施他宁对急性重症胰腺炎患者的疗效观察及对血浆内毒素和TNF-α水平的影响

Efficacy of somatostatin in severe acute pancreatitis and influence on plasma endotoxin and TNF-α

目的 :观察施他宁 (生长抑素 )对急性重症胰腺炎的治疗效果及其对患者血浆内毒素和TNF α水平的影响。方法 :40例急性重症胰腺炎患者随机分为A、B两组 ,A组采用施他宁治疗 (治疗组 ) ,B组给予一般治疗 (对照组 ) ,于入院第 1～ 7天抽血测定血清淀粉酶、血浆内毒素和TNF α。结果 :急性重症胰腺炎患者入院第一天的血浆内毒素 (A/B组 ,0 94± 0 2 1/0 96± 0 2 7EU/ml)和TNF α水平 (A/B组 ,0 87± 0 2 6 / 0 86± 0 31ng/ml)均明显高于健康人(内毒素 0 12± 0 0 4EU/ml,TNF a 0 0 4± 0 0 2ng ml,P值均 <0 0 0 1) ;施他宁治疗组患者血清淀粉酶、血浆内毒素和TNF α水平下降速度明显较对照组快。结论 :急性重症胰腺炎患者早期均存在不同程度的内毒素血症及血浆TNF α水平升高 ,治疗组患者血浆内毒素和TNF α水平下降较快的原因可能是由于施他宁治疗对急性胰腺炎具有较好的疗效 ,胰腺水肿及坏死的病程恢复较快。

Objective: To examine the efficacy of somatostatin in severe acute pancreatitis and its influence on plasma endotoxin and TNF α.Methods:Forty patients with severe acute pancreatitis were randomly divided into two groups:group A(n=20) was treated with somatostatin and group B(n=20) only received traditional treatment.Serum amylase and plasma endotoxin,TNF α levels were determined every day from the lst to 7th day after admission.Results:On the lst day,levels of plasma endotoxin(Group A 0 94±0 21EU/ml,Group B 0 96±0 27EU/ml,respectively)and TNF-α (Group A 0 87±0 26ng/ml,Group B 0 86±0 31ng/ml,respectively) in severe acute pancreatitis patients were significantly elevated when compared with normal control subjects (endotoxin 0 12±0 04EU/ml,TNF-α 0 04±0 02ng/ml).During the therapy period,levels of serum amylase and plasma endotoxins,TNF-α in group A decreased more rapidly than those in group B.Conclusion:In the early stage of severe acute pancreatitis,endotoxiemia and increased plasma TNF-α levels commonly existed.Administration of somatostatin accelerates the decreasing of serum amylase,plasma endotoxin and TNF-α levels in severe acute pancreatitis patients.