摘要
目的评估低分子量肝素钙联合胰岛素在高脂血症性重症胰腺炎治疗中的临床效果,为高脂血症性重症胰腺炎治疗方式的选择提供依据。方法选取2015年4月至2018年4月武汉市第一医院重症医学科收治的76例高脂血症性重症胰腺炎患者作为研究对象,根据随机双盲对照研究方法,分为低分子量肝素钙联合胰岛素治疗组(观察组,38例)和双重血浆置换组(对照组,38例),比较两组治疗后三酰甘油、TNF-α、IL-6、Balthazar CT严重指数(CTSI)、淀粉酶、MODS评分及病死率的差异。结果与对照组比较,观察组在三酰甘油、淀粉酶、CTSI、腹痛缓解时间、淀粉酶转阴时间、住院时间及病死率方面无明显差异(均P>0.05);与观察组相比,对照组的TNF-α、IL-6水平更低,差异具有统计学意义(均P<0.05)。第7天的MODS评分,对照组更低,差异具有统计学意义(P<0.05),但第28天的MODS评分两组之间差异无统计学意义。结论在高脂血症性重症胰腺炎治疗中,双重血浆置换在清除炎性因子方面具有一定优势,但低分子量肝素钙联合胰岛素治疗具有同样的有效性,特别是在不具备双重血浆置换条件的医疗机构,低分子量肝素钙联合胰岛素治疗方案是一个不错的选择。
Objective To evaluate the clinical effect of low-molecular-weight heparin calcium combined with insulin in the treatment of severe hyperlipidemic pancreatitis,and to provide evidence for the choice of treatment methods for severe hyperlipidemic pancreatitis.Methods From April 2015 to April 2018,76 cases of severe hyperlipidemic pancreatitis admitted to the Department of Critical Medicine of Wuhan First Hospital were selected as the study objects.According to the randomized double-blind controlled study,the patients were divided into low-molecular-weight heparin calcium combined with insulin treatment group(38 cases)and double plasma exchange group(38 cases).The differences of triglyceride,TNF-α,IL-6,Balthazar CT severity index(CTSI),amylase,MODS score and mortality were compared between the two groups after treatment.Results There were no significant differences in triacylglycerol,amylase,CTSI,abdominal pain relief time,amylase negative time,hospital stay and mortality between the double plasma exchange group and the low-molecular-weight heparin calcium combined with insulin treatment group(all P>0.05);compared with the low-molecular-weight heparin calcium combined with insulin group,the levels of TNF-αand IL-6 in the double plasma exchange group were lower,with statistical differences(P<0.05).On the 7th day,the MODS score was lower in the double plasma exchange group,which was statistically different(P<0.05),however,there was no significant difference in MODS score between the two groups on the 28th day.Conclusion In the treatment of severe hyperlipidemic pancreatitis,double plasma exchange has certain advantages in eliminating inflammatory factors,but low-molecular-weight heparin calcium combined with insulin treatment has the same effect,especially in medical institutions where double plasma exchange cannot be performed,low-molecular-weight heparin calcium combined with insulin treatment is a good choice..
作者
戴伟
周瑞祥
严骏
张文星
彭丽清
Dai Wei;Zhou Ruixiang;Yan Jun(Department of Critical Care Medicine,Wuhan Hospital of Traditional Chinese and Western Medicine,Tongji Medical College,Huazhong University of Science and Technology,Wuhan No.1 Hospital,Wuhan 430022,China)
出处
《华中科技大学学报（医学版）》
CAS
CSCD
北大核心
2020年第4期500-503,共4页
Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
