奥曲肽联合乌司他丁在改善老年重型急性胰腺炎患者预后中的应用

目的探讨奥曲肽联合乌司他丁在老年重型急性胰腺炎(SAP)患者治疗中的临床应用价值。方法选取2016年5月至2019年2月浙江省中西医结合医院消化科收治的124例老年SAP患者,分为联合组和对照组,每组各62例。联合组给予奥曲肽联合乌司他丁治疗,对照组仅采用奥曲肽进行治疗。全自动生化分析及酶联免疫法监测治疗前及治疗后1、3、5、7、14 d血清白细胞计数、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和淀粉酶水平;分析两组治疗后7 d的疼痛等级评分、急性生理与慢性健康评分(APACHEⅡ)和疗效评价;对比两组患者的进食时间和住院时间,记录治疗过程中相关并发症情况;随访两组患者1年内并发症发生及胰腺炎再复发情况。结果治疗前两组患者血清白细胞计数、CRP、血清淀粉酶、IL-6、TNF-α水平比较,差异均无统计学意义(均P>0.05);治疗后3 d两组患者白细胞计数、CRP和TNF-α水平差异有统计学意义(t=3.735、2.851、-2.147,P=0.036、0.029、0.043),血清淀粉酶、IL-6水平差异无统计学意义(均P>0.05);治疗后7 d两组患者上述各指标结果差异均有统计学意义(t=3.624、2.918、-2.166、2.684、-2.593,P=0.023、0.011、<0.001、0.015、<0.001);治疗后14 d血清淀粉酶、IL-6、TNF-α水平差异有统计学意义(t=-3.515、4.627、-3.189,均P<0.001),白细胞计数、CRP水平比较差异无统计学意义(均P>0.05)。治疗后7 d两组患者VAS、APACHE-Ⅱ评分比较差异有统计学意义(t=-2.346、-3.245,P=0.021、0.002)。治疗后7 d,联合组治疗显效率为79.0%(49/62),对照组为61.3%(38/62),差异有统计学意义(χ²=4.661,P=0.031)。联合组患者平均进食时间为(6.72±1.87)d、平均住院时间为(11.23±2.98)d,对照组为(7.65±1.69)d、(13.85±3.42)d,组间差异有统计学意义(t=-2.868、-4.565,均P<0.05)。治疗过程中,联合组患者感染性胰腺坏死、消化道反应和器官衰竭的发生率分别为11.3%(7/62)、43.5%(27/62)、1.6%(1/62),与对照组25.8%(16/62)、21.0%(13/62)、11.3%(7/62)比较差异有统计学意义(χ²=4.324、7.233、4.810,P=0.038、0.007、0.028)。联合组平均无并发症时间为(10.25±3.26)个月、无复发时间为(10.69±2.51)个月,对照组分别为(8.72±3.73)个月、(9.62±2.92)个月,差异有统计学意义(Log Rankχ²=7.463、4.589,P=0.006、0.032)。结论奥曲肽联合乌司他丁可有效缓解老年SAP患者局部症状和临床进展,降低并发症风险和疾病复发率,促进患者早期康复。

Combination therapy with Octreotide and Ulinastatin for improving the prognosis of elderly patients with severe acute pancreatitis

Objective To investigate the clinical value of Octreotide plus Ulinastatin in the treatment of severe acute pancreatitis(SAP)in elderly patients.Methods From May 2016 to February 2019,124 elderly SAP patients admitted to the gastroenterology department of our hospital were enrolled and divided into the combination therapy group and the control group,with 62 patients in each group.The combination therapy group was treated with Octreotide and Ulinastatin,while the control group was treated with Octreotide alone.Serum leukocyte count,C-reactive protein(CRP),interleukin(IL)-6,tumor necrosis factor(TNF)-αand amylase levels were monitored before and 1,3,5,7 and 14 days after treatment by automated biochemical analysis and enzyme-linked immunosorbent assays.The pain grade scale,APACHE-Ⅱscore and efficacy evaluation were analyzed for the two groups 7 days after treatment.The time to oral refeeding and length of hospitalization were compared between the two groups,and related complications during the treatment were recorded.Complications and the recurrence of pancreatitis within 1 year were followed up in both groups.Results There was no statistically significant difference in serum white blood cell count,CRP,amylase,IL-6 and TNF-αlevels between the two groups before treatment(all P>0.05).Serum white blood cell count,CRP and TNF-αlevels had significant differences(t=3.735,2.851 and-2.147,P=0.036,0.029 and 0.043)and serum amylase and IL-6 levels had no significant difference(P>0.05)between the two groups 3 days after treatment.All the above parameters had significant differences between the two groups 7 days after treatment(t=3.624,2.918,-2.166,2.684 and-2.593,P=0.023,0.011,<0.001,0.015 and<0.001).Serum amylase,IL-6 and TNF-αlevels had significant differences(t=-3.515,4.627 and-3.189,all P<0.001)and serum white blood cell count and CRP had no significant difference(all P>0.05)between the two groups 14 days after treatment.There were significant differences in visual analogue scale(VAS)and APACHE-Ⅱscore between the two groups 7 days after treatment(t=-2.346 and-3.245,P=0.021 and 0.002).On the 7th day after treatment,the effectiveness rate was 79.0%(49/62)in the combination therapy group and 61.3%(38/62)in the control group,with a significant difference between the two groups(χ²=4.661,P=0.031).Compared with the control group,time to oral refeeding and hospitalization length were shorter in the combination therapy group than in the control group(6.72±1.87 d vs.7.65±1.69 d,11.23±2.98 d vs.13.85±3.42 d,t=-2.868 and-4.565,both P<0.05).There were significant differences in the incidences of infectious pancreatic necrosis,gastrointestinal adverse reactions and organ failure between the combination therapy group and the control group(11.3%or 7/62 vs.25.8%or 16/62,43.5%or 27/62 vs.21.0%or 13/62,1.6%or 1/62 vs.11.3%or 7/62,χ²=4.324,7.233 and 4.810,P=0.038,0.007 and 0.028).There were significant differences in mean length of time without complications and recurrence between the combined group and the control group(10.25±3.26 months vs.8.72±3.73 months,10.69±2.51 months vs.9.62±2.92 months,Log Rankχ²=7.463 and 4.589,P=0.006 and 0.032).Conclusions Octreotide combined with Ulinastatin can effectively alleviate local symptoms,slow clinical progression,reduce the risk of complications,decrease the recurrence rate and promote early recovery in elderly SAP patients.