奥曲肽联合持续性血液滤过治疗重症急性胰腺炎合并急性呼吸窘迫综合征患者的效果观察

Therapeutic effect of octreotide combined with continuous hemofiltration in patients with severe acute pancreatitis complicated with acute respiratory distress syndrome

目的观察奥曲肽联合持续性血液滤过治疗对重症急性胰腺炎合并急性呼吸窘迫综合征患者的临床效果。方法选择2010年10月—2017年5月陕西省汉中市3201医院重症医学科收治的重症急性胰腺炎合并急性呼吸窘迫综合征患者100例作为研究对象,随机数字表法分为观察组和对照组,各50例。对照组患者采取常规持续性血液滤过治疗,观察组患者在对照组的基础上加奥曲肽静脉滴注,观察2组患者心率(HR)、呼吸频率(RR)、血液学指标、血气分析、炎性因子及APACHEⅡ评分及SIRS评分。结果与治疗前相比,2组患者治疗后HR、RR、血淀粉酶、内毒素、ALT、BUN均显著下降,而血钙含量增加(P均<0.05),血清细胞因子IL-1、IL-6、TNF-α、CRP降低(P均<0.05),PaO_2、PaCO_2及PaO_2/FiO_2升高(P均<0.05),APACHEⅡ评分及SIRS评分降低(P<0.05);且治疗后观察组患者以上指标改善均明显优于对照组(P均<0.01)。结论奥曲肽联合持续性血液滤过可以有效地清除血液中的炎性因子,改善临床症状和预后。

Objective To investigate the clinical efficacy of octreotide combined with continuous hemofihration in patients with severe acute pancreatitis complicated with acute respiratory distress syndrome. Methods Selected 100 patients with severe acute pancreatitis complicated with acute respiratory distress syndrome from October 2010 to May 2017 ,they were randomly divided into observation group and control group, each group with 50 cases, the control group of patients with conventional continuous hemofiltration therapy,observation group of patients also with octreotide intravenous infusion treatment. Observe the two groups before and after treatment＇ s levels of PaO2 ,PaO2/FiO2 and APACHEⅡ. Results The levels of serum amylase, serum calcium, endotoxin, ALT, BUN, CRP, HR, RR, oxygenation index, APACHE Ⅱ score, SIRS score and IL-1, IL-6, TNF-α were decreased. There was no significant difference in cytokines（ P 〉 0.05 ）. Compared with before treatment ,the levels of serum amylase, endotoxin, ALT, BUN ; CRP, HR and RR were significantly decreased in the two groups after treatment, and the serum calcium content was significantly increased （P 〈 0.01 ）. After treatment, PaO2 , PaCO2 and PaO2/FiO2 values of the two groups were significantly higher than those of the control group （ P 〈 0.01 ）, and the difference was significant （ P 〈 0.01 ）. After treatment, the APACHE 1I score and SIRS score of the two groups were sigfiificantly decreased （P 〈 0.01 ）, and the improvement of the control group was significantly better than that of the control group（P 〈 0.01 ）. Conclusion Octreotide combined with continuous hemofiltration can effectively remove the inflammatory mediators in the blood and improve the clinical symptoms and prognosis.