乌司他丁联合大黄对重症急性胰腺炎患者腹内压及C-反应蛋白的影响

目的 通过研究乌司他丁加大黄治疗对重症急性胰腺炎（SAP）患者腹内压及血清C反应蛋白（CRP）水平的影响,探讨其在SAP中的临床应用价值.方法 通过随机分组的方法将42例SAP患者分成两组.对照组给予常规胃肠减压、抑制胰酶分泌等治疗.联合治疗组在上述治疗的基础上予以乌司他丁和大黄治疗.分别在治疗前、治疗3d、7d、10d监测患者的腹内压及CRP水平、APACHE-Ⅱ评分,以及观察两组患者的病死率（60d）、住院时间和住院费用,通过对比分析治疗效果.结果 联合治疗组患者与治疗前相比,联合治疗后7d、10d腹内压及CRP水平、APACHE-Ⅱ评分均有降低（P〈0.05）.对照组与治疗前相比,治疗至10d腹内压才开始明显降低（P〈0.05）,CRP水平及APACHE-Ⅱ评分治疗后7d、10d均有降低（P〈0.05）.联合治疗组与对照组治疗后同期相比,联合治疗组3d、7d、10d腹内压及CRP水平、APACHE-Ⅱ评分均明显降低（P〈0.05）.联合治疗组与对照组相比,联合治疗组平均住院时间及住院费用明显减少（P〈0.05）,病死率（60d）下降.结论 乌司他丁联合大黄对SAP患者腹内压、血浆CRP及APACHE-Ⅱ评分水平明显降低,并可降低SAP患者住院时间和住院费用,病死率降低,值得推广应用.

Objective To study ulinastatin Dante rhubarb on severe acute pancreatitis （SAP） in patients with intra - abdominal pressure and serum C -reactive protein （CRP） levels and to explore its clinical value in SAP. Methods A randomized method was used to divide 42 cases into two groups, the patients were of SAP in our hospital from January 2003 to January 2011. Control group received routine gastrointestinal decompression, inhibition of pancreatic secretion and other treatment. Treatment of combined treatment group on the basis of the above plus give ulinastatin and rhubarb. Respectively, before treatment 3d, 7d, 10d and intra- abdominal pressure monitoring in patients with CRP levels, APACHE - 11 score, and mortality were observed （60d） , length of hospital stay and hospital costs, by comparing the treatment effect. Results The treatment group compared with before treatment, combined treatment 7d, 10d intra - abdominal pressure and CRP levels, APACHE - II score were lower （ P 〈 0. 05 ） ; the control group before treatment, compared with the control group intra - abdominal pressure to begin treatment significantly reduced 10d （ P 〈 0. 05）, CRP levels and APACHE - II score after treatment 7 d, 10d were lower （ P 〈 0.05） ; combined treatment group and control group after treatment compared to the same combined treatment group 3d, 7d, 10d intra - abdominal pressure and CRP levels, APACHE - II score was significantly lower （P 〈 0.05）. Combined therapy group compared with the control group, combined treatment group, the average length of stay and hospital costs were significantly reduced （ P 〈 0.05 ） , mortality （60d） decreased. Conclusion Ulinastatin combined with Rhubarb have an significant effect on reducing the intra - abdominal pressure, plasma CRP, and APACHE - II score in SAP patients and can reduce length of hospital stay and hospital costs, with low mortality rate. It should be widely applied.