高三酸甘油脂血症併發急性胰臟炎合併多重器官衰竭之案例報告

A Case Study of a Patient with Multiple Organ Failures Caused by Hypertriglyceridemia-induced Acute Pancreatitis

急性胰臟炎在腸胃道疾病方面是個很常見的急性 疾病，大部分的病例經由內科的支持治療可以痊 癒，但有少數病患屬於嚴重患者，不但需入住 加護病房加強照護，同時死亡率也大幅上升。本 篇報告在探討一位高三酸甘油脂併發急性胰臟炎 病人，在七十二小時內進展為敗血性休克、急 性腎損傷、急性呼吸窘迫症等多重器官衰竭。 病人經由血漿交換療法（plasma exchange）、連 續性靜脈對靜脈血液過濾術（continuous venousvenous hemofiltration, CVVH）、體外循環維生系 統（extracorporeal membrane oxygenation, ECMO） 等醫療措施，最終度過危險期並順利轉出加護病 房。運用血漿交換療法在急性胰臟炎的治療中雖 為輔助療法，但卻可快速又有效的降低三酸甘油 脂（Triglyceride, TG），進而改善病況，筆者希望 藉由此一案例分享，對於照護重度高脂血性胰臟 炎患者，提供另一種的選擇。

 

Acute pancreatitis is a common gastrointestinal disease. Supportive therapy is sufficient for treating acute pancreatitis in most cases without complication. However, few severe acute pancreatitis patients require intensive care with high mortality rate. We herein report a patient with hypertriglyceridemia-induced acute pancreatitis that progressed to multiple organ failures including septic shock, acute kidney injury, and acute respiratory distress within 72 hours. The condition of the patient was improved and released from ICU after treating with plasma exchange, continuous venous-venous hemofiltration, and extracorporeal membrane oxygenation. Serum level of triglyceride had been significantly reduced after plasma exchange treatment. Therapeutic plasma exchange can be an effective complementary therapy for patients with acute pancreatitis associated with hypertriglyceridemia.