早期个体化综合治疗重症急性胰腺炎患者对其MODS发生的预防作用分析

Analysis of the prevention effect of early individualized and comprehensive therapy on MODS in patients with severe acute pancreatitis

目的探讨早期个体化综合治疗在预防重症急性胰腺炎患者多器官功能障碍综合征(MODS)发生的中的作用。方法选择2008年1月至2012年1月于承德医学院附属医院就诊的85例重症急性胰腺炎患者,分为实验组43例和对照组42例。对照组采用常规基础治疗,实验组早期采用个体化综合治疗。统计两组患者入院时和入院后的APACHEⅡ评分、MODS评分和Ranson评分。观察患者入院时和入院后各时间点的血清炎症因子水平等指标。结果两组入院时各项评分相比差异无统计学意义(P>0.05),实验组入院后APACHEⅡ评分、MODS评分均低于对照组,差异有统计学意义(P<0.05)。实验组入院后12、24、48h和72h的肿瘤坏死因子-α(TNF-α)低于对照组,差异有统计学意义(P<0.05)。实验组入院后72h和7d的CRP低于对照组,差异有统计学意义(P<0.05)。实验组入院后48h和7d的白细胞介素-10(IL-10)低于对照组,差异有统计学意义(P<0.05)。对照组MODS发生率64.3%(27/42),胰性脑病发生率21.4%(9/43),胰腺感染发生率33.3%(14/42),住院病死率19.1%(8/42),住院时间(30.4±5.7)d。实验组MODS发生率27.9%(12/43),胰性脑病发生率11.6%(5/43),胰腺感染发生率14.0%(6/43),住院病死率4.7%(2/43),住院时间(23.5±4.3)d。实验组MODS发生率、住院病死率和胰腺感染发生率低于对照组,差异有统计学意义(P<0.05)。实验组平均住院时间低于对照组,差异有统计学意义(P<0.05)。结论早期个体化的综合治疗可以降低急性重症胰腺炎的MODS发病率,保护器官功能,减少病死率。

Objective To investigate the effect of individualized and comprehensive therapy in treatment of severe acute pancrea-titis in early stage for preventing MODS .Methods 85 patients with severe acute pancreatitis treated in this Chengde medical college affiliated hospital from January 2008 to January 2012 were divided into two groups .The control group included 42 patients ,all used conventional basic treatment ;the test group included 43 patients ,and all used individualized and comprehensive therapy in early stage .The APACHEⅡ ,MODS and Ranson scores ,and serum inflammatory cytokines indexes of patients in each group before and after admission were all recorded .Results The APACHEⅡ and MODS scores after admission of test group were significantly low-er than the control group（P〈 0 .05） .The TNF α,CRP and IL 10 after admission of two groups had significant difference （P〈0 .05） .The MODS incidence of control group was 64 .3% （27/42） ,pancreatic encephalopathy incidence was21 .4% （9/43） ,the inci-dence of pancreatic infection was 33 .3% （14/42） ,hospital mortality incidence was 19 .1% （8/42） and length of hospital stay was （30 .4 ± 5 .7） d .The MODS incidence of test group was 27 .9% （12/43） ,pancreatic encephalopathy incidence was11 .6% （5/43） , pancreatic infection rate was 14 .0% （6/43） ,hospital mortality incidence was 4 .7% （2/43） and length of hospital stay was （23 .5 ± 4 .3） d .The incidence of MODS ,hospital mortality and pancreatic infection rates of test group were significantly lower than that of the control group （P〈0 .05） .The average length of stay of test group were significantly lower than the control group （P〈0 .05） . Conclusion To use individualized and comprehensive therapy in treatment of severe acute pancreatitis in early stage can reduce MODS ,protect organ function ,and reduce mortality .