连续性血液滤过治疗对重症急性胰腺炎肠道屏障功能的影响

目的探讨连续性血液滤过治疗对重症急性胰腺炎（SAP）肠道屏障功能的影响。方法将32例SAP患者按治疗方法的不同分为2组：对照组（15例）和治疗组（17例）。2组均采用常规治疗,包括禁食禁水、胃肠减压、抗感染、抑制胃酸分泌（质子泵抑制剂）、生长抑素（醋酸奥曲肽注射液）及改善微循环（丹参注射液）等。在此基础上,治疗组采用连续性血液滤过治疗。2组在治疗前及治疗6、12和24h后检测血清二胺氧化酶（DAO）、血浆内毒素及D-乳酸的水平。结果 2组治疗6、12和24h后血清DAO、血浆内毒素和D-乳酸水平均较治疗前明显下降（均P〈0.05）,2组治疗6、12h后血清DAO、血浆内毒素和D-乳酸水平比较差异均无统计学意义（均P〉0.05）;治疗组治疗24h后血清DAO、血浆内毒素和D-乳酸水平均较对照组明显下降（均P〈0.05）。结论SAP患者采用常规治疗的基础上行连续性血液滤过治疗较常规治疗更能改善SAP患者早期肠道通透性,减少内毒素的易位,对SAP患者肠道屏障功能有保护作用,是一项重要的辅助治疗措施。

Effect of Continuous Hemofiltration on Intestinal Barrier Function in Severe Acute Pancreatitis

Objective To discuss the effect of continuous hemofiltration on intestinal barrier function in the treatment of severe acute pancreatitis（SAP）.Methods Thirty-two patients with SAP were divided into control group（n=15）and treatment group（n=17）.All patients were given conventional therapy,including food or water deprivation,gastrointestinal decompression,anti-in-fection,inhibition of gastric acid secretion（proton pump inhibitors）,somatostatin（acetate octreoti-de inj ection）,and improvement of microcirculation（salvia miltiorrhiza inj ection）.In addition,pa-tients in treatment group were treated with continuous hemofiltration.Levels of serum diamine oxidase（DAO）and plasma endotoxin and D-lactic acid were measured before treatment and after treatment for 6,12 and 24 hours .Results Levels of serum DAO and plasma endotoxin and D-lac-tic acid significantly decreased after treatment in both groups（P〈0.05）.However,there were no significant differences in these parameters between the two groups after treatment for 6 and 1 2 hours（P〉0.05）.Compared with control group,levels of serum DAO and plasma endotoxin and D-lactic acid significantly decreased in treatment group after treatment for 24 hours（P〈0.05）. Conclusion As an important auxiliary treatment,continuous hemofiltration can improve the early intestinal permeability,reduce endotoxin translocation and protect intestinal barrier function in patients with SAP.