简易腹腔灌洗对重症急性胰腺炎血清炎性因子和各脏器功能的影响

Influences of Simple Peritoneal Lavage on Serum Inflammatory Factors and the Impact of Organ Function in Patients

目的探讨简易腹腔灌洗对重症急性胰腺炎血清炎性因子和各器官功能的影响。方法以腹腔穿刺针穿入腹腔,滴入0.9%氯化钠溶液,然后排出,之后滴入利多卡因、地塞米松及抗生素,1次/d,直至灌洗液由血性变清亮。治疗期间由专人观察记录两组患者的症状、体征和不良反应,并于治疗前及治疗后第1、3、5、7、14 d以全自动生化分析仪查血尿淀粉酶、肝肾功能及C反应蛋白,同时用放免法测定血清肿瘤坏死因子(TNF-α)、IL-6、IL-8、IL-10含量。结果治疗组44例患者均治愈,症状体征消失时间及治愈时间显著短于对照组;血尿淀粉酶、血清ALT、AST在治疗后3、5、7 d明显低于对照组;尿素氮(BUN)、肌酐(Cr)、C反应蛋白(CRP)则在治疗后5、7 d明显低于对照组;血清炎性因子TNF-α、IL-6、IL-8在治疗后1、3、5、7、14 d较对照组明显下降,抗炎因子IL-10则相对显著升高,差异均有统计学意义(P<0.05)。结论简易腹腔灌洗能及时清除血清炎性因子TNF-α、IL-6、IL-8,有利于抗炎因子IL-10的产生,同时有利于受损的肝肾功能尽早恢复正常,避免多脏器功能衰竭,在重症胰腺炎的治疗上较常规治疗效果明显。

Objective To investigate the influences of simple peritoneal lavage on serum inflammatory factors and the organ function in patients with severe acute pancreatitis.Methods We used the abdominal puncture needle to penetrate into the abdominal cavity,dripping normal saline,and then discharged,followed by trickle lidocaine,dexamethasone,and antibiotics.The procedure was performed once daily,until the color of the fluid changed from bloody to bright.Changes of symptoms,signs,and side effects were recorded during treatment.Before treatment and 1,3,5,7,and 14 days after treatment,serum and urine amylase,hepatic and renal functions,and C-reactive proteins were measured,and serum levels of tumor necrosis factor（TNF-α）,Interleukin-6（IL-6）,Interleukin-8（IL-8）,and Interleukin -10（IL-10） were determined.Results All the 44 patients in the treatment group were cured.Symptoms and signs disappear significantly faster in the treatment group than in the control group.Serum and urine amylase,serum ALT,AST 3,5,and 7 days after treatment were significantly lower than those in the control group.BUN,Cr,and CRP in the first 5 and 7 days after treatment was significantly lower than in the control group.Serum inflammatory factors including TNF-α,IL-6,and IL-8 1,3,5,7,and 14 days after treatment significantly decreased compared with the control group,while anti-inflammatory cytokines IL-10 was relatively increased.Conclusion Simple peritoneal lavage can promptly remove serum inflammatory factors TNF-α,IL-6,and IL-8,facilitate the production of anti-inflammatory factor IL-10,promote the recovery of the damaged liver and kidney functions,and thus avoid multiple organ failure.Compared with conventional therapies,it has certain advantages in the treatment of severe acute pancreatitis.