微创置管引流对重症急性胰腺炎早期炎症反应的影响

Minimally invasive catheter drainage lessens the early inflammatory response of severe acute pancreatitis

目的:探讨微创置管引流对重症急性胰腺炎(SAP)患者早期炎症反应的疗效。方法:将57例SAP且有腹腔积液患者,采用随机数表法分为微创置管引流治疗组(观察组,29例)和常规治疗组(对照组,28例)。两组均给予相同的基础治疗,观察组给予微创置管引流,对照组给予B超引导下穿刺置管引流。检测两组患者治疗前后TNF-α,IL-6,IL-8及C反应蛋白(CRP)等急性炎症指标,并观察肠道功能恢复时间,全身炎症反应综合征(SIRS)持续时间及多器官功能不全综合征(MODS)的发生率。结果:两组患者均有急性炎症反应发生。两组血清炎症指标术后均不同程度逐渐降低,观察组引流后第3,7天TNF-α,IL-6及CRP的水平与对照组比较明显下降(均P<0.05),而血清IL-8引流后第7天明显低于对照组(P<0.05);观察组肠道功能恢复时间、SIRS持续时间均明显短于对照组的(均P<0.01);观察组MODS发生率(13.8%)也明显低于对照组(28.6%)(P<0.01)。结论:微创置管引流治疗SAP,能明显减轻早期炎症反应,促进肠道功能恢复,降低MODS的发生率。

Objective： To investigate the therapeutic effect of minimally invasive catheter drainage on early inflammatory response of severe acute pancreatitis（SAP）. Methods： Fifty-seven SAP patients with peritoneal effusion were divided into the observation group（29 cases with minimally invasive catheter drainage） and control group（28 cases with conventional drainage） using a random number table.Both groups underwent the same basic regimen of treatment,and then the observation group received the minimally invasive drainage while the control group had conventional ultrasound-guided catheter drainage.The inflammatory indexes responding to acute inflammatory such as TNF-α,IL-6,IL-8 and CRP were detected before and after treatment.Meanwhile,the recovery time of bowel function,and duration of systemic inflammatory response syndrome（SIRS） and incidence of multiple organ dysfunction syndrome（MODS） were observed. Results： The acute inflammatory response occurred in the both groups,and all the serum inflammatory indexes detected in the both groups tended to gradually decrease with different degrees.The levels of TNF-α,IL-6 and CRP on day 3 and 7,and the level of IL-8 on day 7 after drainage in the observation group were significantly lower than those of the control group（all P0.05）.The recovery time of bowel function and the SIRS duration of the observation group were shorter than those of the control group（both P0.05）.Furthermore,the incidence of MODS of the observation group（13.8%） was also significantly lower than that of the control group（28.6%）（P0.01）. Conclusion： Minimally invasive catheter drainage for SAP can lessen the early inflammatory response,accelerate bowel function recovery,and reduce the incidence of MODS.