血液净化时强化生长抑素治疗高脂性重症急性胰腺炎的疗效观察

目的 观察血液净化时强化生长抑素治疗重症急性胰腺炎的临床疗效.方法 将中国医科大学附属盛京医院急诊重症监护室诊治的1 12例重症急性胰腺炎患者按照血液净化过程中是否增加生长抑素输注速度分为对照组和观察组,两组患者均接受常规治疗,观察组(56例)患者在血液净化过程中提高生长抑素的输注速度,对照组(56例)血液净化过程中不改变生长抑素的输注速度,对比两组相关症状缓解时间、实验室检验指标变化、炎性因子变化及并发症、病死率等.结果 治疗后1周,两组血清C反应蛋白(C reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor α,TNF-α)、白介素-6(interleukin-6,IL-6)水平均由治疗前的(35.3±13.1)mg/L、(149.3 ±26.4) ng/L、(131.9±19.3) ng/L下降至(12.8±4.4)mg/L、(88.4±19.4)ng/L、(66.0±17.4) ng/L,P＜0.05.观察组患者的住院时间、腹痛腹胀缓解时间、白细胞恢复正常时间及血淀粉酶恢复至正常的时间分别为(18.2±4.1)d、(6.4±1.9)d、(8.8±3.3)d、(7.1±1.2)d、(9.5±2.0)d,较对照组相应的(20.5±5.4)d、(7.7±2.5)d、(11.2±4.1)d、(8.1±3.3)d、(10.8±2.9)d,均显著缩短(P＜0.05).观察组患者治疗后1周的APACHEⅡ评分(7.5±2.3)显著低于对照组(8.8±2.2),P ＜0.05.强化治疗的局部并发症发生率显著低于对照组(P＜0.05),且观察组对并发症的OR值=0.429,对死亡的OR值=为0.65.结论 在治疗急性重症胰腺炎的血液净化治疗过程中增加生长抑素输注速度能更好的减轻机体炎症反应,提高临床疗效,降低并发症和死亡风险.

Observation on the therapeutic effects of somatostatin injected in different rates on the fat-derived severe acute pancreatitis during hemoperfusion

Objective To observe the therapeutic effects of somatostatin administered in different speeds on the severe acute pancreatitis during hemoperfusion.Methods A total of 112 severe acute paricreatitis patients with routine treatment in emergency intensive care unit were divided into control group and experimental group according to the speed of somatostatin injection during hemoperfusion.Patients of experimental group (n =56) received accelerated injection of somatostatin,while the patients of control group (n =56) got somatostatin in a steady speed injection.The time required for relieving clinical symptoms,time consumed for resuming normal results of laboratory tests,changes of inflammatory mediators,morbidity and mortality rate were compared between two groups.Results The levels of serum C-reactive protein,tumor necrosis factor-α and interleukin-6 in experimental group were significantly decreased from(35.3±13.1) mg/L,(149.3±26.4) ng/L,(131.9±19.3) ng/Lto (12.8±4.4) mg/L,(88.4 ± 19.4) ng/L,(66.0 ± 17.4) ng/L,respectively compared to those of control group (P ＜0.05).There were shortened hospital stay (18.2 ± 4.1) d,and reduced the time required for relief of abdominal pain and distention (6.4 ± 1.9) d,(8.8 ± 3.3) d,and for normalized WBC and amylase (7.1 ± 1.20) d,(9.5 ±2.0) d found after accelerated injection of somatostatin in experimental group compared with controlgroup (20.5±5.4) d,(7.7±2.5) d,(11.2±4.1) d,(8.1±3.3) d,(10.8±2.9) d,(P ＜0.05).Compared with control group (8.8 ± 2.2),the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ scores after treatment for one week were significantly lower in the experimental group (7.5 ± 2.3) (P ＜ 0.05).The incidence of morbidity in experimental group was significantly lower than that in control group (P ＜ 0.05).Additionally,OR value for morbidity was 0.429,and OR value for death was O.65.Conclusions The accelerated injection of somatostatin during hemoperfusion could obviously improve the therapeutic effect and decrease the serum inflammatory mediators in severe acute pancreatitis,as well as reduce the incidence of morbidity and mortality.