重症急性胰腺炎区域动脉灌注药物序贯组合方案的研究

Sequential drug combination schemes of regional intra-arterial infusion for severe acute pancreatitis

目的：探讨重症急性胰腺炎（SAP）区域动脉灌注（RAI）序贯治疗的可行性及药物组合方案。方法：回顾性分析45例采用早期RAI治疗SAP患者的临床资料。结果：全组均使用的药物包括：⑴肝素生理盐水（25 U/mL,并以其作为作溶剂）;⑵5-FU（第1周,250 mg/12 h,共7 d）;⑶生长抑素或其类似物（0.4 mg/24 h善宁或6 mg生长抑素,共2周左右）;⑷抗生素（12例继发感染者持续使用;23例无继发感染者预防性使用2周）。选择使用的药物包括：⑴乌司他丁灌注（5例合并MODS者,10~20万U/12 h,共7 d）;⑵前列腺素E1（4例微循环障碍者,10μg/12 h）。全组2例死亡,其余43例治愈。结论：RAI治疗SAP有效可行,灌注中应注意药物的选择及配伍。

Objective： To study the feasibility of sequential regional intra-arterial infusion（RAI） and drug combination schemes in treatment of severe acute pancreatitis（SAP）. Methods： The clinical data of 45 patients with SAP undergoing early RAI treatment were retrospectively analyzed. Results： The drugs used in all cases included： ⑴ Disebrin saline（25 U/mL,used as the infusion vehicle for all drugs）;⑵ 5-FU（250 mg/12 h,used in the first week for 7 days）;⑶ Somatostatin or its analogue（0.4 mg sandostatin or 6 mg somatostatin,daily,for about 2 weeks）;⑷ Antibiotics（continuous infusion in 12 cases with secondary infection and prophylactic use for 2 weeks in 23 cases without secondary infection）.The selectively used medications included：⑴ Ulinastatin（10 000-20 000 U/12 h,in 5 cases complicated with MODS）;⑵ Prostaglandin E1（10 μg/12 h,in 4 cases who had microcirculatory disturbance）.Of the whole group,2 cases died and 45 cases were cured. Conclusion： RAI is a feasible and effective modality for SAP patients,but care must be taken for drug selection and compatibility during infusion.