生长抑素联合质子泵抑制剂治疗重症胰腺炎患者的临床效果及对二胺氧化酶、D-乳糖的影响

THE CLINICAL EFFECT OF SOMATOSTATIN AND PROTON PUMP INHIBITORS IN DIAMINE OXIDASE,D-LACTOSE OF PATIENTS WITH SEVERE PANCREATITIS

目的:探讨生长抑素联合质子泵抑制剂治疗重症胰腺炎患者的临床效果及对二胺氧化酶、D-乳糖的影响。方法:选取2014年9月至2015年9月在广东省深圳市松岗人民医院住院治疗的112例重症胰腺炎患者为研究对象,按随机数字表法分为研究组和对照组,每组56例。两组患者入院后均给予常规治疗,包括禁食禁饮、持续肠胃减压、补充水、纠正电解质酸碱平衡、吸氧、抑制胃液与胰液分泌、止痛、抗感染、营养支持等对症治疗;对照组在常规治疗基础上应用生长抑素3 mg溶于500mL生理盐水中,静脉滴注,1次/d;研究组在对照组基础上应用奥美拉唑40mg溶于100mL生理盐水中,静脉滴注,12h持续滴注;两组患者疗程均为1周。比较两组患者的临床效果,临床症状改善时间,腹内高压、二胺氧化酶、D-乳糖、肿瘤坏死因子(TNF-α)、白细胞介素(IL)-8的水平变化,并记录两组患者的不良反应发生情况。结果:治疗后,研究组总有效率为89.3%,显著高于对照组的73.2%(P<0.05);研究组在肠道功能恢复时间、腹痛腹胀缓解时间、平均住院时间及血尿淀粉酶恢复时间方面均明显低于对照组(均P<0.05);两组患者腹内高压、二胺氧化酶、D-乳糖、TNF-α、IL-8水平均较治疗前明显降低(均P<0.05),其中研究组改善程度优于对照组(P<0.05);两组患者均出现肺部感染、腹腔大出血、腹腔脓肿、胰腺假性囊肿等不良症状,经对症处理后恢复正常,两组间不良反应比较差异无统计学意义(均P>0.05)。结论:生长抑素联合质子泵抑制剂能改善重症胰腺炎患者临床症状,降低二胺氧化酶、D-乳糖水平,调节肠道黏膜屏障功能,有利于患者预后,值得临床推广应用。

Objective：To investigate the clinical effect of somatostatin and proton pump inhibitors in diamine oxidase,D-lactose of patients with severe pancreatitis.Methods：112cases of patients with severe pancreatitis treated in hospital from September 2014 to September 2015 were selected and divided into the study group（56cases）and control group（56cases）.Patients of both groups received conventional treatment after admission,while the patients of control group were received extra somatostatin（3mg dissolved 500 mL 0.9% saline,intravenous infusion,1time/d）.On the basis of the control group,the patients of study group were treated with omeprazole（40mg dissolved 100 mL 0.9%saline,intravenously,12 hcontinuous infusion）.The course of treatment is one week.The clinic results,adverse effects,clinical symptoms improved time,changes of IAH,levels of diamine oxidase,D-lactose,TNF-αand IL-8were compared between two groups.Results：The total effective rate of the study group is 89.3%,which was significantly higher than that of the control group（73.2%）（P〈0.05）.The recovery time of urine amylase bowel function,abdominal bloating relief time,the average duration of hospitalization,and the recovery time of urine amylase in the study group were significantly shorter than those in the control group（P〈0.05）.The levels of IAH,diamine oxidase,D-lactose,TNF-αand IL-8in both groups were decreased significantly after treatment（P〈0.05）,while the study group showed a more significant decline（P〈0.05）.There were no significant difference in the adverse symptoms including lung infections,abdominal bleeding,abdominal abscess and pancreatic pseudocyst in both groups（P〉0.05）.Conclusion：Somatostatin and proton pump inhibitors can improve the clinical symptoms and the prognosis of patients with severe pancreatitis,by reducing the levels of diamine oxidase and D-lactose,adjusting the dysfunction of intestinal mucosa.