血液净化在重症急性胰腺炎多器官支持治疗中的角色演进

Evolution of the Role of Blood Purification in Multi-Organ Support Therapy for Severe Acute Pancreatitis

摘要: 血液净化在重症急性胰腺炎(SAP)治疗中的角色已从传统的肾脏替代功能扩展为多器官支持治疗(MOST)的核心组成部分。本文综述了血液净化在SAP治疗中的最新应用，除探讨其免疫调节、炎症介质清除与多器官保护作用外，还分析了当前面临的临床争议、证据局限性，并提出了基于临床表型的个体化治疗策略。研究表明，血液净化技术能够非选择性地清除血液中的促炎细胞因子，如IL-6和TNF-α，调节免疫内稳态，减轻过度免疫反应并改善器官功能。通过精细的液体管理，血液净化有助于恢复血管张力、改善心肌功能，并保护肝脏与肠道屏障，减少并发症的发生。此外，血液净化与早期肠内营养等治疗的协同，为SAP患者提供了更全面的器官功能支持，有助于改善预后。随着技术的进步和个体化治疗的发展，血液净化将继续在SAP的多器官支持治疗中发挥重要作用。

Abstract: The role of blood purification in the treatment of severe acute pancreatitis (SAP) has expanded from traditional renal replacement to a core component of multi-organ support therapy (MOST). This article reviews the latest applications of blood purification in SAP treatment. Beyond examining its roles in immunomodulation, inflammatory mediator clearance, and multi-organ protection, it critically analyzes current clinical controversies, evidence limitations, and proposes phenotype-based individualized treatment strategies. Studies have shown that blood purification techniques can non-selectively remove pro-inflammatory cytokines such as IL-6 and TNF-α from the blood, regulate immune homeostasis, mitigate excessive immune responses, and improve organ function. Through precise fluid management, blood purification helps restore vascular tone, improve myocardial function, and protect the liver and intestinal barrier, thereby reducing complications. Furthermore, the synergy between blood purification and other treatments, such as early enteral nutrition, provides comprehensive organ function support for SAP patients, contributing to improved outcomes. With technological advancements and the development of individualized treatment strategies, blood purification will continue to play a vital role in multi-organ support therapy for SAP.