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目的 探讨奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性.方法 2011年1月至2014年1月期间郑州大学第五附属医院急诊科收治的120例急性重症胰腺炎患者,随机将其分成对照组和乌司他丁治疗组,每组各60例患者,对照组患者给予奥曲肽注射治疗,乌司他丁治疗组患者给予奥曲肽联合乌司他丁治疗.治疗结束后,比较两组患者治疗有效率,血清相关指标及临床指标改善情况,并发症发生情况.结果 乌司他丁治疗组患者治疗总有效率(83.3％)明显高于对照组患者(65.0％)(P＜0.05);乌司他丁治疗组患者腹痛缓解时间、胃肠减压时间、中转手术率、住院时间以及病死率[(1.9±0.9)d,(6.3±2.2)d,1.7％;(11.8±0.5)d,5％]均明显低于对照组患者[(3.6±0.7)d,(10.4±3.1)d,8.3％;(23.7±2.1)d,15.0％](P＜0.05);乌司他丁治疗组患者治疗后血液淀粉酶、白细胞、CRP以及IL-6[(107.2±9.1)U/L,(6.2±1.0)×109/L,(7.3±3.4)mg/L,(28.3±4.3) ku]均明显低于对照组患者[(430.8±20.2)U/L,(11.2±1.2)×109/L,(16.3±5.2)mg/L,(45.3±5.9) ng/L],(P＜0.05);乌司他丁治疗组患者并发症ARDS、急性肾衰竭、休克发生率(10.0％,5.0％,13.3％)明显低于对照组患者(36.7％,21.7％,33.3％)(P＜0.05).结论 奥曲肽联合乌司他丁治疗急性重症胰腺炎疗效显著,能够明显改善患者的血清及临床指标,减少并发症的发生率,值得临床推广应用.

Objective To explore the clinical efficacy and safety of ulinastatin plus octreotide for patients with severe acute pancreatitis (SAP).Methods During January 2011 to January 2014 at our hospital,120 SAP patients were randomly divided into control and observation groups (n =60 each).The control group received an injection of octreotide injection while the observation group had a combination of ulinastatin and octreotide.After treatment,clinical efficiency,serum indicators and their improvements and complications were compared for two groups.Results The overall efficiency of observation group was significantly higher than that of control group (83.3％ vs 65.0％,P ＜ 0.05).And abdominal pain relief time,decompression time,surgical intervention rate,length of stay and mortality rate of observation group (1.9 ±0.9 d,6.3 ±2.2 d,1.7％,11.8 ±0.5 d,5％) were significantly lower than those of control group (3.6±0.7 d,10.4±3.1 d,8.3％,23.7±2.1 d,15.0％) (P＜0.05).After treatment,the levels of blood amylase,white blood cell (WBC),C-reactive protein (CRP) and interleukin 6 (IL-6) of observation group (107.2 ±9.1 U/L,6.2 ± 1.0 × 109/L,7.3 ±3.4 mg/L,28.3 ±4.3 pg/ml) were significantly lower than those of control group (430.8 ± 20.2) U/L,(11.2 ± 1.2) × 109/L,(16.3 ± 5.2) mg/L,(45.3 ± 5.9) ng/L,(P ＜ 0.05).And the incidences of such complications as acute respiratory distress syndrome (ARDS),acute renal failure and shock of observation group (10.0％,5.0％,13.3％) were significantly lower than those of control group (36.7％,21.7％,33.3％) (P ＜ 0.05).Conclusion Ulinastatin plus octreotide can significantly improve the serum and clinical parameters and reduce the incidence of complications in SAP patients.And it is worthy of wider popularization.