异甘草酸镁及泮托拉唑钠联合生长抑素治疗重症急性胰腺炎的效果观察

目的 探讨异甘草酸镁、泮托拉唑钠、生长抑素联合治疗重症急性胰腺炎(SAP)的疗效及安全性.方法 收集SAP患者123例,随机分为A组、B组、C组,A组给予异甘草酸镁注射液治疗.B组给予泮托拉唑钠、生长抑素联合治疗.C组给予异甘草酸镁、泮托拉唑钠、生长抑素联合治疗.比较3组治疗前后的C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)等炎症指标及尿素氮、谷丙转氨酶、氧合指数等脏器功能指标变化情况及腹痛缓解时间、胃肠道功能恢复时间及撤离呼吸机时间.结果 治疗后,A组CRP、TNF-α、IL-6水平分别为(36.5±4.6) mg/L、(28.6±6.5)pg/L、(125.8±30.1) pg/L,B组为(34.7±5.1) mg/L、(29.0±6.2) pg/L、(123.4±28.7) pg/L,C组为(19.4±5.0)mg/L、(22.4±5.7)pg/L、(91.4±20.3)pg/L,3组CRP、TNF-α、IL-6水平均较治疗前明显降低(P＜0.05),而C组降低程度最明显(P＜0.05).A组腹痛缓解时间、胃肠道功能恢复时间、撤离呼吸机时间分别为(3.2±0.5)d、(3.2±0.9)d、(4.2±0.8)d,B组为(3.3±0.6)d、(3.1±0.8)d、(4.1±0.7)d,C组为(1.7±0.6)d、(2.4±0.6)d、(2.8±0.6)d,C组腹痛缓解时间、胃肠道功能恢复时间、撤离呼吸机时间均显著低于A、B组(P＜ 0.05).治疗后,A组氧合指数、尿素氮、谷丙转氨酶水平分别为(310.8±51.3)mmHg(1 mmHg=0.133 kPa)、(8.6±2.4) mmol/L、(48.5± 10.1) U/L,B组为(315.9 ±54.0)mmHg、(8.4±2.6)mmol/L、(49.6±9.8)U/L,C组为(463.7±92.0) mmHg、(6.1±1.4) mmol/L、(29.2±8.4)U/L,3组氧合指数均较治疗前明显升高(P＜0.05),尿素氮、谷丙转氨酶水平较治疗前明显降低;治疗后,C组氧合指数较A组、B组明显升高(P＜0.05).C组的总有效率(90.2％)明显高于A组(68.3％)、B组(68.3％)(P＜ 0.05).结论 异甘草酸镁、泮托拉唑钠、生长抑素联合治疗SAP能明显改善患者的炎症反应,改善其体征及临床症状,保护脏器功能,提高临床疗效,值得临床推广应用.

Effect observation of magnesium isoglycyrrhizinate combined with pantoprazole and somatostatin in the treatment of severe acute pancreatitis

Objective To investigate the efficacy and safety of magnesium isoglycyrrhizinate combined with pantoprazole and somatostatin in the treatment of severe acute pancreatitis (SAP).Methods 123 patients with SAP were randomly divided into group A,group B,and group C.Group A was treated with magnesium isoglycyrrhizinate injection,group B was treated with pantoprazole combined somatostatin,and group C was treated with magnesium isoglycyrrhizinate combined with pantoprazole and somatostatin.The inflammatory indexes such as C reactive protein (CRP),tumor necrosis factor alpha (TNF-α),and interleukin-6 (IL-6),the changes of organ function indexes such as urea nitrogen,alanine aminotransferase,oxygenation index before and after treatment,the abdominal pain relief time,recovery time of gastrointestinal function,and ventilator withdrawal time were compared among the three groups.Results After treatment,the levels of CRP,TNF-α,IL-6 in the group A were respectively (36.5±4.6)mg/L,(28.6±6.5)pg/L,(125.8±30.1)pg/L,those in the group B were respectively (34.7±5.1)mg/L,(29.0±6.2)pg/L,(123.4±28.7)pg/L,those in the group C were respectively (19.4±5.0) mg/L,(22.4±5.7)pg/L,(91.4±20.3)pg/L,the levels of CRP,TNF-α,IL-6 in the three groups were significantly lower than those before treatment (P＜0.05),and those in the group C decreased the most obviously (P＜0.05).The abdominal pain relief time,recovery time of gastrointestinal function,and ventilator withdrawal time in the group A were respectively (3.2±0.5)d,(3.2±0.9)d,(4.2±0.8)d,those in the group B were respectively (3.3±0.6)d,(3.1±0.8) d,(4.1±0.7)d,those in the group C were respectively (1.7±0.6)d,(2.440.6)d,(2.8±0.6)d,the abdominal pain relief time,recovery time of gastrointestinal function,and ventilator withdrawal time in the group C were significantly lower than those in the group A and group B (P＜0.05).After treatment,the oxygenation index,the levels of urea nitrogen and alanine aminotransferase in the group A were respectively (310.8±51.3)mmHg,(8.6±2.4)mmol/L,(48.5±10.1)U/L,those in the group B were respectively (315.9±54.0)mmHg,(8.4±2.6)mmol/L,(49.6±9.8)U/L,those in the group C were respectively (463.7±92.0)mmHg,(6.1±l.4)mmol/L,(29.2±8.4)U/L,the oxygenation index in the three groups were significantly higher than those before treatment,the levels of urea nitrogen and alanine aminotransferase were significantly lower than those before treatment (P＜0.05),the oxygenation index in the group C was significantly higher than those in the group A and group B (P＜0.05).The total effective rate in the group C (90.2％) was significantly higher than that in the group A (68.3％) and group B (68.3％) (P＜0.05).Conclusion Magnesium isoglycyrrhizinate combined with pantoprazole and somatostatin in the treatment of severe acute pancreatitis can significantly improve the inflammatory reaction,the clinical signs and symptoms,protect organ function,improve the clinical efficacy,worthy of clinical application.