丹参川芎嗪注射液联合丙氨酰谷氨酰胺并机械通气治疗SAP合并ARDS的临床效果

Effect of Danshen ligustrazine injection,alanylglutamine combined with mechanical ventilation on severe acute pancreatitis complicated with acute respiratory distress syndrome

目的 观察丹参川芎嗪注射液联合丙氨酰谷氨酰胺、机械通气治疗重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)临床疗效。方法 2015年1月—2016年12月陕西省汉中市中心医院重症医学科收治SAP合并ARDS患者30例,根据随机数字表法分为观察组(n=15)及对照组(n=15),2组均使用机械通气并进行常规治疗,同时对照组加用丙氨酰谷氨酰胺,观察组在对照组基础上加用丹参川芎嗪注射液治疗,观察2组病情变化及血液相关指标变化,比较2组患者预后情况。结果 观察患者治疗后Murray急性肺损伤评分、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)较对照组显著降低(t=2.053、2.607,<0.05),观察组机械通气时间、入住ICU时间较对照组显著缩短(t=6.304、5.562,P<0.05)。病死率显著低于对照组(33.3%vs.13.3%,χ~2=4.227,P=0.008)。观察组治疗后的呼吸、心率较对照组明显降低(t=1.964、12.425,P<0.05),氧合指数较对照组明显升高(t=14.721,P<0.01),而2组治疗后体温、平均动脉压则无显著性差异(P>0.05)。观察组治疗后血清淀粉酶、内毒素水平及血清肿瘤坏死因子-α(TNF-α)、白介素-8(IL-8)、白介素-6(IL-6)水平显著低于对照组(t=30.517、23.113、13.607、20.002、18.952,P<0.01)。结论 丹参川芎嗪注射液联合丙氨酰谷氨酰胺能有效提高SAP合并ARDS患者治疗效果,改善患者氧合功能及肠黏膜屏障功能,减轻炎性损伤,降低患者病死率。

Objective To investigate the effect of Danshen ligustrazine injection,alanylglutamine combined with mechanical ventilation on severe acute pancreatitis （SAP） complicated with acute respiratory distress syndrome （ARDS）. Methods Thirty cases of patients with SAP and ARDS were divided into observation group （ n =15） and control group （ n = 15） according to the random number table from January 2015 to December 2016. Both groups used mechanical ventilation for routine treatment. The control group was treated with alanylglutamine and observation group was treated with Danshen ligustrazine injection on the control group. The inflammatory factors of two groups was tested before and after treatment. Results The scores of acute lung injury score,acute physiology and chronic health status score （APACHEⅡ） of observation group were respectively（6.04±1.23）and（16.21±2.09）,which were lower than of control group with（7.76±1.19）and（20.42±2.32） （ t =2.053、2.607, P 〈0.05）. The time of mechanical ventilation time and check in ICU time of observation group were（ 3.76± 0.82）and（5.88±1.35）respectively,which were shorter than control group with（5.24±1.17）and（7.92±2.02） （ t = 6.304 , t =5.562, P 〈0.05）. The breathing and heart rate of observation group after treatment were significantly lower than that of the control group （ t =1.964, t =12.425, P 〈0.05）, and the oxygenation index was obviously higher than that of the control group （ t =14.721, P 〈0.05）, but temperature and mean arterial pressure of the two groups after treatment had no significant difference （ t =0.711, t =0.678, P 〉0.05）. The levels of serum amylase,endotoxin, tumor necrosis factor-α（TNF-α）,interleukin-8 （IL-8） and interleukin-6 （IL-6） of observation group were lower than control group （ t =30.517, t =23.113, t =13.607, t =20.002, t =18.952, P 〈0.01）. Conclusion Alanylglutamine combined with Danshen ligustrazine injection can effectively improve the treatment effect of SAP combined with ARDS, and improve the function of oxygenation and intestinal mucosal barrier and reduce the level of inflammatory factors and the mortality of patients.