十四肽生长抑素联合乌司他丁治疗急性重症胰腺炎的临床观察

Clinical Observation of Tetradecapeptide Somatostatin Combined with Ulinastatin in the Treatment of Acute Severe Pancreatitis

目的:观察十四肽生长抑素联合乌司他丁治疗急性重症胰腺炎的临床效果。方法:将65例急性重症胰腺炎患者随机分为治疗组(33例)与对照组(32例)。对照组于确诊当天给予十四肽生长抑素250μg缓慢静脉推注后,以250μg·h-1的速度采用静脉微量泵持续泵入;治疗组在对照组基础上给予20万U乌司他丁加入5%葡萄糖注射液500mL中静脉滴注2h。观察2组血清炎性因子水平。结果:除对照组1例患者死于多脏器功能衰竭外,其余患者均临床痊愈,且治疗组症状体征恢复时间及治愈时间均显著短于对照组(P<0.05);血清丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿素氮、肌酐在相同时间点治疗组均低于对照组(P<0.05),碳酸氢盐则高于对照组(P<0.05);治疗组肿瘤坏死因子α、白介素-6、白介素-8均较对照组显著下降(P<0.05),白介素-10则显著升高(P<0.05)。2组治疗期间未见不良反应发生。结论:十四肽生长抑素联合乌司他丁治疗急性重症胰腺炎时能及时清除炎性因子,避免多脏器功能衰竭。

OBJECTIVE： To investigate the clinical effect of tetradecapeptide somatostatin combined with ulinastatin for acute severe pancreatitis. METHODS： 65 acute severe pancreatitis patients were randomly divided into treatment group （33 cases） and control groups（32 cases）. Intravenous continuous micro-pump infusion of tetradecapeptide somatostatin 250 μg. h 1 was given after slow intravenous injection 250 μg on the day of diagnosis in control group, while ulinastatin 200 000 U dissolved in 5% glucose in- fusion 500 mL with intravenous dripping for 2 h was added in treatment groups. RESULTS： All patients were cured except 1 pa- tient died for MSOF in control group, and the recovery time and the time of symptom and signs disappeared were significantly shorter than in control group （P〈0.05）. The serum levels of ALT, AST, BUN and Cr were lower than in control group （P〈 0.05）, and the HCO3- level was higher than in control group （P〈0.05） ; the serum level of TNF-a, IL-6 and IL-8 were lowered significantly （P〈0.05） and the IL-10 level was increased, compared with control group （P〈0.05）. There was no ADR found in both group. CONCLUSION： Tetradecapeptide somatostatin combined with ulinastatin can effectively eliminate the peritoneal fluid contained inflammatory factors and prevent multiple system organ failure.