生长抑素与前列腺素E1联合应用治疗重症急性胰腺炎初步临床研究

Preliminary clinical study of somatostatin combined with prostaglandin E1 in patients with severe acute pancreatits

目的观察生长抑素(SS)和前列腺素E1(PGE1)联合应用对重症急性胰腺炎(SAP)的临床效果,探讨两者联合应用的作用机制。方法将收治的31例SAP的患者分为对照组(SS治疗组,n=15)和联合治疗组(SS+PGE1组,n=16),于入院后第1、4、7天检测外周血内毒素、肿瘤坏死因子-α(TNF-α)、IL-6、IL-10及CRP的变化;监测血小板(PLT)、凝血酶凝结时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)和D-二聚体;检测血清淀粉酶和乳酸脱氢酶和清蛋白;观察ICU入住时间、治疗14d后APACHEⅡ评分、Binder积分、中转手术率、28d病死率。结果与对照组比较,联合治疗组于治疗7、14d后上述临床及实验室检测指标均有改善,差异有统计学意义(P<0.05)。结论 SS和PGE1联合应用可显著改善SAP患者的预后,缩短ICU入住时间,降低28d病死率,其可能的作用机制是减轻急性期炎症介质和细胞因子的过度释放,提高机体免疫能力等多层次,改善胰腺的微循环,纠正高凝状态,避免SAP患者并发多器官功能障碍。

Objective To study the effect of somatostatin（SS） combined with prostaglandin E1 （PGE1） in patients with severe acute pancreatits （SAP） and to elucidate its underlying mechanisms .Methods 31 cases of SAP patients were randomly divided into control group （SS group ,n=15） and combined treatment group （group SS＋ PGE1 ,n=16） .On the first ,4th ,7th day after admis-sion ,the peripheral blood endotoxin ,TNF-α,IL-6 ,IL-10 and CRP changes of patients in two groups were detected ;PLT ,TT ,PT , APTT ,FIB and D two dimer were monitored ;serum amylase and lactate dehydrogenase （LDH ） and serum albumin （ALB ） were detected ;and ICU occupancy time ,after 14 d treatment APACHE Ⅱ ,Binder integral ,transit operation rate ,the mortality of 28 d were also observed .Results Compared with control group ,the treatment group for the treatment of 7 ,14 days after the clinical and laboratory parameters were improved ,and there were significant difference .Conclusion SS and PGE1 combination can significantly improve the prognosis of patients with SAP ,reduce ICU inpatient time and the mortality of 28 d ,its possible mechanism of action would be to reduce acute phase inflammatory mediators and the release of cytokines ,improve the immunity of the organism ,multi-level ,improve the pancreatic microcirculation ,correct the hypercoagulable state ,and avoid complications of multiple organ dysfunc-tion in SAP patients .