乌司他丁联合参附注射液对重症急性胰腺炎心肌损伤的保护作用

目的研究乌司他丁联合参附注射液在治疗重症急性胰腺炎过程中对心肌损伤的保护作用。 方法选取重症急性胰腺炎伴心肌损伤病人90例，随机将病人分为治疗组和对照组，每组45例。对照组在常规治疗基础上加用乌司他丁，治疗组在常规治疗基础上加用乌司他丁及参附注射液，整个疗程共10 d。观察2组的临床症状恢复时间、急性生理与慢性健康评分(APACHE Ⅱ)和急性胰腺炎严重程度床边指数(BISAP)。抽取病人空腹静脉血，在治疗前、治疗5 d和治疗10 d后分别测定血清N-末端前体脑钠肽(NT-proBNP)、血清肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)水平，比较2组生化指标差异。 结果治疗组治疗后腹痛、腹胀、排气、排便、肠鸣音恢复时间均短于对照组(P < 0.05)。治疗后10 d 2组NT-proBNP、cTnI、CK-MB水平均低于治疗前(P < 0.01)，且治疗组血清NT-proBNP和cTnI水平均低于对照组(P < 0.05)。治疗组治疗5 d后血清cTnI和CK-MB水平均低于对照组(P < 0.05)。2组病人治疗前后相比，BISAP评分和APACHEⅡ评分均下降(P < 0.05)；治疗组治疗后BISAP评分和APACHEⅡ评分均低于对照组(P < 0.05和P < 0.01)。 结论乌司他丁联合参附注射液对重症急性胰腺炎病人心肌损伤有一定的保护作用，能改善病人临床症状，调节cTnI、CK-MB、NT-proBNP水平，具有临床推广的应用价值。

Study on the protective effects of ulinastatin combined with Shenfu injection on the myocardial injury in severe acute pancreatitis

ObjectiveTo investigate the protective effects of ulinastatin combined with Shenfu injection on the myocardial injury in patients with severe acute pancreatitis. MethodsNinety patients with severe acute pancreatitis complicated with myocardial injury were randomly divided into the treatment group and control group(45 cases in each group).The control group was treated with conventional therapy combined with ulinastatin, the treatment group was additionally treated with ulinastatin and shenfu injection on the basis of conventional treatment, and the whole course of treatment was 10 days.The clinical symptom recovery time, acute physiology and chronic health score(APACHE Ⅱ) and bedside index of severity in acute pancreatitis(BISAP) in two groups were observed.The fasting venous blood was extracted from the patients, and the serum levels of N-terminal pro-B type brain natriuretic peptide(NT-proBNP), troponin I(cTnI) and creatine kinase MB isoenzyme(CK-MB) in two groups were determined before treatment.After 5 d and 10 d of treatment, the differences of biochemical indexes between two groups were compared. ResultsThe recovery time of abdominal pain, abdominal distention, exhaust, defecation and bowel sounds in treatment group were shorter than those in control group after treatment(P < 0.05).On day 10 after treatment, all indexes in two groups were lower than those before treatment(P < 0.01), and the serum levels of NT-proBNP and cTnI in treatment group were lower than those in control group(P < 0.05).The serum levels of cTnI in treatment group was lower than that in control group after 5 and 10 days of treatment(P < 0.05).The serum level of CK-MB in treatment group was lower than that in control group after 5 days of treatment(P < 0.05).Compared with before treatment, the BISAP score and APACHE Ⅱ score in two groups decreased after treatment(P < 0.05). ConclusionsThe ulinastatin combined with Shenfu injection has a good protective effect on myocardial injury in patients with severe acute pancreatitis, can improve the clinical symptoms of patients, regulate the levels of cTnI, CK-MB and NT-proBNP, and has clinical application value.