乳果糖灌肠佐治急性胰腺炎的临床研究

Clinical research of lactulose enema in adjunctive treatment of acute pancreatitis

目的探讨急性胰腺炎(AP)应用乳果糖(LAC)灌肠联合生长抑素(SS)治疗的临床效果及对患者白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及超敏C反应蛋白(hs-CRP)水平的影响。方法选取该院2015年1月至2017年1月收治的150例AP患者作为研究对象,采用随机数字表法均分为两组。所有患者均给予相同的AP临床处理流程,对照组在此基础上予以SS治疗,观察组加用LAC灌肠联合SS治疗。记录比较两组症状、体征缓解时间,治疗前后血清炎性因子水平及肠黏膜屏障功能变化情况以及临床疗效。结果与对照组相比,观察组各项症状、体征的缓解时间均明显缩短,差异有统计学意义(P<0.01);与组内治疗前比较,两组治疗7d后血清IL-6、TNF-α、hs-CRP、内毒素脂多糖、D-乳酸、二胺氧化酶水平均明显降低;观察组治疗7d后血清炎性因子水平及肠黏膜屏障功能指标与对照组同期相比,明显更低,差异均有统计学意义(P<0.01)。治疗7d后,观察组总有效率为92.0%,较对照组(77.3%)明显上升,差异有统计学意义(P<0.05)。结论 AP应用LAC灌肠联合SS治疗更能有效缓解患者的临床症状与体征,改善肠黏膜屏障功能,减轻炎性反应,提高治疗效果。

Objective To explore the effect of lactulose（LAC）enema combined with somatostatin（SS）in treating acute pancreatitis（AP）and its impact to interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）and high sensitivity C-reactive protein（hsCRP）levels.Methods One hundred and fifty cases of AP in the hospital from January 2015 to January 2017 were selected as the research subjects and divided into the two groups by adopting the random number table method.All cases were given the same AP clinical treatment procedure,on this basis the control group was given the SS treatment and the observation group was added with the LAC enema combined with SS.The remission time of symptoms and signs,serum inflammatory factors levels and intestinal mucosal barrier function change before and after treatment as well as clinical efficacy were recorded and compared between the two groups.Results The remission time of various symptoms and signs in the observation group was significant shorter than that in the control group with statistical difference（P〈0.01）;The serum IL-6,TNF-α,hs-CRP,LPS,D-lactic acid and DAO levels on 7dafter treatment in the two groups were significantly decreased compared with those before treatment（P〈0.01）.The serum inflammatory factors and intestinal mucosal barrier function indicators on 7dafter treatment in the observation group were much lower than those at same time in the control group,the difference was statistically significant（P〈0.01）.The overall effective rate on 7dafter treatment in the observation group was 92.0%,which was significant increased compared with 77.3% in the control group（P〈0.05）,the difference was statistically significant.Conclusion Applying LAC enema combined with somatostatin can much more effectively relieve clinical symptoms and signs in AP patients,improves intestinal mucosal barrier function,reduces inflammatory response and increases the treatment effect.