生长抑素联合乌司他丁和/或加贝酯治疗重症急性胰腺炎的临床疗效研究

Somatostatin plus Ulinastatin and/or Gabexate for Severe Acute Pancreatitis

目的探讨生长抑素(SM)联合乌司他丁(US)和/或加贝酯(GB)治疗重症急性胰腺炎(SAP)的效果。方法选择2008年7月—2018年1月收治的266例SAP患者,按随机数字表法分为SM、SM+GB、SM+US、SM+US+GB组。比较4组腹胀消失时间、腹痛消失时间、呼吸恢复正常时间、心率恢复正常时间、血清淀粉酶恢复正常时间、血糖恢复正常时间、白细胞计数(WBC)、C反应蛋白(CRP)、血尿素氮(BUN)、血肌酐(Scr)、住院费用、住院时间、治愈率、不良反应发生率及病死率。结果 SM+GB组及SM+US组的腹胀消失时间、腹痛消失时间、呼吸恢复正常时间、心率恢复正常时间、血清淀粉酶恢复正常时间、血糖恢复正常时间、WBC和CRP均低于SM组,差异有统计学意义(P<0.05);SM+US+GB组的上述参数均低于SM+GB组或SM+US组,差异有统计学意义(P<0.05)。SM+US组及SM+US+GB组的BUN低于SM组,SM+US+GB组低于SM+US组,差异有统计学意义(P<0.05)。SM+US组及SM+US+GB组的住院费用高于SM组,SM+US+GB组高于SM+US组,差异有统计学意义(P<0.05);SM+GB组及SM+US组的住院时间短于SM组,SM+US+GB组的住院时间短于SM+GB组或SM+US组,差异有统计学意义(P<0.05);4组治愈率、不良反应发生率、病死率比较,差异有统计学意义(P<0.05),但两两比较,差异无统计学意义(P>0.008 3)。结论 SM能有效治疗SAP,联用US或GB均能提高临床疗效,联用US和GB效果更佳。

ObjectiveTo evaluate the effectiveness of Somatostatin（SM） plus Ulinastatin（US） or/and Gabexate（GB） for the treatment of severe acute pancreatitis（SAP）.MethodsA total of 266 consecutive patients with SAP who received treatment during July 2008 to January 2018 were enrolled.Based on table of random number,they were divided into 4 groups,receiving SM,SM plus GB,SM plus US,SM plus US and GB,respectively.Clinical parameters including abdominal pain and distention relief time,normal autonomous respiration recovery time,normal heart rate recovery time,normal serum amylase recovery time,blood glucose recovery time,white blood count（WBC）,C reaction protein （CRP）,blood urea nitrogen （BUN）,serum creatinine （Scr）,hospitalization costs,length of stay（LOS） and cure rate,incidences of adverse reaction and mortality were analyzed.ResultsBoth SM plus GB,and SM plus US groups needed less time for abdominal pain and distention relief,recovery of normal autonomous respiration,normal heart rate,normal serum amylase and normal blood glucose,and showed decreased WBC and CRP compared with SM group（P〈0.05）,as did SM plus US and GB group when compared with SM plus GB group or SM plus US group（P〈0.05）.SM plus GB,and SM plus US and GB groups also showed decreased BUN in comparison to SM group, as did SM plus US and GB group when compared with SM plus US group（P〈0.05）. Compared with SM group,both SM plus US group and SM plus US and GB group had higher hospitalization costs（P〈0.05）. SM plus US and GB group had higher hospitalization costs than SM plus US group（P〈0.05）. Furthermore,SM plus GB group and SM plus US group had shorter LOS compared with SM group（P〈0.05）. In comparison with SM plus GB group or SM plus US group,the LOS was shorter in the SM plus US and GB group （P〈0.05）. Significant differences in the cure rate,incidence of adverse reactions and mortality were detected by the overall comparison among the four groups（P〈0.05）. However,pairwise comparisons did not find obvious differences in the cure rate,incidence of adverse reactions and mortality（P〉0.008 3）. ConclusionSM is effective for SAP.Moreover,the effectiveness will be better if it is used in combination with US or GB,and far better if used in combination with both the two.