生长抑素联合生长激素治疗急性重症胰腺炎临床研究

目的:探讨生长激素和生长抑素治疗急性坏死性胰腺炎的疗效.方法:对60例重症急性胰腺炎(SAP),随机分为善宁治疗组(n=30),生长激素和善宁联合治疗组(n=30).观察并对比两组治疗后住院天数、严重并发症的发生率、中转手术率、病死率和住院费用;APACHE Ⅱ评分;血清IL-1,IL-6和TNF-α水平;测定入院时和入院后2周的血浆清蛋白水平.结果:联合治疗组的住院天数、并发症发生率、中转手术率、病死率、均明显低于善宁组(P＜0.05);联合组抑制SAP的炎性细胞因子高表达及促进清蛋白合成的作用亦优于善宁组(均P＜0.05).结论:联合应用生长抑素和生长激素是早期治疗急性坏死性胰腺炎的一种有效治疗方法.     

联合应用生长抑素和生长激素治疗重症急性胰腺炎疗效观察

目的探讨联合使用生长抑素和生长激素治疗重症急性胰腺炎的疗效。方法将31例重症急性胰腺炎患者随机分为对照组和观察组,分别给予善宁、生长激素联合善宁治疗,观察两组平均住院天数、严重并发症的发生率,中转手术和死亡的例数,治疗前后血清总蛋白及白蛋白变化。结果观察组的住院天数、并发症发生率、中转手术率、病死率均明显低于对照组（P均〈0．05）;观察组治疗后血清总蛋白及白蛋白水平与对照组比较有统计学差异（P均〈0．05）。结论联合应用生长抑素和生长激素是早期治疗重症急性胰腺炎的有效方法。     

生长抑素治疗重症急性胰腺炎40例

[目的]观察在中西医结合治疗重症急性胰腺炎（SAP）的基础上，早期应用生长抑索的临床疗效。[方法]将72例SAP患者随机分为生长抑素治疗组40例和对照组32例，两组均予中西医结合治疗，治疗组加用生长抑素250μg／h持续微泵泵人，持续5～7d，对两组之间腹痛及压痛缓解、多项实验室指标、腹水消失、住院时间以及并发症发生率、转手术率、病死率进行分析。[结果]治疗组腹痛及压痛缓解时间、实验室指标恢复时间、腹水消失、住院时间等明显优于对照组（P〈0．05，〈0．01），并发症发生、转手术率及病死率低于对照组（P〈0．05）。[结论]早期中西医结合联合生长抑素对SAP治疗有重要价值。     

生长抑素联合生长激素治疗对重症急性胰腺炎大鼠脑损伤的保护作用

目的 观察重症急性胰腺炎(SAP)时脑损伤与血清内皮素(ET)-l／一氧化氮(NO)比值的关系以及生长抑素和生长激素的保护作用。方法 80只大鼠经胰胆管逆行注射3．5％牛磺胆酸钠2．5n11／kg建立SAP模型，然后分成4组：重症胰腺炎组(SAP组)，生长抑素组(S组，每天静脉注射42μg／1kg，共2d)，生长激素组(G组，每天皮下注射O．5μg／kg，共2d)和联合治疗组，每组20只。另取20只不造模大鼠为正常对照组。观察各组治疗前后脑水肿、血脯屏障、脑细胞凋亡变化以及与血清ET-1／N0的相关性,结果SAP大鼠血清ET-1／NO显著升高，与脑水肿、血脑屏障损伤程度及脑细胞凋亡呈正相关。生长激素和生长抑素可降低血清ET-1／N0水平，减轻脑组织水肿，减少脑细胞凋亡，改善血脑屏障通透性。同时观察到SAP大鼠脑电图呈慢波改变，治疗后好转。结论生长激素和生长抑素可降低SAP大鼠血清ET-1／NO比值，改善脑水肿和血脑屏障通透性，减少脑细胞凋亡，对SAP时的脑损伤有保护作用。     

生长抑素与生长激素联合应用治疗重症急性胰腺炎多中心对照临床初步研究

目的 评价生长抑素(SS)和生长激素(GH)联合应用对重症急性胰腺炎(SAP)的治疗效果，并试图揭示两者联合应用的作用机制。方法 采用前瞻性、对照、开放、多中心临床研究，将确诊为SAP的患者分为SS治疗组和SS联合GH治疗组，共有59例患者完成此方案规定内容，其中SS治疗组31例，SS联合GH治疗组28例。急性胰腺炎(AP)的诊断依据临床症状、体征、血淀粉酶及影像学(B超或CT)检查。AP严重度评估分别依据Ranson标准、APACHEⅡ评分或Balthazar CT积分。结果 两组患者入院时年龄、性别、病因构成及SAP严重度评分诸方面差异均无显著性。与单用SS治疗组相比，SS联合GH治疗组患者的血清白蛋白于入院2周后显著升高；血浆内毒素水平自入院后第3天开始显著降低，肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β水平明显降低；血清胰岛素样生长因子(IGF-1)和胰岛素样生长因子结合蛋白(IGFBP-3)水平于入院后第10天显著升高；APACHEⅡ评分及Binder合并症积分明显改善；并发症和平均住院时间明显缩短，死亡率降低(0比16％)。但血清淀粉酶和乳酸脱氢酶(LDH)活性于治疗后无明显变化。住院费用两组差异无显著性。结论 SS和GH联合应用可显著改善SAP患者的预后，缩短住院时间，其可能的作用机制是通过促进IGF-1和IGFBP-3释放，从而间接加强肠道黏膜屏障功能、减轻细菌和内毒素移位、减轻急性期炎症介质和细胞因子的过度释放、提高机体免疫能力等多层次、多水平阻断SAP时的高应激反应，避免SAP患者并发多器官功能障碍。     

生长抑素在中西医结合治疗老年重症急性胰腺炎中的疗效观察

老年重症急性胰腺炎（SAP）临床表现不典型，常合并多种疾病，预后差。我院对老年SAP应用生长抑素（施他宁）与中西医结合治疗，取得良好疗效。     

生长抑素联合前列地尔治疗急性重症胰腺炎的疗效观察

目的 评价我院生长抑素联合前列地尔治疗急性重症胰腺炎患者的临床疗效。方法 将2011年1月到2015年1月我院收治的急性重症胰腺炎患者共64例随机分为对照组和观察组二组治疗,对照组给予生长抑素治疗,观察组给予生长抑素+前列地尔联合治疗,比较二组患者不同症状消失时间,并发症,中转手术率以及治疗效果。结果 观察组总有效率(93.75%)明显好于对照组(78.12%)(P<0.05)；同时观察组腹痛消失、腹胀消失、排气恢复以及患者平均住院时间明显少于对照组(P<0.05)；此外并发症和中转手术率也明显少于对照组(P<0.05)。结论 生长抑素联合前列地尔治疗急性重症胰腺炎临床总有效率高,同时能减轻患者痛苦,降低并发症和中转手术率,值得临床应用推广。     

生长抑素与大黄联合应用治疗急性重症胰腺炎疗效观察

目的探讨生长抑素（施他宁）联合大黄治疗重症急性胰腺炎（SAP）的效果。方法将45例SAP患者随机分为联合治疗组和对照组，观测和对比两组临床指征、实验室指标、APACHE-Ⅱ评分。结果联合治疗组腹痛缓解的时间及体温、肠鸣音、血淀粉酶恢复时间与对照组比较，差异有统计学意义（P〈0．05）。两组患者入院后7d和14d，联合治疗组APACHE-Ⅱ评分与对照组比较，差异有统计学意义（P〈p．05）。联合治疗组在入院7d及14d时，ALT及总胆红素水平与对照组相比，差异有统计学意义（P〈0．05）；在入院14d，联合治疗组肌酐和尿素氮水平与对照组比较，差异有统计学意义（P〈0．05）。结论施他宁和大黄联合治疗SAP有简便、价廉、疗效确切等优点，值得临床推广应用。     

生长抑素治疗重症急性胰腺炎的临床研究

目的观察生长抑素施他宁及其类似物善宁治疗重症急性胰腺炎(SAP)的治疗效果及评估其临床价值。方法按Ranson标准判断病情严重程度,将106例病情大致相近的SAP患者分成施他宁治疗组37例,善宁治疗组36例及对照组33例。对照组用一般常规治疗方法,治疗组在一般常规治疗方法治疗的基础上加用施他宁6mg／d或善宁0．6mg／d,维持治疗7～14d。观察3组血尿淀粉酶变化、平均腹痛持续时间、禁食天数、住院天数、并发症、手术率及住院费用等多项指标。结果施他宁和善宁治疗SAP均能显著降低血尿淀粉酶水平,控制腹痛,缩短禁食时间和住院天数,减少并发症和手术率,并且没有明显的增加住院费用。结论生长抑素施他宁和善宁对SAP有明显疗效,可以阻止病情进展和恶化,减少并发症,改善预后。     

生长抑素和生长激素联用对兔重症急性胰腺炎肠黏膜屏障损伤的保护作用

目的 观察生长抑素(SS)和生长激素(GH)联合应用对重症急性胰腺炎(SAP)兔肠黏膜屏障损伤的保护作用,探讨其对治疗SAP的意义.方法 72只新西兰大白兔平均分为3组,SAP模型组(SAP组)、SS治疗组(SS组)以及SS和GH联合治疗组(SS+GH组).经胰管开口逆行注入5%牛磺胆酸钠溶液诱导兔SAP模型,造模后3组均每日予5%葡萄糖氯化钠(GNS)治疗,SS组造模后按3.5μg·kg-1·h-1持续48 h泵入SS治疗,SS+GH组造模后第1、24 h在持续泵入SS的基础上,按0.15 IU/kg皮下注射GH治疗.观察各组动物造模后第6、12、24、48小时血清淀粉酶、肿瘤坏死因子(TNF)-α,血浆二胺氧化酶水平的变化,观察兔胰腺和肠黏膜的病理学变化及存活率.采用SPSS 16.0统计软件进行分析,组间比较采用单因素方差分析.结果 SS+GH组兔血清TNF-α和血浆二胺氧化酶水平较SAP组和SS组均明显降低,造模后24 h[分别为(2.43±0.14)pg/ml和(4.61±0.45)U/L]和48 h[分别为(2.08±0.23)pg/rl和(3.75±0.47)U/L]较SS组[24 h分别为(2.80±0.30)pg/ml和(8.74±1.77)U/L,48 h分别为(2.45±0.12)pg/m1和(5.02±0.95)U/L]显著降低,差异均有统计学意义(P＜0.05).SS+GH组较SAP组和SS组兔肠黏膜炎性反应减轻,肠黏膜的完整性增加,胰腺组织炎性反应减轻,存活率提高,但血清淀粉酶在各时间点与SS组相比差异均无统计学意义.结论 SS和GH联合应用可增强兔肠黏膜屏障功能,改善SAP预后.

Abstract：

Objective To investigate the protective effect of somatostatin (SS)combined with growth hormone (GH) in treatment of intestinal mucosal barrier injury in rabbits with severe acute pancreatitis (SAP), as well as its clinical significance. Methods Seventy-two rabbits were equally assigned into model group (SAP group), SS treated group (SS group) and SS combined with GH treated group (SS + GH group). SAP models were induced by retro-injection of 5% sodium taurocholate into the pancreatic duct. After modeling, all rabbits were given 5 % glucose saline daily.The rabbits in SS group and SS+GH group were continuously Given SS (3.5μg·kg-1·h-1)for 48 hours. Besides, the rabbits in SS+GH group were subcutaneously injected with 0.15 IU/kg of GH at the 1st and the 24th hours after modeling. The levels of serum amylase, serum tumor necrosis factor-α (TNF-α) and plasma diamine oxidase were measured at the 6th, 12th, 24th and 48th hours after modeling. The pathological changes of pancreatic tissue and ileal mucosa were observed. Survival rate was calculated. Data were analyzed using SPSS 16.0 software. The univariate analysis was used to compare the difference among groups. Results In SS+GH group, the levels of serum TNF-α and plasma diamine oxidase were (2. 43 ± 0. 14) pg/ml and (4. 61 ± 0. 45) U/L at the 24th hour respectively, and were (2.08±0.23) pg/ml and (3.75±0.47) U/L at the 48th hour, respectively,which were lower than those in SAP group and SS group [(2.80 0.30) pg/ml and (8.74 ± 1.77)U/L, respectively, at the 24th hour; (2. 45±0.12) pg/ml and (5. 02±0.95) U/L, respectively, at the 48th hour)]with significant difference (P＜0.05). The inflammation in pancreas and ileal mucosa was alleviated, and the integrity of bowel mucosa was improved. Survival rate of SS+GH group was significantly higher than SAP group and SS group. There was no significant difference in level of serum amylase between SS+GH group and SS group. Conclusion The combination of SS with GH may enhance the function of intestinal mucosa barrier and improve the prognosis of SAP in rabbits.     

生长抑素和生长激素联用对兔重症急性胰腺炎肠黏膜屏障损伤的保护作用

Objective To investigate the protective effect of somatostatin (SS)combined with growth hormone (GH) in treatment of intestinal mucosal barrier injury in rabbits with severe acute pancreatitis (SAP), as well as its clinical significance. Methods Seventy-two rabbits were equally assigned into model group (SAP group), SS treated group (SS group) and SS combined with GH treated group (SS + GH group). SAP models were induced by retro-injection of 5% sodium taurocholate into the pancreatic duct. After modeling, all rabbits were given 5 % glucose saline daily.The rabbits in SS group and SS+GH group were continuously Given SS (3.5μg·kg-1·h-1)for 48 hours. Besides, the rabbits in SS+GH group were subcutaneously injected with 0.15 IU/kg of GH at the 1st and the 24th hours after modeling. The levels of serum amylase, serum tumor necrosis factor-α (TNF-α) and plasma diamine oxidase were measured at the 6th, 12th, 24th and 48th hours after modeling. The pathological changes of pancreatic tissue and ileal mucosa were observed. Survival rate was calculated. Data were analyzed using SPSS 16.0 software. The univariate analysis was used to compare the difference among groups. Results In SS+GH group, the levels of serum TNF-α and plasma diamine oxidase were (2. 43 ± 0. 14) pg/ml and (4. 61 ± 0. 45) U/L at the 24th hour respectively, and were (2.08±0.23) pg/ml and (3.75±0.47) U/L at the 48th hour, respectively,which were lower than those in SAP group and SS group [(2.80 0.30) pg/ml and (8.74 ± 1.77)U/L, respectively, at the 24th hour; (2. 45±0.12) pg/ml and (5. 02±0.95) U/L, respectively, at the 48th hour)]with significant difference (P＜0.05). The inflammation in pancreas and ileal mucosa was alleviated, and the integrity of bowel mucosa was improved. Survival rate of SS+GH group was significantly higher than SAP group and SS group. There was no significant difference in level of serum amylase between SS+GH group and SS group. Conclusion The combination of SS with GH may enhance the function of intestinal mucosa barrier and improve the prognosis of SAP in rabbits.     

生长抑素和生长激素联用对兔重症急性胰腺炎肠黏膜屏障损伤的保护作用

Objective To investigate the protective effect of somatostatin (SS)combined with growth hormone (GH) in treatment of intestinal mucosal barrier injury in rabbits with severe acute pancreatitis (SAP), as well as its clinical significance. Methods Seventy-two rabbits were equally assigned into model group (SAP group), SS treated group (SS group) and SS combined with GH treated group (SS + GH group). SAP models were induced by retro-injection of 5% sodium taurocholate into the pancreatic duct. After modeling, all rabbits were given 5 % glucose saline daily.The rabbits in SS group and SS+GH group were continuously Given SS (3.5μg·kg-1·h-1)for 48 hours. Besides, the rabbits in SS+GH group were subcutaneously injected with 0.15 IU/kg of GH at the 1st and the 24th hours after modeling. The levels of serum amylase, serum tumor necrosis factor-α (TNF-α) and plasma diamine oxidase were measured at the 6th, 12th, 24th and 48th hours after modeling. The pathological changes of pancreatic tissue and ileal mucosa were observed. Survival rate was calculated. Data were analyzed using SPSS 16.0 software. The univariate analysis was used to compare the difference among groups. Results In SS+GH group, the levels of serum TNF-α and plasma diamine oxidase were (2. 43 ± 0. 14) pg/ml and (4. 61 ± 0. 45) U/L at the 24th hour respectively, and were (2.08±0.23) pg/ml and (3.75±0.47) U/L at the 48th hour, respectively,which were lower than those in SAP group and SS group [(2.80 0.30) pg/ml and (8.74 ± 1.77)U/L, respectively, at the 24th hour; (2. 45±0.12) pg/ml and (5. 02±0.95) U/L, respectively, at the 48th hour)]with significant difference (P＜0.05). The inflammation in pancreas and ileal mucosa was alleviated, and the integrity of bowel mucosa was improved. Survival rate of SS+GH group was significantly higher than SAP group and SS group. There was no significant difference in level of serum amylase between SS+GH group and SS group. Conclusion The combination of SS with GH may enhance the function of intestinal mucosa barrier and improve the prognosis of SAP in rabbits.     

生长抑素联合前列地尔治疗重症急性胰腺炎43例临床观察

目的:评价生长抑素联合前列地尔治疗重症急性胰腺炎(SAP)的临床疗效并探讨其作用机制。方法:将69例SAP患者分为生长抑素联合前列地尔组(联合组)和单用生长抑素组(对照组),观察2组患者血内毒素、TNF-α、IL-6、血浆内血小板颗粒膜蛋白(GMP140)、血栓素B2(TXB2)、血管性假血友病因子相关抗原(vWF:Ag)水平的变化,比较2组患者治疗前和治疗后14dAPACHEⅡ评分及Binder评分,平均ICU住院时间及28d病死率。结果:2组患者入院时血内毒素、TNF-α、IL-6、GMP140、TXB2、vWF:Ag均高于正常,治疗后降低,联合组较对照组下降的趋势更明显(均P<0.05)。治疗后与对照组比较,联合组APACHEⅡ评分及Binder合并症评分降低更为明显(P<0.05);ICU住院时间明显缩短(P<0.05);病死率显著下降(P<0.05)。结论:生长抑素联合前列地尔治疗SAP比单独应用生长抑素更能抑制炎症介质释放,改善胰腺微循环障碍,缩短ICU住院日。     

生长抑素在重症胰腺炎中的治疗价值

目前对于老年重症急性胰腺炎(SAP)的治疗 ,多数学者认为仍以内科保守治疗为主 ,措施包括禁食、支持疗法、抗生素的应用、抑制胰酶药物应用、解痉止痛药等 ,重点在于保护器官功能、防止感染发生。外科治疗仅限于已怀疑发生胰腺、胰周感染 ,或已发生严重并发症及保守治疗不能稳定     

生长抑素和生长激素联合应用对急性胰腺炎患者C反应蛋白和疗效的影响

目的 探讨C反应蛋白与急性胰腺炎病情发展相关性及联合应用生长抑素(SS)和生长激素(GH)治疗后对其变化的影响.方法 比较MAP和SAP患者治疗前CRP差别及AP患者在生长抑素联合生长激素治疗前后APACHEII评分、CRP及中转手术率、病死率、住院天数及住院费用.结果 MAP患者外周血的CRP,入院时与空白对照组有显著性差异(P＜0.05),但SAP入院时CRP升高更明显(P＜0.01);GH组的治疗后APACHEⅡ积分和CRP、中转手术率、病死率、住院天数及住院费用均明显低于SS组及对照组(P＜0.05).结论 CRP变化能反映AP病情的变化,可帮助判断预后与指导治疗;联合应用生长抑素和生长激素能显著缩短患者住院时间及CRP回复时间,减少严重并发症发生,具有良好疗效.     

生长抑素联合参附注射液治疗重症急性胰腺炎的实验研究

[目的]探讨生长抑素（SS）联合参附注射液（SFI）对实验性重症急性胰腺炎（SAP）的治疗作用，为临床采用中西医结合治疗SAP提供依据。[方法]用5％牛磺胆酸钠逆行胰胆管注射制备SAP大鼠模型，根据实验分为假手术对照（对照）组、SAP组、SFI组、善宁组、SFI加善宁（联合）组。观察各组血中一氧化氮（N0）、内皮素（ET）、淀粉酶的变化及胰腺组织病理学改变。[结果]与对照组比较，SAP组N0、ET、血清淀粉酶均明显升高（P〈0．01），光镜下胰腺组织病理损害明显；SFI组、善宁组上述各检测指标均较SAP组明显改善（P〈0．05），但联合组改善最明显（P〈0．01），与SFI组、善宁组比较差异有统计学意义（P〈0．05）。[结论]联合应用善宁和SFI治疗SAP有协同作用，疗效优于单一的西药或中药治疗。     

柴芍承气汤联合生长抑素辅助治疗重症急性胰腺炎100例效果观察

目的探讨柴芍承气汤（CSCQS）联合生长抑素（SST）治疗重症急性胰腺炎（SAP）的临床疗效。方法将同期收治的200例SAP患者随机分为观察组和对照组各100例,两组均予液体复苏、禁食、胃肠减压、抗感染及SST治疗,在此基础上观察组加服CSCQS。观察两组临床症状、生化指标改善时间,远期并发症发生率、中转手术率、住院时间及临床疗效。结果观察组腹痛腹胀缓解时间、肛门排便时间及住院时间均显著短于对照组,远期并发症发生率及病死率均显著低于对照组,治愈率显著高于对照组,P均〈0．05。结论CSCQS联合SST辅助治疗SAP可显著提高临床疗效、改善患者预后,可能机制为两药可通过不同作用靶点产生协同效应。     

奥宁治疗重症急性胰腺炎疗效的观察

SAP是临床上常见的消化系统急性重症,临床经过凶险,严重者伴有休克、呼吸衰竭及肾脏衰竭,病死率高达15%～30%[1,2]。近10余年来,由于生长抑素类似药物奥曲肽的临床应用,使SAP的治疗有了很大进展[3]。我院从1996年以来一直使用进口奥曲肽(善宁)治疗SAP,2004年起,我院又引入国产奥曲肽(奥宁)治疗。为了解奥宁的疗效,现将奥宁与善宁治疗的对照结果总结如下。资料与方法一、临床资料我院2004年2月至2006年5月共收治SAP76例,其中,使用善宁组31例,使用奥宁组45例,所有病例均符合2002年世界胃肠病大会制定的AP诊治指南的临床和分级标准[4]。…     

生长抑素联合香丹注射液治疗急性胰腺炎疗效观察

目的：对生长抑素联合香丹注射液治疗急性胰腺炎的临床治疗效果进行观察和分析。方法选择50例于2011年1月至2013年8月间在我院进行急性胰腺炎治疗的患者资料进行研究和分析,将患者分为对照组和研究组两组,每组各有25例患者,对对照组患者进行常规治疗和生长抑素治疗,在此治疗基础上对研究组患者加用香丹注射液治疗,比较和分析两组患者的治疗效果。结果对照组6例患者痊愈,7例患者治疗显效,5例患者治疗有效,7例患者治疗无效,治疗总有效率为72%,研究组10例患者痊愈,9例患者治疗显效,5例患者治疗有效,1例患者治疗无效,治疗总有效率为96%,两组患者临床治疗效果差异具有统计学意义（P〈0.05）。治疗后研究组肝肾功能指标下降幅度明显高于对照组患者,差异具有统计学意义（P〈0.05）。治疗后研究组患者血淀粉酶下降幅度明显高于对照组患者,差异具有统计学意义（P〈0.05）。对照组患者平均住院时间、腹部压痛腹胀以及腹痛消失时间明显长于研究组患者,差异具有统计学意义（P〈0.05）。结论对急性胰腺炎患者进行生长抑素联合香丹注射液治疗能够取得更加理想的临床治疗效果。     

生长抑素联合胰炎合剂治疗重症急性胰腺炎疗效观察

36例重症急性胰腺炎患者随机分为两组,各18例,对照组单用生长抑素治疗,治疗组用生长抑素联合胰炎合剂治疗.结果显示,治疗组腹部症状、体征及血淀粉酶、C-反应蛋白(CRP)、乳酸脱氢酶(LDH)、AST的恢复时间均短于对照组(P均<0.05),急性生理和慢性健康状况评分(APACHE Ⅱ)优于对照组(P<0.05),治疗组血清内毒素水平低于对照组(P<0.05).认为生长抑素联合胰炎合剂治疗重症急性胰腺炎可明显改善患者病情.