地塞米松抑制炎症介质改善重症急性胰腺炎的预后

Improving the prognosis of severe acute pancreatitis by using dexamethasone inhibiting inflammatory mediators

目的 探讨应用地塞米松抑制炎症过程中多种炎症介质的作用或抑制炎症介质的产生 ,以期提高重症急性胰腺炎 (SAP)的治疗效果 .方法 SAP4 0例随机分为 2组 :治疗组和普通组 ,于治疗后 1,3,5 ,7,10 ,14 d测定外周血 6 -酮 -前列腺素 F1 α(6 - keto- PGF1 α)、血栓素 (TXB2 )、白细胞介质 - 6(IL - 6 )的水平并用硝酸还原法测定一氧化氮 (NO)水平 ,每 7d CT测定胰腺影像变化 ,统计并发症发生率、感染中转手术率、平均住院时间 .结果 治疗组 6 - Keto- PGF1 α,TXB2 ,IL -6 ,NO较普通组显著下降 (P<0 .0 5 ) ,CT示胰腺坏死、胰周渗出在 2 wk后明显减少 ,并发症发生率、感染中转手术率明显低于普通组 (P<0 .0 5 ) .结论 应用非特异性炎症介质拮抗剂地塞米松可以显著降低血中炎症介质水平 ,降低胰腺炎症程度 ,是治疗 SAP的有效药物 .

AIM To investigate how to improve the prognosis of SAP by using dexamethasone to inhibit the production of in flammatory mediators or by blocking the effects of inflammatory mediators. METHODS Forty patients with SAP were randomly allocated into two groups: Treatment group and ordinary group. 6 Keto PGF 1α, TXB 2, IL 6, and NO were measured 1, 3, 5, 7, 10 and 14 days after the treat ment. 20 volunteers served as healthy controls. RESULTS In the dexmethasone treatment group: 6 Keto PGF 1α, TXB 2, IL 6, NO levels significantly decreased as compared with the ordinary group ( P <0.05). The complication, infection and operation rates were lower and the time for hospital stay was shorter in the treatment group than in the ordinary group ( P <0.05). The scepage close pancreas and pancreatic necrosis improved obviously. CONCLUSION Dex, a non specific inhibitor of inflammatory mediators, reduced the severity of acute pancreatitis. It is an effective medicament in treatment of SAP.