血浆置换与胰岛素治疗高脂血症急性胰腺炎的比较

Q4 Nursing

中华临床营养杂志 Pub Date : 2018-08-30 DOI:10.3760/CMA.J.ISSN.1674-635X.2018.04.002

Yecheng Liu, Lei Guo, Zhi-wei Qi, Jun Xu, Huadong Zhu

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All patients were divided into plasma exchange group (n=42) and insulin group (n=56) according to rapid lipid lowering method. \n \n \nResults \nThere were no significant differences in the onset-to-treatment time, the proportion of patients with diabetes, the proportion of patients with pregnancy, the initial triglyceride level, Acute Physiology, Age and Chronic Health Evaluation Ⅱ score and modified CT severity index score score and conditioning-test stimulus interval(CTSI) score between the plasma exchange group and the insulin group (P>0.05). In addition, there were also no significant differences in the incidences of acute respiratory distress syndrome, acute kidney injury, shock and pancreatic abscess, and the proportion of moderate pancreatitis and severe pancreatitis, oral / jejunum nutrition tolerating start time, hospitalization time and mortality between the two groups (P>0.05). 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引用次数: 2

摘要

目的比较血浆置换和胰岛素两种快速降脂方法治疗高脂血症急性胰腺炎的疗效。方法回顾性分析2014年1月至2016年12月北京协和医院98例高脂血症急性胰腺炎患者的临床资料。根据快速降脂方法将患者分为血浆置换组(42例)和胰岛素组(56例)。结果血浆置换组与胰岛素组在起病至治疗时间、糖尿病患者比例、妊娠患者比例、初始甘油三酯水平、急性生理、年龄和慢性健康评估Ⅱ评分、改良CT严重程度指数评分和调节试验刺激间隔(CTSI)评分方面差异均无统计学意义(P < 0.05)。此外，两组患者急性呼吸窘迫综合征、急性肾损伤、休克、胰腺脓肿发生率、中度胰腺炎与重度胰腺炎比例、口服/空肠营养耐受开始时间、住院时间、死亡率差异均无统计学意义(P < 0.05)。血浆交换组达到目标甘油三酯水平和达到正常游离脂肪酸水平的时间明显少于胰岛素组[(13.09±12.50)h比(46.92±20.92)h, t=3.291, P=0.001;h(15.75±14.13)和(73.21±38.49)h t = 3.291, P = 0.001)。血浆置换组胰腺假性囊肿发生率显著低于胰岛素组(7.14% vs.23.21%， t=2.120, P=0.034)，住院费用显著高于胰岛素组[(81 794.92±33 719.69)元vs(56 042.43±30 565.34)元，t=2.034, P=0.042]。结论血浆置换和胰岛素均能迅速降低血脂。血浆置换在降脂方面比胰岛素有一定的优势，速度更快，胰腺假性囊肿发生率更低，可以应用于经济条件允许的患者。关键词:急性脂肪性胰腺炎;血浆置换;胰岛素

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Comparison of plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis

Objective To compare the efficacy of two rapid lipid lowering methods as plasma exchange and insulin in the treatment of hyperlipidemic acute pancreatitis. Methods The clinical data of 98 patients with hyperlipidemic acute pancreatitis in Peking Union Medical College Hospital from January 2014 to December 2016 were retrospectively analyzed. All patients were divided into plasma exchange group (n=42) and insulin group (n=56) according to rapid lipid lowering method. Results There were no significant differences in the onset-to-treatment time, the proportion of patients with diabetes, the proportion of patients with pregnancy, the initial triglyceride level, Acute Physiology, Age and Chronic Health Evaluation Ⅱ score and modified CT severity index score score and conditioning-test stimulus interval(CTSI) score between the plasma exchange group and the insulin group (P>0.05). In addition, there were also no significant differences in the incidences of acute respiratory distress syndrome, acute kidney injury, shock and pancreatic abscess, and the proportion of moderate pancreatitis and severe pancreatitis, oral / jejunum nutrition tolerating start time, hospitalization time and mortality between the two groups (P>0.05). The plasma exchange group had significantly less time to achieve the target triglyceride level and to reach normal free fatty acids level than the insulin group [(13.09 ±12.50)h vs. (46.92±20.92)h, t=3.291, P=0.001; (15.75±14.13)h vs.(73.21±38.49)h, t=3.291, P=0.001]. The pancreatic pseudocyst incidence was significantly lower (7.14% vs.23.21%, t=2.120, P=0.034), and the hospitalization cost was significantly higher[(81 794.92±33 719.69)yuan vs. (56 042.43±30 565.34)yuan, t=2.034, P=0.042] in the plasma exchange group than in the insulin group. Conclusions Both plasma exchange and insulin can rapidly lower blood lipids. Plasma exchange has certain advantages over insulin in lipid-lowering, for it is faster, and has lower incidence of pancreatic pseudocyst, thus can be applied in patients whose financial conditions permit. Key words: Acute fat pancreatitis; Plasma exchange; Insulin

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来源期刊

中华临床营养杂志 Nursing-Nutrition and Dietetics

CiteScore

0.20

自引率

0.00%

发文量

2282

期刊介绍： The Chinese Journal of Clinical Nutrition was founded in 1993. It is the first professional academic journal (bimonthly) in my country co-sponsored by the Chinese Medical Association and the Chinese Academy of Medical Sciences to disseminate information on clinical nutrition support, nutrient metabolism, the impact of nutrition support on outcomes and "cost-effectiveness", as well as translational medicine and nutrition research. It is also a professional journal of the Chinese Medical Association's Parenteral and Enteral Nutrition Branch. The purpose of the Chinese Journal of Clinical Nutrition is to promote the rapid dissemination of knowledge on nutrient metabolism and the rational application of parenteral and enteral nutrition, focusing on the combination of multidisciplinary and multi-regional field investigations and clinical research. It mainly reports on nutritional risk screening related to the indications of parenteral and enteral nutrition support, "cost-effectiveness" research on nutritional drugs, consensus on clinical nutrition, guidelines, expert reviews, randomized controlled studies, cohort studies, glycoprotein and other nutrient metabolism research, systematic evaluation of clinical research, evidence-based case reports, special reviews, case reports and clinical experience exchanges, etc., and has a special column on new technologies related to the field of clinical nutrition and their clinical applications.