区域性和全身性给药治疗重症急性胰腺炎的临床研究

Clinical Research of Continuous Regional Intra-arterial infusion and Whole Body infusion in the Treatment to Severe Acute Pancretitis

目的 探讨区域性和全身性给药对重症急性胰腺炎（severe acute pancreatitis,SAP）的治疗作用。方法 自1998年12月至2001年2月收治SAP67例,入选条件:①SAP的临床诊断和分级标准符合1996年制订的第二次方案;②发病时间在72h内;③暂无急诊手术指征。符合上述条件者共计46例,随机分成两组即组1（区域灌注组）、组2（全身给药组）,病例数分别为27例和19例。组1采用改良Sheldinger法经股动脉分别插管至胰十二指肠上动脉及胰大动脉近端、肠系膜上动脉左右支、胃十二指肠动脉和肠系膜上动脉、胰十二指肠上动脉、胰背动脉、胃十二指肠动脉。两组均行深静脉置管。两组除一般支持治疗外,组1经股动脉插管持续予生长抑素14肽、抗生素及血管活性药物等,时间为5～7d。而组2则采用静脉给药的方法给予上述药物。结果 两组平均住院时间分别为（14.3±2.2）d和（28.4±4.3）d,感染发生率为14.8％和52.6％,治愈率为96.3％和57.9％,统计分析均有显著差异（P<0.01）。结论 区域灌注对SAP的治愈率高于常规静脉给药,并在防止感染发生及SAP重型化方面优于全身给药组。

Objective To study the therapeutic effects of continuous regional intra-arterial infusion (CRI) and Whole body infusion in the treatment to severe acute pancreatitis (SAP). Methods 46 cases of SAP were divided into two groups randomly: group 1(CRI, 27 cases) and group 2(control group, 19 cases). The Sheldinger's method was used to insert a catheter into the pancreatic regional artery, and irrigate the sandostatin and antibiotics by pump for 24hs through group 1. The same drugs were given by vein through group 2. Results In group 1, the abdominal pain of all patients was apparently released after 24hs and disappeared after 7~12 days, and total 26 patients were cured in the end. While in group 2 it lasted for a longer time, and only after 5~7 days treatment it began to release. Conclusions CRI in the treatment to SAP can hold back the development of pancreatic infection and reduce the therapeutic time. And it has better therapeutic effects than the whole body infusion.