早期连续性血液净化联合腹腔微创穿刺引流对重症急性胰腺炎腹内压、肝功能及炎症因子的影响

Influence of early continuous blood purification combined with abdominal minimally invasive drainage on intra-abdominal pressure, liver function, and inflammatory indexes in patients with severe acute pancreatitis

摘要:

目的 探讨早期连续性肾脏替代治疗（CRRT）联合腹腔微创穿刺引流对重症急性胰腺炎（SAP）患者腹内压（IAP）、肝功能及炎症因子的影响。方法 回顾性分析2015年1月—2019年12月梅州市人民医院收治的86例SAP患者的临床资料，根据治疗方式分为两组：采取CRRT治疗的患者为对照组（48例）；采取CRRT联合腹腔微创穿刺引流术的患者为观察组（38例）。比较两组治疗前后IAP、肝功能［天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、总胆红素（TBIL）、γ-转肽酶（γ-GT）］、炎症因子［降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）］水平，以及急性生理学和慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。比较两组治疗前后炎症指标（PCT、CRP、IL-6）。比较两组治疗及康复情况。结果 治疗前后观察组的IAP、血清AST、ALT、TBIL、γ-GT、PCT、CRP、IL-6及APACHEⅡ评分的差值高于对照组（P <0.05）。与对照组比较，观察组的机械通气时间、腹内高压（IAH）持续时间、白细胞计数（WBC）复常时间、器官功能障碍持续时间、住院时间缩短（P <0.05）。观察组多器官功能障碍综合征（MODS）发生率低于对照组（68.43% VS 32.25%）（P <0.05）。结论 早期CRRT联合腹腔微创穿刺引流术能够降低SAP患者的IAP及炎症反应，降低MODS发生风险，保护肝功能，促进病情康复。

Abstract:

Objective To investigate the early continuous blood purification (CRRT) combined with abdominal minimally invasive drainage on intra-abdominal pressure (IAP), liver function, and inflammatory indexes in patients with severe acute pancreatitis (SAP).Methods Clinical data of 86 patients with SAP admitted in our hospital from January 2015 to December 2019 were retrospectively analyzed. According to the treatment method, patients were divided into two groups: CRRT was performed in 48 patients (control group), and CRRT combined with abdominal minimally invasive drainage was performed in 38 patients (observation group). The IAP, liver function indicators [aspartate aminotransferase (AST), alanine aminotransferase (AST), total bilirubin (TBil), γ-transpeptidase (γ-GT) ], inflammatory factors [procalcitonin (PCT), C-reactive protein (CRP), interleukin-6 (IL-6) ], acute physiology, and chronic health evaluation scoring system Ⅱ (APACHE Ⅱ) score were compared between the two groups.Results Compared with control group, mechanical ventilation time, IAH duration, WBC normalization time, organ dysfunction duration, and hospital stay in the observation group were significantly shortened, the differences were statistically significant (P < 0.05). The decreased values of the IAP, APACHE Ⅱ score, serum levels of AST, ALT, TBIL, γ-GT, PCT, CRP, and IL-6 of the observation group were significantly higher than the control group, and the differences were statistically significant (P < 0.05). The incidence of multiple organ dysfunction syndrome (MODS) in the observation group was lower than that in the control group (68.43% VS 32.25%), and the difference was statistically significant (P < 0.05).Conclusion Early CRRT combined with abdominal minimally invasive drainage can reduce IAP and inflammatory response in SAP patients, which can reduce the risk of MODS, protect liver function, and promote rehabilitation.