胰岛素强化治疗对重症胰腺炎的临床疗效研究

The clinical effects of intensive insulin therapy in patients with severe acute pancreatitis

目的探讨胰岛素强化治疗对于急性重症胰腺炎（SAP）的疗效。方法2004年6月-2010年6月134例SAP患者随机分为对照组，胰岛素强化治疗组。对照组给予常规治疗，治疗组在常规治疗基础上给予胰岛素持续泵入。观察两组治疗前、后白细胞计数、血淀粉酶、血清白蛋白、动脉血氧分压以及肠道功能恢复时间、住院时间及病死率。结果与对照组比较采用胰岛素强化治疗后，可显著降低第3、5、7、14天自细胞计数（P〈0．05）、血淀粉酶（P〈0．01）；显著提高治疗后3、5、7、14天的血清白蛋白水平（P〈0．01），显著提高第3、5、7天动脉血氧分压（P〈0．01）；显著缩短肠道功能恢复时间、减少住院时间、降低病死率（P〈0．01）。结论胰岛素强化治疗可显著改善急性重症胰腺炎的疗效，缩短住院时间，降低病死率。

Objective To study the clinical effects of intensive insulin therapy to severe acute pancreatitis. Methods 134 SAP qualified patients between June 2006 and June 2010 were randomly divided into two groups, control group （n=66） treated with conventional therapy, and intensive insulin therapy group （n=68） treated with conventional therapy plus insulin pumping continuously. The following parameters were measured with the method indicated on days 1, 3, 7, and 14 of the therapeutic course, WBC count, serum amylase, albumin, and PaO2. And the time of intestinal function restoring, the time of residence and the mortality were also observed and compared. Results After intensive insulin therapy, the WBC counts and serum amylase were both significantly reduced on day 3, 5, 7 and 14 after IIT （P〈0.05）, and the level of serum albumin was significantly increased on day 3,5,7 andl4 （P〈0.01）, and the PaO2 was significantly elevated on day 3, 5, 7 andl4 （P〈0.01）. The time of intestinal function restoring, the time of residence and the mortality were markedly decreased （P〈0.01）. Conclusion The results suggested that early treatment with intensive insulin therapy might improve the therapeutic effects of SAP and decrease the time of residence and reduce the mortality as a result.