生长抑素联合前列地尔治疗重症急性胰腺炎的疗效及对部分血清炎症因子的影响

Clinical effect of somatostatin combined with alprostadil for patients with severe acute pancreatitis and its effect on the serum inflammatory factors

目的观察生长抑素联合前列地尔治疗重症急性胰腺炎的疗效及对部分血清炎症因子的影响。方法选取云南省第三人民医院在2015年5月至2017年5月收治的73例重症急性胰腺炎患者,按照随机数字表法分为观察组和对照组,对照组在常规治疗基础上加用生长抑素治疗,观察组在常规治疗基础上加用生长抑素联合前列地尔治疗,2周为一疗程;观察两组患者临床疗效、症状缓解时间、血清炎症因子水平、不良反应及死亡率。结果观察组临床总有效率为87.5%(28/32),对照组临床总有效率为75.6%(31/41),比较差异具有统计学意义(P<0.05);观察组腹痛缓解时间、肠功能恢复时间、血清淀粉酶(AMY)恢复时间、平均住院时间均低于对照组[(3.2±1.2)d vs.(4.9±1.1)d、(3.7±1.1)d vs.(5.4±1.4)d、(5.8±1.1)d vs.(7.5±1.3)d、(14.8±5.2)d vs.(18.6±4.6)d],差异均具有统计学意义(P<0.05);治疗后两组患者急性生理与慢性健康评分Ⅱ(APACHEⅡ评分)、白细胞(WBC)、超敏C反应蛋白(CRP)、AMY、丙氨酸转氨酶(ALT)、血清肌酐(Cr)水平明显下降,治疗后7 d、14 d观察组APACHEⅡ评分、WBC、CRP、AMY、ALT、Cr水平明显低于对照组[(9.2±2.2)分vs.(10.5±1.5)分、(12.2±3.2)×10~9/L vs.(13.9±2.9)×109/L、(72.3±17.3)mg/L vs.(106.5±20.1)mg/L、(389.6±57.6)U/L vs.(1066.3±152.4)U/L、(62.9±8.8)U/L vs.(80.4±11.5)U/L、(82.5±18.6)μmol/L vs.(108.6±20.5)μmol/L;(6.8±2.0)分vs.(8.3±2.4)分、(7.5±1.2)×109/L vs.(8.6±1.4)×109/L、(24.2±8.6)mg/L vs.(52.7±15.2)mg/L、(72.6±15.2)U/L vs.(138.2±25.6)U/L、(22.5±6.4)U/L vs.(42.6±12.8)U/L、(46.2±10.4)μmol/L vs.(70.1±16.2)μmol/L],差异均具有统计学意义(P<0.05);治疗后两组患者血清内毒素、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平明显下降,观察组血清内毒素、TNF-α、IL-6水平明显低于对照组[(45.3±9.8)Eu/ml vs.(53.2±10.3)Eu/ml、(62.5±13.7)ng/L vs.(76.3±14.2)ng/L、(60.3±11.4)ng/L vs.(81.2±20.9)ng/L],差异均有统计学意义(P均<0.05);观察组死亡率为12.5%(4/32),对照组死亡率为24.4%(10/41),两组比较差异有统计学意义(P<0.05)。结论生长抑素联合前列地尔治疗重症急性胰腺炎疗效显著,可有效降低患者血清炎症因子水平,值得临床推广。

Objective To observe the clinical effect of somatostatin combined with alprostadil in the treatment of severe acute pancreatitis and its influence on serum inflammatory factors.Methods Seventy-three patients with severe acute pancreatitis were enrolled in this study from May 2015 to May 2017 in Department of Hepatobiliary Surgery of Third People′s Hospital of Yunnan Province.These patients were randomly divided into observation group and control group according to the random number table method.The patients in control group were treated with routine treatment combined with somatostatin,and the patients in observation group were treated with routine treatment combined with somatostatin and alprostadil for 2 weeks.The clinical efficacy,symptom remission time,serum inflammatory factor level,adverse reaction rate and mortality rate of the two groups were observed.Results The total effective rate was 87.5%(28/32)in observation group and 75.6%(31/41)in control group,and the difference was statistically significant(P<0.05).The recovery time of bowel pain,recovery time of intestinal function,recovery time of blood amylase(AMY)and the average hospitalization time of observation group were shorter than those of control group[(3.2±1.2)d vs.(4.9±1.1)d,(3.7±1.1)d vs.(5.4±1.4)d,(5.8±1.1)d vs.(7.5±1.3)d,(14.8±5.2)d vs.(18.6±4.6)d],and the differences were statistically significant(P<0.05).The levels of acute physiology and chronic health evaluationⅡ(APACHEⅡ),white blood count(WBC),C-reactive protein(CRP),AMY,alanine aminotransferase(ALT)and serum creatinine(Cr)in the two groups after treatment declined significantly.The levels of APACHEⅡ,WBC,CRP,AMY,ALT and Cr in observation group were lower than those in control group at 7 days and 14 days after treatment[(9.2±2.2)vs.(10.5±1.5),(12.2±3.2)×10 9/L vs.(13.9±2.9)×10 9/L,(72.3±17.3)mg/L vs.(106.5±20.1)mg/L,(389.6±57.6)U/L vs.(1 066.3±152.4)U/L,(62.9±8.8)U/L vs.(80.4±11.5)U/L,(82.5±18.6)μmol/L vs.(108.6±20.5)μmol/L;(6.8±2.0)vs.(8.3±2.4),(7.5±1.2)×10 9/L vs.(8.6±1.4)×10 9/L,(24.2±8.6)mg/L vs.(52.7±15.2)mg/L,(72.6±15.2)U/L vs.(138.2±25.6)U/L,(22.5±6.4)U/L vs.(42.6±12.8)U/L,(46.2±10.4)μmol/L vs.(70.1±16.2)μmol/L],and the differences were statistically significant(P<0.05).The levels of endotoxin,tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)in the two groups declined significantly after treatment.The levels of endotoxin,TNF-αand IL-6 in observation group were lower than those in control group[(45.3±9.8)Eu/ml vs.(53.2±10.3)Eu/ml,(62.5±13.7)ng/L vs.(76.3±14.2)ng/L,(60.3±11.4)ng/L vs.(81.2±20.9)ng/L],and the differences were statistically significant(P<0.05).The mortality rate was 12.5%(4/32)in observation group and 25.4%(10/41)in control group,and the difference was statistically significant(P<0.05).Conclusion The effect of somatostatin combined with alprostadil in the treatment of severe acute pancreatitis is obvious,and this treatment can reduce effectively the levels of serum inflammatory factors,which is worthy to be popularized.