高渗盐水对急性胰腺炎IL-6、IL-8及血流动力学变化的影响

目的:研究高渗盐水重复用于手术胰腺炎病人对IL-6、IL-8及血流动力学变化的影响,以探讨其可能的作用机制,为临床应用HS治疗AP提供理论依据。方法:48例重症胰腺炎手术病人随机分为A组(24例)和B组(24例),A组在术前及术后24 h时输7.5%高渗盐水4 m l/kg,B组则在同时点输复方氯化钠溶液,分别于术后1 d、3d、5 d、7 d、10 d、15 d进行血尿淀粉酶及白细胞计数的变化;并分别于入手术室时(T0)、术后4 h(T1)、24 h(T2)、36小时(T3)、48 h(T4)分别测定IL-6和IL-8。结果:T1、T3时A组MAP、CVP明显高于B组(P<0.05),HR组间比较无差异(P>0.05);T2时A组HR较B组低(P<0.05),MAP、CVP组间无差异(P>0.05);T2、T3、T4时A组IL-6、IL-8明显低于B组(P<0.05),且均低于T0时。血淀粉酶在术后15d内、尿淀粉酶在术后1周内组间无显著性差异(P>0.05),但10 d、15 d时A组明显低于B组(P<0.05);WBC则自3d起A组明显低于B组(P<0.05)。结论:高渗盐水可降低胰腺炎围手术期间的血浆IL-6、IL-8水平,抑制全身性炎症反应,对胰腺炎伴随的全身炎性反应有肯定治疗作用。

The effect of hypertonic saline on inflammatory cytokines and hemodynamics in acute pancreatitis

Objective To investigate the effect of hypertonic saline on inflammatory cytokines and hemodynamics in acute pancreatitis and provide a basis for clinical application of hypertonic saline in acute pancreatitis.Methods Forty-eight patients with critical pancreatitis were randomly allocated to receive intravenously either 4 ml/kg of 7.5% hypertonic saline(n=24;group A) or compound sodium chloride(n=24;group B) at preoperation and 24 h after operation.Blood and urine amylase level and WBC count were analysed at 1 d,3 d,5 d,7 d,10 d,15 d after operation;IL-6 and IL-8 were measured at the time of entering operation room(T_0) and at 4 h(T_1),24 h(T_2),36 h(T_3),48 h(T_4) after operation.Results At T_1,the mean arterial pressure(MAP) and central venous pressure(CVP) in group A were significantly higher than that in group B(P<0.05),and heart rate(HR) in group A did not differ from that in group B(P>0.05;at T_2,HR in group A was significantly lower than in group B(P<0.05),and there was not difference in MAP and CVP between both groups(P>0.05);at T_3,MAP and CVP in group A were significantly higher than that in group B(P<0.05),and there was not difference in HR between both groups(P>0.05).At T_2,T_3 and T_4,IL-6 and IL-8 in group A were significantly lower than that in group B and than at T_0 in group A(P<0.05).in 15d after operation and in 1w after operation was not different between both groups(P>0.05);while blood amylase and urine amylase in group A was significantly lower than in group B at 10d,15d after operation(P<0.05).WBC count in group A was significantly lower than in group B from 3d after operation(P<0.05).Conclusions During peri-operation period,hypertonic saline may reduce IL-6 and IL8 level in plasma,which has therapeutic effect through inhibiting systemic inflammatory response in acute pancreatitis.