乌司他汀联合生大黄治疗重症急性胰腺炎疗效观察

Clinical observation of ulinastatin combined with rhubarb in treatment of patients with severe acute pancreatitis

目的观察乌司他汀联合生大黄治疗重症急性胰腺炎疗效。方法重症急性胰腺炎52例,根据治疗方式不同分为2组,治疗组(应用乌司他汀+生大黄)26例,对照组(常规治疗)26例,观察2组患者的症状、体征、血淀粉酶、白细胞、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、白细胞介素8(IL-8)的变化。结果①治疗组与对照组腹痛缓解时间(3.9±1.3)h vs(5.0±2.5)h(P<0.05)、肠鸣音恢复时间(4.4±1.8)h vs(6.8±2.5)h(P<0.05)、排便恢复时间(4.8±1.6)h vs(7.2±2.2)h(P<0.05)、腹部压痛消失时间比较(5.5±0.8)h vs(7.3±0.9)h(P<0.05);②治疗组在应用乌司他汀+生大黄后第3天、6天、10天测定血淀粉酶和血白细胞值呈明显下降,而对照组常规治疗后第3天、6天、10天血淀粉酶和血白细胞值也有下降,但下降速度较治疗组缓慢。两组在组间差异无统计学意义(P>0.05),但在不同时点以及组间和不同时点交互作用差异均有统计学意义(P<0.05或<0.01);③治疗组在第3天、6天、10天测定血清TNF-α、IL-6、IL-8值均有明显下降,而对照组常规治疗后第3天、6天、10天测定血清TNF-α、IL-6、IL-8也有下降,但下降速度较治疗组缓慢,两组在组间差异无统计学意义(P>0.05),但在不同时点以及组间和不同时点交互作用差异均有统计学意义(P<0.05或<0.01)。结论乌司他汀联合生大黄治疗重症急性胰腺炎可更有效抑制胰酶释放,阻止急性胰腺炎病情发展。

Objective To observe the clinical effect of ulinastatin（UTI） combined with rhubarb in treatment of patients with severe acute pancreatitis. Methods Fifty-two patients with severe acute pancreatitis were divided into two groups according to different treatment methods. Twenty-six cases in the control group were treated with normal therapy. And other twenty-six cases in the treatment group were treated with UTI combined with rhubarb on the base of normal therapy. The symptoms, signs, hemodiastase, white blood cell, tumor necrosis factor-α（TNF-α） ,interleukin-6 （IL-6）,and IL-8 were observed. Results （1）There were significant difference between two groups in abdominal pain （3.9±1.3） h vs （5.0±2.5） h（ P 〈0.05）,horborygmus recovery time（4.4±1.8） h vs （6.8± 2.5） h（ P 〈0.05）, defecation recovery time （4. 8±1.6） h vs （7.2±2.2） h（ P 〈0.05） and abdominal tenderness fade time （5.5±0.8） h vs （7.3±0.9） h（ P 〈0.05）. （2） For the treatment group in ulinastatin combined with rhubarb from the day 3 to the day 6 and 10, hemodiastase and leucocyte counts had significant decline tendency, but the control group appeared to decline at the day 3,6 and 10 after normal therapy with lower speed. There were no significant difference between the two groups（ P 〉 0.05）, but the differences of interblock, time dissimilarity and interaction of interblock with time dissimilarity between the two groups showed statistical significance（ P 〈0.05 or 〈0.01）. （3） For the treatment group in ulinastatin and rhubarb from the day 3 to the day 6 and 10,the levels of TNF-α,IL-6,IL-8 had significant decline tendency,but the control group appeared to decline at the day 3,6 and 10 after normal therapy with lower speed. There were no difference between two groups （ P 〉 0.05）, but the differences of interblock, time dissimilarity and interaction of interhlock with time dissimilarity between the two groups showed statistical significance（ P 〈0.05 or 〈0.01）. Conclusion Ulnastatin combined with rhubarb can control the progress of severe acute pancreatitis, and increase the effectiveness.