影响.现代生物医学进展2017;17:4650-4652,4675[DOI:10.13241/j.cnki.pmb.2017.24.011]
18程开,王为光,遇常虹.清胰利胆颗粒对胰腺炎大鼠TNF-α的影响.黑龙江医药科学2011;34:10-11[DOI:10.3969/j.issn.1008-0104.2011.02.005]
19程开,王卓,吴文婷,卓越.清胰利胆颗粒对胰腺炎大鼠AMS的影响.中国民康医学2011;23:1070-1071[DOI:10.3969/j.issn.1672-0369.2011.09.010]
20王军.清胰利胆颗粒联合乌司他丁和生长抑素治疗急性重症胰腺炎的临床研究.现代药物与临床2016;31:1477-1481[DOI:10.7501/j.issn.1674-5515.2016.09.037]
21林洋.清胰利胆颗粒联合五水头孢唑林钠用于ERCP术后并发胰腺炎的疗效观察.河北医药2017;39:2903-2905,2909[DOI:10.3969/j.issn.1002-7386.2017.19.005]