低分子肝素联合乌司他丁治疗急性胰腺炎的效果观察

Effects of low molecular heparin combined with ulinastatin in treatment of acute pancreatitis

目的研究低分子肝素联合乌司他丁治疗急性胰腺炎(AP)的疗效。方法 135例AP患者随机分为A、B、C 3组,均行常规治疗,A组加用低分子肝素,B组加用乌司他丁,C组联合应用此两药。治疗8 d后,对比3组症状明显缓解时间、临床疗效以及肠道黏膜屏障功能和炎症因子变化。结果治疗后,A组缓解率为80.00%,重症化率为13.33%,手术率为6.67%;B组分别为82.22%、11.11%、6.67%;C组分别为95.56%、2.22%、2.22%,C组缓解率显著高于A、B两组(P<0.05),重症化率低于A、B两组;治疗后3组二胺氧化酶(DAO)、D-乳酸和尿L/M值显著降低(P<0.05),且降低幅度由高至低依次为C、B和A组(P<0.05);治疗后3组TNF-α和IL-1含量显著降低(P<0.05),IL-10含量显著升高(P<0.05),C组变化幅度高于A、B两组(P<0.05)。结论低分子肝素联合乌司他丁治疗AP疗效较两药单用效果显著,可显著改善患者肠道黏膜屏障功能,降低炎症反应,值得临床推广。

bObjective To study the effects of low molecular heparin combined with ulinastatin in the treatment of acute pancreatitis（AP）. Methods A total of 135 patients with AP were randomly and evenly divided into groups A, B and C. The three groups were treated with conventional therapy. Group A was additionally treated with low molecular heparin, group B with ulinastatin and group C with the said two drugs. Eight days after the treatment, the time of obvious relief of symptoms, effects and the changes in intestinal mucosal barrier function and inflammatory factor among the three groups were compared. Results After the treatment, the remission rate in group A was 80.00%, and the severe rate 13.33% and the operation rate 6.67%; those in group B were 82.22%,11.11% and 6.67% respectively, and those in group C were 95.56%, 2.22% and 2.22% respectively; the remission rate in group C was significantly higher than that in groups A and B（P 〈 0.05） and the severe rate was lower than that in groups A and B; the diamine oxidase（DAO）, d-lactic acid and urine L/M in the three groups decreased significantly（P 〈 0.05）, and the sequence of the decrease from high to low was group C, group B and group A（P 〈 0.05）; the post-treatment contents of TNF-α and IL-1 decreased significantly（P 〈 0.05）, the contents of IL-10 increased greatly（P 〈 0.05）, the changes in group C were greater than those in groups A and B（P〈 0.05）. Conclusion Low molecular heparin combined with ulinastatin has better effects in the treatment of AP than single drug, can significantly improve intestinal mucosal barrier function in patients, and relieve inflammatory reaction; it is worthy of clinical popularization.