| Research background and purpose:Hyperlipidemia severe acute pancreatitis(HLSAP)can cause damage to multiple systems throughout the body,with a fatality rate as high as 15-20%.Acute severe lipogenic pancreatitis can involve multiple organs,and has the characteristics of many complications,acute onset,rapid disease progression,and high mortality.In recent years,continuous blood purification(CBP)technology has been clinically applied to treat HLSAP.Hemodialysis(HD)and hemoperfusion(HP)are part of the blood purification technology.The application of HLSAP is controversial,and the choice of inpatient treatment for this type of patients in China is also a controversial issue faced by clinicians.In this study,the general clinical data and different treatment methods of 95 HLSAP patients were reviewed and summarized,to explore the best treatment plan for HLSAP patients,and to provide clinical basis for better treatment of HLSAP.Materials and Methods:A total of 348 patients with acute pancreatitis who were admitted to the Gastroenterology ward of the First Affiliated Hospital of Chengdu Medical College from January 2017 to December 2020 were collected,and a total of 95 cases finally met the criteria after being screened strictly according to the inclusion and exclusion criteria.The general clinical data and laboratory data of the patients were collected,including gender,age,body mass index(BMI),Marshall score,APACHE II score,hospital stay,time to reach the standard triglyceride(<5.65mmol/L),systemic Complications(1.acute respiratory distress syndrome(ARDS);2.acute renal failure(ARF);3.shock),local complications(1.peripancreatic accumulation)2.Pancreatic pseudocyst;3.Pancreatic necrosis),before treatment,3 days after treatment,7 days after treatment Laboratory data include(white blood cell count,hemoglobin,platelet count,neutrophil count,neutrophil count Percentage,platelet pressure,alanine aminotransferase,aspartate aminotransferase,serum albumin,total bilirubin,direct bilirubin,blood urea nitrogen,serum creatinine,serum calcium ion,C-reactive protein,serum amylase,serum lipase,triglycerides).Among the patients who met the criteria,the hemodialysis combined with hemoperfusion group(n=45 in the research group)and the conventional treatment group (n=50 in the control group),the gender,age,BMI,Marshall score,APACHE II score,hospitalization time of the two groups were compared.,Triglyceride standard time(<5.65mmol/L),systemic complication rate,local complication rate,laboratory data before treatment,laboratory data on the 3rd day after hospitalization,laboratory data on the 7th day after hospitalization,The research group and the control group were compared for each laboratory index,and the risk factors for local complications and systemic complications were analyzed for statistical analysis.Result:1.Basic information of the patient There were 45 cases in the study group and 50 cases in the control group,including32 males and 13 females in the study group,and 31 males and 19 females in the control group.The median age of the study group was 46(36.50-54)years,and the median age of the control group was 45(37.75-52.25)years.The BMI of the study group was26.40±2.27(kg/m~2),and the BMI of the control group was 26.11±2.30(kg/m~2).The Marshall score of the study group was 3(2-3.50),and the Marshall score of the control group was 3(2-3).The APACHE II score in the study group was 21.30 ± 2.90,and the APACHE II score in the control group was 22.50 ± 2.10.Statistical analysis showed that there was no significant difference in age,gender,BMI,Marshall score and APACHE II score between the two groups(p>0.05).2.Biochemical parameters before and after treatment.During the management of blood purification combined with hemoperfusion,the patient’s heart rate,body temperature,and respiratory rate are observed in real time to ensure safety.In addition,some biochemical indicators were also tested to evaluate the treatment effect.On the 3rd day after treatment,the white blood cell count in the study group was 9.17(6.48～11.23)109/L,and the white blood cell count in the control group was 11.17(8.35～14.16)109/L.The white blood cell count in the study group was significantly lower than that in the control group,and the difference was statistically significant.Significance(P<0.05).The C-reactive protein of the study group was 96(61.25-127.60)mg/L,and the C-reactive protein of the control group was 193.50(107-271.75)mg/L.The C-reactive protein of the study group was significantly lower than that of the control group,and the difference was statistically significant(P<0.05).).The triglyceride in the study group was 3.75(2.64-5.15)mmol/L,and the triglyceride in the control group was 10.81(5.12-17.04)mmol/L.The triglyceride level in the study group was significantly lower than that in the control group,and the difference was statistically significant(P <0.05).On the 7th day after treatment,the white blood cell count in the study group was 6.37(5.36～9.17)109/L,and the white blood cell count in the control group was 9.20(6.85～14.20)109/L,the difference was statistically significant(P<0.05),and the white blood cell count in the study group was 9.20(6.85～14.20)109/L.The counts were significantly lower than the control group.On the7 th day after treatment,the C-reactive protein of the study group was 15(9.80-25)mg/L,and the C-reactive protein of the control group was 120.50(78.40-246.25)mg/L,and the difference was statistically significant(P<0.05).C-reactive protein was significantly lower than the control group.On the 7th day after treatment,the triglyceride in the study group was 2.62(1.73-3.80)mmol/L,and the triglyceride in the control group was 4.63(2.84-6.73)mmol/L,and the difference was statistically significant(P<0.05).The triglyceride level in the study group was significantly lower than that in the control group.Comparing the differences in laboratory indicators between the two groups,the white blood cell count,c-reactive protein,serum amylase,serum lipase,and serum triglyceride in the study group and the control group were decreased,and the difference was statistically significant(P<0.05).3.Observation Metrics: Length of hospital stay,time to reaching the target triglyceride level,incidence of systemic and local complications,and risk factors related to systemic and local complications The length of hospital stay in the study group was 13(10.50-16)days,and the length of stay in the control group was 21(19-25)days.Statistical analysis showed that the length of stay in the study group was significantly shorter than that in the control group(P<0.05).The time to reach the standard of triglyceride in the study group was 1(1-3)days,and the time for the standard of triglyceride in the control group was 7(3-8)days.The statistical analysis showed that the time to reach the standard of triglyceride in the study group was significantly shorter than that in the control group.Time to reach the standard(P<0.05).The incidence of systemic complications was 75.60% in the study group and 68.00% in the control group.The incidence of local complications was 95.60% in the study group and 90.00% in the control group.There was no significant difference in the incidence of systemic complications and local complications between the two groups(P>0.05).The different types of systemic complications were analyzed separately.The incidence of acute respiratory distress syndrome in the study group was33.30%,and the incidence of acute respiratory distress syndrome in the control group was 26%.The incidence of acute renal failure in the study group was 40.00%,and the incidence of acute renal failure in the control group was 30.00%.The incidence of shock was 17.80% in the study group and 14% in the control group.The difference was not statistically significant(P>0.05).Local complications: the incidence of peripancreatic effusion in the study group was 88.90%,and the incidence of peripancreatic effusion in the control group was 84.00%.The incidence of pancreatic pseudocyst was 4.40% in the study group and 6.00% in the control group.The incidence of pancreatic necrosis was 51.10% in the study group and 52.00% in the control group.The difference was not statistically significant(P>0.05).Further analysis of the risk factors related to local complications and systemic complications was performed.Logistic regression analysis showed that the occurrence of local complications and systemic complications was not correlated with age,BMI,length of hospital stay,and various laboratory indicators(P>0.05).Conclusion:Hemodialysis combined with hemoperfusion has obvious effect in the treatment of acute severe lipogenic pancreatitis,which can effectively reduce the level of triglyceride,shorten the time to reach the standard of triglyceride,reduce the length of hospital stay,and effectively reduce the inflammatory index,which helps to relieve the inflammatory state of the patient,worthy of clinical application. |
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