生长抑素5-氟脲嘧啶和雷尼替叮对急性出血性坏死性胰腺炎治疗作用的实验研究

Treatment effects of somatostatin,5-fluorouracil and ranitidine on experimental acute hemorrhagic necrotizing pancreatitis

胰酶自身消化是急性出血性坏死性胰腺炎(AHNP)发病机制中的关键因素。因此.抑制胰腺外分泌是治疗 AHNP 一种重要方法。近年来陆续报道了生长抑素(SMS)、5氟脲嘧啶(5-FU)和雷尼替叮(Ranitidine)对急性胰腺炎的治疗效果。但结论不一,三者的比较性研究也未见报道。本实验用5%牛磺胆酸钠溶液加压注入犬的主胰管制成犬的 AHNP 模型。将24只犬随机分成四组。Ⅰ组为对照组,余为治疗组,分别于术后半小时给予 SMS、5-FU 和 Ranitidine 治疗。于术前0.5h 和术后1h、4h、7h、12h 和24h 采静脉血,并于术后4h、7h、12h 和24h 采腹水和胰液测定淀粉酶和脂肪酶的浓度。记录动物死亡时间,并测量胰腺坏死范围和观察病理变化。结果表明:动物造成 AHNP 后血清、腹水和胰液中淀粉酶和脂肪酶明显增高。应用 SMS、5-FU和 Ranitidine 不同程度的降低了体液中酶的浓度。SMS 和5-FU 不仅降低了体液中酶的浓度,还缩小了胰腺的坏死范围,病理变化减轻,胰液分泌量也明显减少,使犬存活时间延长。实验结果表明:生长抑素降低体液中酶浓度效果较早,血清淀粉酶于术后1h 就与另三组有显著差异。但于术后7h 开始又有增高的趋势,这可能是 SMS 停药后的反跳现象,而酶的浓度仍明显低于对照组。因此,我们认为 SMS 对犬 AHNP 治疗效果较好,而5-FU 次之。它们可以做为AHNP 综合治疗的辅助方法。

Acute hemorrhagic necrotizing pancreatitis(AHNP)was induced in four groups of dogs hy retrograde injection of sodium taurocholate into the major pancreatic duct.Thirty minutes after AHNP was induced,the dogs were given no treatment(group Ⅰ),and treatment with 5-fluorouracil (group Ⅱ),ranitidine(group Ⅲ)and somatostatin(group Ⅳ).Samples of blood,ascites and pancreatic juice were drawn to determinate amylase and lipase and measure pancreatic flow.Dogs from each of the study groups were autopsied and necrotic range of the pancreas were measured at the time of death or at 24 hours after operation.The results showed that somatostatin,5-fluorouracil and ranitidine not only decrease in concentration of amylase and lipase in serum,ascites and pancreatic juice but also abolished volume of pancreatic juice.Moreover,somato- statin and 5-fluorouracil reduce the necrotic range of pancreas and make the dogs surviving longer.The results indicate that somatostatin is the most beneficial of them in treatment of pancreatitis.They would be a useful adjuvant in the treatment of AHNP.