生长抑素与乌司他丁联合肠内营养治疗重症急性胰腺炎患者的临床研究

目的观察生长抑素与乌司他丁联合肠内营养对重症急性胰腺炎(SAP)患者血管内皮功能及肠黏膜屏障的影响。方法将102例SAP患者,随机分为对照组和试验组,各51例。2组均予生长抑素6 mg,用微量泵进行24 h持续静脉滴注,乌司他丁起始剂量每次10万单位,溶于5%葡萄糖注射液或0.9%NaCl注射液500 mL中静脉滴注,每次1~2 h,每天1~3次,根据患者状况改善情况逐渐减量。对照组给予常规静脉营养支持;试验组给予肠内营养支持。2组均治疗2周。比较2组患者治疗前后炎性因子、血管内皮功能、肠黏膜屏障指标、白蛋白、淀粉酶及急性生理与慢性健康评分(APACHE-Ⅱ)。结果治疗后,试验组白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)、血栓素B2(TXB2)、血管性血友病因子(vWF)、内皮素(ET)、D-乳酸、二胺氧化酶(DAO)、果糖/甘露醇(L/M)、淀粉酶及APACHE-Ⅱ、白蛋白(ALB)和一氧化氮(NO)水平分别为(18.94±4.05)pg·mL^-1,(22.73±4.29)pg·mL^-1,(15.53±3.31)pg·mL^-1,(211.52±11.24)pg·mL^-1,(103.73±14.83)%,(102.51±11.06)pg·mL^-1,(5.27±6.51)μg·mL^-1,(2.05±0.96)U·mL^-1,0.13±0.05,(428.59±52.35)U·L^-1,6.63±2.11,(4.24±1.18)g·L^-1,(10.71±3.94)U·mL^-1。对照组的上述指标分别为(27.51±6.27)pg·mL^-1,(36.58±5.61)pg·mL^-1,(19.15±4.08)pg·mL^-1,(274.94±13.08)pg·mL^-1,(151.62±14.85)%,(122.82±12.59)pg·mL^-1,(8.14±7.29)μg·mL^-1,(3.41±1.02)U·mL^-1,0.22±0.09,(861.81±74.83)U·L^-1,8.54±2.28,(2.65±1.09)g·L^-1,(5.62±2.08)U·mL^-1,差异均有统计学意义(均P<0.05)。对照组和试验组的药物不良反应发生率分别为3.92%和0,组间比较差异无统计学意义(P>0.05)。结论生长抑素与乌司他丁联合肠内营养可以有效抑制SAP患者体内炎症反应,促进血管内皮功能的恢复和肠黏膜屏障的修复。

Clinical trial of somatostatin and ulinastatin combined with enteral nutrition in the treatment of patients with severe acute pancreatitis

Objective To investigate the effects of somatostatin and ulinastatin combined with enteral nutrition on vascular endothelial function and intestinal mucosal barrier in patients with severe acute pancreatitis(SAP). Methods A total of 102 SAP patients were randomly divided into control group and treatment group, with 51 cases in each group. Both groups were treated with somatostatin 6 mg, injected intravenously for 24 h, the initial dose of ulinastatin 1.0×10^5 U each time, dissolved into 5% glucose injection or 0. 9% NaCl injection 500 m L,intravenous infusion for 1-2 h a time,1-3 times a day,and gradually decreased according to the improvement of patients’ conditions. Control group was recieved routine intravenous nutrition support. Treatment group was given enteral nutrition. All patients were treated for 2 weeks. The levels of inflammatory factors,vascular endothelial function,intestinal mucosal barrier index,albumin,amylase,acute physiology and chronic health evaluation(APACHE-Ⅱ) score were compared between the two groups before and after treatment. Results After treatment,the levels of interleukin-6(IL-6),interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),thromboxane B2(TXB2),von Willebrand factor(vWF),endothelin(ET),D-lactic acid,dioxygenase(DAO),fructose/mannitol(L/M),amylase,APACHE-Ⅱ,albumin(ALB) and nitric oxide(NO) in treatment group were(18. 94 ± 4. 05) pg · mL^-1,(22. 73 ± 4. 29) pg · mL^-1,(15. 53 ± 3. 31) pg·mL^-1,(211. 52 ± 11. 24) pg·mL^-1,(103. 73 ± 14. 83) %,(102. 51 ± 11. 06) pg·mL^-1,(5. 27 ± 6. 51) μg·mL^-1,(2. 05 ± 0. 96) U·mL^-1,0. 13 ± 0. 05,(428. 59 ± 52. 35) U·L^-1,6. 63 ± 2. 11,(4. 24 ± 1. 18) g·L^-1 and(10. 71 ± 3. 94) U·mL^-1,all with significant difference with those in control group,which were(27. 51 ± 6. 27)pg·mL^-1,(36. 58 ± 5. 61) pg · mL^-1,(19. 15 ± 4. 08) pg · mL^-1,(274. 94 ± 13. 08) pg · mL^-1,(151. 62 ± 14. 85) %,(122. 82 ± 12. 59) pg · mL^-1,(8. 14 ± 7. 29) μg · mL^-1,(3. 41 ± 1. 02) U · mL^-1,0. 22 ± 0. 09,(861. 81 ± 74. 83) U·L^-1,8. 54 ± 2. 28,(2. 65 ± 1. 09) g·L^-1 and(5. 62 ± 2. 08) U·mL^-1(all P < 0. 05). The incidence of adverse drug reactions in control group and treatment group were 3. 92%,0,with no significant difference(P > 0. 05). Conclusion Somatostatin and ulinastatin combined with enteral nutrition can effectively inhibit the inflammatory reaction in SAP patients,promote the recovery of vascular endothelial function and repair of intestinal mucosal barrier.