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中华肝脏外科手术学电子杂志 ›› 2023, Vol. 12 ›› Issue (04) : 464 -468. doi: 10.3877/cma.j.issn.2095-3232.2023.04.021

所属专题: 综述

综述

血液净化治疗在高血脂性重症胰腺炎中的应用
许磊, 孙杰, 陈先志, 张家泉, 李旺勇, 冯其柱, 王琦()   
  1. 232007 安徽省淮南市,安徽理工大学第一附属医院肝胆外科
  • 收稿日期:2023-03-09 出版日期:2023-08-10
  • 通信作者: 王琦
  • 基金资助:
    安徽省高校自然科学重点研究项目(KJ2021A0439)

Application of hemopurification for hyperlipidemic severe pancreatitis

lei Xu, Jie Sun, Xianzhi Chen   

  • Received:2023-03-09 Published:2023-08-10
引用本文:

许磊, 孙杰, 陈先志, 张家泉, 李旺勇, 冯其柱, 王琦. 血液净化治疗在高血脂性重症胰腺炎中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(04): 464-468.

lei Xu, Jie Sun, Xianzhi Chen. Application of hemopurification for hyperlipidemic severe pancreatitis[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2023, 12(04): 464-468.

急性胰腺炎(acute pancreatitis,AP)是常见的急腹症之一,也是引起腹腔感染的第四大原因[1]。AP常见的病因有胆结石、过量饮酒、高甘油三酯血症(hypertriglyceridemia,HTG)和ERCP治疗,但近些年HTG病因上升到第2位[2]。对于继发于HTG的AP的确切发病机制尚不清楚,可能与游离脂肪酸、氧化应激、Ca2+超载、微循环障碍和遗传等有关[3,4]。系统性炎症反应综合征(systemic inflammation reaction syndrome,SIRS)是重症急性胰腺炎(severe acute pancreatitis,SAP)的早期特征,SIRS病情的持续进展可导致多器官功能障碍(multiple organ dysfunction syndrome,MODS),最终引发严重的腹腔感染、败血症以及休克,导致较高的病死率,这可能与具有促炎和抗炎成分的细胞因子失衡有关[5]。继发于HTG的AP似乎较其他原因导致的AP更严重[6]。迄今为止,已有多种高血脂性重症胰腺炎(hyperlipidemic severe acute pancreatitis,HL-SAP)的降脂治疗方法,比如胰岛素、肝素和降血脂药物等保守疗法,但降脂速度缓慢[7]。血液净化可在短时间内降低甘油三酯(triglycerides,TG)水平,解除病因,有效缓解病情进展。然而,对于血液净化治疗的远期获益存在争议[8]。本文重点关注不同模式及组合的血液净化治疗在HL-SAP中的应用,希望能为个体化血液净化治疗提供帮助。

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