不同剂量血必净注射液对重症急性胰腺炎患者预后的影响

目的探讨不同剂量血必净注射液治疗重症急性胰腺炎患者的疗效,特别是对机体炎症指标和脏器功能的改善状况。方法根据是否使用血必净和不同使用剂量,将重症急性胰腺炎患者分为常规治疗组(n=70)、小剂量血必净治疗组(n=61)和大剂量血必净治疗组(n=53)。3组患者均按照急性胰腺炎诊治指南治疗,包括液体复苏、去除病因和器官功能维护等措施。常规治疗组不使用血必净;小剂量组使用血必净剂量为100 mL/d静脉滴注,连续使用≥7 d;大剂量组血必净剂量为200 mL/d静脉滴注,连续使用≥7 d。比较3组患者的炎症指标、常规血生化指标和器官功能指标评分、接受有创呼吸支持治疗的比例及时间、预后指标等。结果大剂量组患者治疗一周后血白细胞、C反应蛋白和急性生理学和慢性健康状况评价(acute physiology and chronic health evaluation,APACHEⅡ)评分比常规治疗组有明显改善(P<0.05),而小剂量组与常规治疗组差异无统计学意义(P>0.05)。大剂量血必净治疗组机械通气时间[(9.59±7.43)d]短于其他两组(P<0.05);小剂量血必净治疗组机械通气时间[(15.83±15.18)d]虽然较常规治疗组[(20.96±23.29)d]有下降,但差异尚无统计学意义。与常规治疗组相比,大剂量组的开腹手术率降低、住院时间明显减少(P<0.05),但3组患者在胰腺坏死评分和死亡率方面的差异无统计学意义(P>0.05),小剂量血必净治疗组在这4项指标上与常规治疗组差异也均无统计学意义(P>0.05)。结论常规治疗联合大剂量血必净治疗能有效改善重症急性胰腺炎患者的炎症指标和脏器功能,改善病情预后,缩短住院时间。

Effects of different doses of Xuebijing injection on prognosis of patients with severe acute pancreatitis

  Objective  To investigate the efficacy of different doses of Xuebijing injection in the treatment of patients with severe acute pancreatitis, specifically the improvement of inflammatory indexes and organ function.  Methods  Patients with severe acute pancreatitis were divided into three groups: routine treatment (n = 70), low-dose Xuebijing treatment (n = 61), and high-dose Xuebijing treatment (n = 53). The patients were treated according to the guidelines for the treatment of acute pancreatitis, which included fluid resuscitation, etiology removal, and organ function maintenance; additionally, the patients in the Xuebijing treatment groups received Xuebijing (100 mL in low dose and 200 mL in high dose) in intravenous drip per day for ≥ 7 days. The inflammatory indexes, routine blood biochemical indexes, and organ function index scores, the proportion and timing of receiving invasive respiratory support treatment, and prognostic indexes including pancreatic necrosis score, laparotomy, hospitalization days, and mortality were compared among these groups.  Results  After one week of treatment, the white blood cells, scores of C-reactive protein and APACHE Ⅱ of patients in the high-dose group were significantly improved compared with those in the conventional treatment group (P < 0.05), while there was no significant difference between patients in the low-dose group and the conventional treatment group (P > 0.05). The time of mechanical ventilation [(9.59 ±7.43) d] in the high-dose Xuebijing treatment group was shorter than that in the low dose Xuebijing treatment group [(15.83 ±15.18) d] and the conventional treatment group [(20.96 ±23.29) d] (P < 0.05), while the difference was not statistically significant between the low dose treatment group and the conventional treatment group. Compared with the conventional treatment group, the proportion of laparotomy, hospitalization days in the high-dose group were significantly reduced (P < 0.05), but there was no significant difference in pancreatic necrosis score and mortality among these three groups (P > 0.05), and there was no significant difference in these four indicators between the low-dose Xuebijing treatment group and the conventional treatment group (P > 0.05).  Conclusions  Conventional therapy combined with high-dose Xuebijing therapy can effectively improve the inflammatory indexes and organ function of patients with severe acute pancreatitis, improve the prognosis, and shorten the hospitalization time.