依诺肝素钠治疗重症急性胰腺炎的临床研究

Clinical study of enoxaparin sodium in treatment of acute severe pancreatitis

目的观察依诺肝素钠联合常规方案治疗重症急性胰腺炎的临床疗效。方法选取2015年6月-2018年6月福建省立金山医院收治的重症急性胰腺炎患者118例作为研究对象,采用随机数字法将患者分为对照组(58例)、观察组(60例)。对照组采用微量泵入注射用生长抑素,6~12 mg/d;静脉滴注注射用泮托拉唑钠,40 mg/次,2次/d;静脉滴注左氧氟沙星氯化钠注射液,0.5 g/次,1次/d,及营养补液治疗,疗程10~14 d。观察组在对照组基础上皮下注射依诺肝素钠注射液,6000 IU/次,1次/12 h,疗程10~14 d。观察两组患者的临床指标改善情况、急性生理与慢性健康评分(APACHEⅡ)、改良Marshall评分、并发症率、治愈率、病死率、中转手术率及平均住院日,同时比较两组患者治疗前后的实验室指标、胰腺损害CT评分(Balthazar-CTSI),并观察患者的不良反应及1年的随访情况。结果治疗14 d后,观察组临床症状和体征改善率分别为93.33%、83.67%,而对照组分别为79.31%、70.69%,两组比较差异具有统计学意义(P<0.05)。治疗后,观察组的APACHEⅡ评分、改良Marshall评分均低于对照组,差别具有统计学意义(P<0.05)。治疗后,观察组的并发症率、治愈率、病死率、中转手术率均优于对照组,差别具有统计学意义(P<0.05);观察组的平均住院时间明显短于对照组,两组比较差异具有统计学意义(P<0.05)。治疗14 d后,两组治疗后白细胞(WBC)、血小板(PLT)、凝血酶原时间(PT)、丙氨酸氨基转移酶(ALT)、肌酐(CRE)、血钙、血糖、血氧分压(pO2)、C反应蛋白(CRP)、血淀粉酶、尿淀粉酶均较治疗前改善(P<0.05),二氧化碳分压(pCO2)治疗前后无明显差别。其中观察组WBC、PLT、PT、ALT、CRE、血钙、血糖、pO2、CRP、血淀粉酶、尿淀粉酶在治疗3 d、7 d和14 d均明显优于对照组,差别具有统计学意义(P<0.05)。治疗14 d后,两组Balthazar-CTSI评分均较治疗前显著降低,同组治疗前后比较差异具有统计学意义(P<0.05);其中观察组Balthazar-CTSI评分较对照组明显减少,两组比较差别具有统计学意义(P<0.05)。治疗过程中,观察组的出血、皮下瘀斑和皮下结节发生率分别为6.67%、11.67%和8.33%,均高于对照组。随访1年,观察组患者症状反复明显少于对照组(P<0.05)。结论依诺肝素钠治疗重症急性胰腺炎疗效肯定,不良反应少,值得临床推广。

Objective To observe the clinical efficacy of enoxaparin sodium combined with conventional regimen in the treatment of severe acute pancreatitis.Methods Patients(118 cases)with acute severe pancreatitis in Fujian Provincial Hospital South Branch from June 2015 to June 2018 were randomly divided into control(58 cases)and observation(60 cases)group.Patients in the control group were microscale pumping with Somatostatin for Injection,6-12 mg/d,iv administered with Pantoprazole Sodium for Injection,40 mg/time,twice daily,and iv administered with Levofloxacin and Sodium Chloride Injection,0.5 g/time,once daily.And nutritional fluid therapy,10-14 d course of treatment.Patients in the observation group were injected with Enoxaparin Sodium Injection on the basis of the control group,6000 IU/time,once every 12 h,and the course of treatment was 10-14 d.Clinical indexes,APACHE II,modified Marshall score,complication rate,cure rate,case fatality rate,transit operation rate,and average such confinement in two groups were observed.At the same time,the laboratory indexes and Balthazar-CTSI before and after treatment were compared,and the adverse reactions of patients and 1 year of follow-up were observed.Results After treatment,the improvement rates of clinical symptoms and signs in the observation group were 93.33%and 83.67%,respectively,while those in the control group were 79.31%and 70.69%,respectively,the difference between two groups was statistically significant(P<0.05).After treatment,APACHEⅡscore and modified Marshall score in the observation group were lower than those in the control group,with statistically significant differences(P<0.05).After treatment,the complication rate,cure rate,case fatality rate,and transfer operation rate in the observation group were better than those in the control group,and the differences were statistically significant(P<0.05).And the average length of stay in the observation group was significantly shorter than that in the control group,and the difference between the two groups was statistically significant(P<0.05).After 14 days of the treatment,the levels of WBC,PLT,PT,ALT,CRE,blood calcium,blood glucose,pO2,CRP,blood amylase,and urine amylase were improved(P<0.05),there was no significant difference in pCO2 before and after treatment.After treatment of 3,7,and 14 d,the levels of WBC,PLT,PT,ALT,CRE,blood calcium,blood glucose,pO2,CRP,blood amylase,and urinary amylase in the observation group were significantly better than those in the control group,with statistically significant differences(P<0.05).After treatment,Balthazar-CTSI scores in two groups were significantly decreased,and the difference before and after treatment in the same group was statistically significant(P<0.05).And the Balthazar-CTSI score in the observation group was significantly lower than that in the control group,and the difference between the two groups was statistically significant(P<0.05).During the treatment,the incidence of hemorrhage,subcutaneous ecchymosis,and subcutaneous nodules in the observation group were 6.67%,11.67%and 8.33%,respectively,which were all higher than the control group.Followed up for 1 year,the recurrence of symptoms in the observation group was significantly less than that in the control group(P<0.05).Conclusion Enoxaparin Sodium Injection in treatment of severe acute pancreatitis has positive efficacy,less adverse reactions,worthy of clinical promotion.