重症急性胰腺炎患者连续血液净化过程中补充生长抑素的疗效观察

Observation on additional somatostatin injection during continuous blood purification in patients with severe acute pancreatitis

目的观察连续血液净化治疗重症急性胰腺炎的过程中针对血液净化丢失量提高生长抑素输注速度的疗效。方法将我院EICU诊治的96例重症急性胰腺炎患者按照血液净化过程中是否提高生长抑素输注速度分为2组。两组患者均接受常规治疗,观察组(40例)血液净化过程中根据废液中生长抑素含量予以针对性补充,对照组(56例)血液净化过程中不改变生长抑素输注速度。比较两组临床症状缓解时间、实验室指标恢复正常时间、血清炎症因子改变、并发症、死亡率等情况。结果连续血液净化过程中观察组血清生长抑素水平下降程度低于对照组(P<0.05),血清炎症因子(CRP、TNF-α、IL-6)及APACEHⅡ评分降幅超过对照组(P<0.05),观察组患者的平均住院时间、腹痛腹胀缓解时间、血淀粉酶恢复正常时间均显著短于对照组(P<0.05),观察组的死亡率及局部并发症发生率显著低于对照组(P<0.05)。结论连续血液净化治疗重症急性胰腺炎过程中,针对生长抑素丢失量提高生长抑素输注速度,可以稳定体内生长抑素浓度,从而降低机体炎症因子水平及局部并发症发生率,提高临床疗效。

Objective To observe the effect of additional somatostatin injection during continuous blood purification on severe acute pancreatitis.Methods Ninety-six patients with severe acute pancreatitis in Emergency ICU were divided into 2 groups and were studied with retrospective analysis.The two groups were given routine treatment with blood purification.Observation group（n =40） received additional somatostatin injection based on the ELISA test of somatostatin concentration in effluent,while control group（n =56） received unaltered somatostatin.The time of relieving clinical symptoms,the recovery time of laboratory indexes,the change of inflammatory mediators,the complications,and mortality rate were compared between the two groups.Results The serum somatostatin concentrations in observation group were higher than those of control group（P〈0.05）.The levels of serum C-reactive protein（CRP）,tumor necrosis factor-α（TNF-α） and interleukin-6（IL-6） in observation group were lower than those of control group（P〈0.05）.The length of stay,the disappearance time of stomachache and abdominal distention and the time for serum and urine amylase to return to normal were significantly better than those of control group（P〈0.05）.Compared with control group,the APACHE Ⅱ scores after treatment for one week were significantly lower in observation group（P〈0.05）.The rates of complications and mortality in observation group were significantly lower than those of control group（P〈0.05）.Conclusion Additional somatostatin injection during blood purification can keep the serum somatostatin concentrations stable,greatly improve the clinical effect and decrease the serum inflammatory mediators of severe acute pancreatitis.