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目的 :通过监测炎性细胞因子的变化,分析连续性血液净化(continuous blood purification,CBP)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的时机与疗效之间的关系。方法 :SAP患者入院后即行CBP治疗,CBP治疗模式为连续性静脉-静脉血液滤过(continuity veno-venos hemofiltration,CVVHF),每天治疗12 h,连续3 d。根据CBP治疗距SAP发病时间,将33例SAP患者随机分为A、B、C共3组,分别在SAP发病0~24、24~48、48~72 h开始给予CBP治疗。在CBP治疗开始及结束检测肿瘤坏死因子α(TNF-α)、白介素(IL)-1、IL-6、IL-8、血淀粉酶(amylase,AMY)、C反应蛋白(C-reactive protein,CRP)、APACHEⅡ评分等指标变化。结果:3组SAP患者经过CBP治疗后,TNF-α、IL-1、IL-6、IL-8等炎性细胞因子水平与AMY、CRP、APACHEⅡ评分等病情评估指标水平均较治疗前明显降低。比较3组SAP患者的AMY、CRP、APACHEⅡ评分等病情评估指标的降低幅度上,C组(48~72 h CBP治疗组)较A、B组(0~24、24~48 h CBP治疗组)明显减少;而TNF-α、IL-1、IL-6、IL-8等炎性细胞因子的降低幅度上,C组较A、B组明显增加。结论:通过CBP治疗可有效降低SAP患者炎性细胞因子的浓度,并改善病情。48 h内开始CBP治疗对SAP患者病情的改善幅度要优于48 h以后。
Objective: To analyze the relationship between timing and effect of continuous blood purification (CBP) in the treatment of severe acute pancreatitis (SAP) by monitoring the changes of inflammatory cytokines. Methods: SAP patients were treated with CBP immediately after admission. CBP was treated with continuous veno-venous hemofiltration (CVVHF) for 12 hours every day for 3 days. According to the onset time of CBP from SAP, 33 patients with SAP were randomly divided into three groups: A, B and C, and CBP was given at 0-24, 24-48 and 48-72 hours after onset of SAP. At the beginning and the end of CBP treatment, the levels of TNF-α, IL-1, IL-6, IL-8, amylase (AMY) and C-reactive protein CRP), APACHE Ⅱ score and other indicators change. Results: The levels of inflammatory cytokines, such as TNF-α, IL-1, IL-6 and IL-8, as well as AMY, CRP and APACHEⅡ score in three groups of patients with SAP were significantly lower than those before treatment . Comparing the decrease of AMY, CRP and APACHEⅡscore in three groups of patients with SAP, the C group (48 ~ 72 h CBP treatment group) than the A, B group (0-24, 24-48 h CBP treatment group) While the decrease of inflammatory cytokines such as TNF-α, IL-1, IL-6 and IL-8 in C group was significantly higher than that in A and B groups. Conclusion: The CBP treatment can effectively reduce the concentration of inflammatory cytokines in patients with SAP, and improve the condition. CBP treatment within 48 h began to improve the condition of patients with SAP better than 48 h later.