腹腔置管灌洗对急性重症胰腺炎患者炎症因子水平的影响

Effect of Peritoneal Lavage on Systemic Inflammatory Response in Patients with Severe Acute Pancreatitis

【目的】探讨腹腔置管灌洗对急性重症胰腺炎（SAP）患者炎症因子水平影响。【方法】选择2014年1-12月本院普外科室收治的临床诊断为SAP患者82例，按照随机数法将其患者分为观察组（n=46）和对照组（n=36）。观察组给予腹腔置管灌洗合并常规治疗，对照组给予单纯常规治疗。比较两组患者不同时间内毒素、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、IL-8和C反应蛋白（CRP）动态变化规律，以及两组患者预后指标的差异。【结果】治疗7d后，观察组和对照组血清内毒素、TNF-α、IL-6、IL-8水平均低于治疗前及治疗2d后，差异均具有统计学意义（均P〈0．05）；对照组治疗4d后，血清IL-6水平低于治疗后2d；治疗4d、7d后，观察组内毒素、TNF-α、IL6、IL-8、CRP均明显低于对照组同时间点（均P〈0.05）。观察组ICU停留时间短于对照组，胰腺感染率和器官功能障碍综合征（MODS）发生率均低于对照组，差异均有统计学意义（均Pd0．05）；两组患者均无住院死亡病例。【结论】腹腔置管灌洗可降低SAP患者相关炎症反应因子水平，降低胰腺感染率和多器官功能障碍发生率，改善患者预后。

[Objective]To explore the effect of peritoneal lavage on systemic inflammatory response and prognosis in patients with severe acute pancreatitis （SAP）. [Methods]Eighty-two patients with SAP from January to December of 2014 in our hospital were randomly divided into the observation group （ n =46） and the control group （ n =36）. Patients in the observation group were given peritoneal lavage in addition to routine treatment while patients in the control group were given only routine treatment. The dynamic changes of inflammatory factors in patients of the two groups, such as endotoxin, tumor necrosis factor alpha （TNF-α）, leukocyte mediated-6 and -8 （IL-6 and IL-8） , and C reactive protein （CRP） levels were detected at different time points between patients of the two groups and retrospectively analyzed, [Results]Levels of endotoxins, tumor necrosis factor alpha, leukocyte mediated IL - 6 and - 8, and C reactive protein in both groups were lower at seven days after treatment than before treatment and two days after treatment; the differences were statistically significant （ P〈0.05）. In the control group, levels of IL-6 were lower at four days after treatment than they were two days after treatment. At four and seven days after treatment, levels of endotoxins, TNF-α, IL-6, IL-8, and CRP were significantly lower in patients of the observation group than those of patients in the control group （ P 〈0.05）. ICU times of patients in the observation group were shorter than those of patients in the control group, and the occurrence rate of pancreatic infection and multiple organ dysfunction syndrome （MODS） in the observation group was lower than in the control group. The differences were significantly different （ P〈0.05）. There were no cases of death in either group. [Conclusion]Peritoneal lavage can reduce systemic inflammatory response, pancreatic infection, and MODS, which will improve the prognosis of patients with SAP.