胰岛素联合低分子肝素治疗妊娠期高甘油三酯性胰腺炎12例

Insulin and Low Molecular Weight Heparin Therapy for 12 Cases of Hypertriglyceridemic Pancreatitis in Pregnancy

目的探讨胰岛素联合低分子肝素在妊娠期高甘油三酯血症性胰腺炎治疗的临床应用方案,效果及安全性。方法 回顾分析昆明医科大学第一附属医院重症医学科于2015年1月至2018年4月入住的12例妊娠期高甘油三酯性胰腺炎患者的临床数据及使用胰岛素联合低分子肝素等治疗措施。结果 使用胰岛素(以0.1 U/(kg·h)为起始剂量)+低分子肝素(0.4 mL q12 h)的治疗方案,12例患者TG均在3~6 d内降至<11.3 mmol/L,且无患者发生低血糖、低血钾等不良反应。12例患者中4例继续妊娠,7例行剖宫产,1例行引产术。12例患者除1例21 d后转外院治疗外,其余11例于5~15 d转出ICU,后续恢复良好。结论 胰岛素联合低分子肝素的降低TG的治疗方案对于治疗妊娠期高甘油三酯血症性胰腺炎是安全有效的,尤其对于妊娠中期的孕妇可能更易于接受这种治疗方案,值得临床推广应用。

Objective To investigate the clinical application, efficacy and safety of Insulin and low molecular weight heparinin the treatment of hypertriglyceridemic pancreatitis in pregnancy. Methods The clinical data of 12 patients with hypertriglyceridemic pancreatitis in pregnancy admitted from 2015-1 to 2018-4 in the Department of intensive Medicine of the first affiliated Hospital of Kunming Medical University were retrospectively analyzed. And The specific measures of insulin combined and low molecular weight heparin(LMWH) therapy were described. Results Insulin(Starting with 0.1 U/(kg·h)+ Low Molecular Heparin(0.4 mL q12 h),which is effective for the treatment of hypertriglyceridemic pancreatitis in pregnancy. In 12 patients,TG decreased to < 11.3 mmol/L within 3-6 days,and no adverse reactions such as hypoglycemia and hypokalemia were observed. 4 patients continued pregnancy,7 patients underwent cesarean section and 1 patients received induced labor. Except for one patient who was transferred to other hospital after 21 days, the other 11 patients were transferred out of ICU within 5-15 days. The follow-up recovery was good. Conclusions Insulin and LMWH therapy for reducing TG is safe and effective in the treatment of hypertriglyceridemic pancreatitis in pregnancy. This treatment is more likely to be accepted by pregnant women in the second trimester. And it is worth popularizing and applying in clinic.