乌司他丁联合奥曲肽治疗轻症急性胰腺炎的治疗效果分析

Analysis of the efficacy of ulinastatin combined with octreotide in the treatment of mild acute pancreatitis

目的探讨乌司他丁、奥曲肽单用或联用对轻症急性胰腺炎(Mild acute pancreatitis,MAP)的治疗效果。方法前瞻性分析2015年11月~2019年10月我院收治的MAP患者279例,按随机数字表法与析因设计分为四组:空白对照组、乌司他丁组、奥曲肽组、奥曲肽+乌司他丁组。比较四组患者治疗前后血淀粉酶(Amylase,AMS)、脂肪酶(Lipase,LPS)、白细胞计数(White blood cell,WBC)、降钙素原(Procalcitonin,PCT)、C反应蛋白(C-reaction protein,CRP)的浓度变化、腹痛与腹胀时间、住院时间、住院费用、治愈率、不良反应发生率。结果与治疗前相比,治疗后各组患者的实验室指标浓度均显著性降低;与空白对照组相比,治疗后乌司他丁组或奥曲肽组或奥曲肽+乌司他丁组在血AMS、LPS、WBC、PCT、CRP的浓度、腹痛与腹胀消失时间、住院时间、住院费用均显著性降低,而不良反应发生率显著升高,差异有统计学意义;奥曲肽组与乌司他丁组上述参数相比较,差异无统计学意义;与乌司他丁组或奥曲肽组相比,治疗后奥曲肽+乌司他丁组血AMS、LPS、WBC、PCT、CRP等指标浓度、住院时间、住院费用、腹痛与腹胀消失时间均显著性降低,但不良反应发生率升高,差异有统计学意义。四组患者治愈率比较,差异无统计学意义。结论对于MAP患者的治疗,奥曲肽或乌司他丁与常规治疗相比不能提高治愈率,但能改善临床症状,缩短住院时间,减少住院费用,二者联用能进一步提高疗效。

Objective To explore the therapeutic effect of ulinastatin and octreotide administration alone or in combination on mild acute pancreatitis(MAP).Methods 279 patients with MAP treated in our hospital from November 2015 to October 2019 were prospectively analyzed.They were divided into 4 groups including blank group,ulinastatin group,octreotide group,octreotide+ulinastatin groupaccording to the random number table and factorial design.The changes of blood amylase(AMS),lipase(LPS),white blood cell(WBC),procalcitonin(PCT)and C-reactionprotein(CRP)concentration,abdominal pain and bloating time,length of hospital stay,cost of hospitalization,cure rate,incidence of adverse reactionsin the 4 groups before and after treatment were compared.Results Compared with those before treatment,the concentrations of laboratory indicators in each group after treatment were significantly reduced.Compared with those of the blank control group,the concentrations of blood AMS,LPS,WBC,PCT,CRP,the disappearance time of abdominal pain and bloating,the length of hospital stay,and the cost ofhospitalization in the ulinastatin group or octreotide group or octreotide+ulinastatin group after treatmentwere all significantly reduced,while the incidence of adverse reactions was significantly increased,and the difference was statistically significant.There was no statistically significant difference in the above parameters betweem the octreotide group and the ulinastatin group.Compared with those of the ulinastatin group or the octreotide group,the concentrations of blood AMS,LPS,WBC,PCT and CRP,hospitalization time,and hospitalization cost,and the disappearancetime of abdominal pain and abdominal distension in the octreotide+ulinastatin group were all significantly reduced,but the incidence of adverse reactions increased,and the difference was statistically significant.There was no significant difference in cure rates between the four groups.Conclusion For the treatment of patients with MAP,compared with conventional treatment,octreotide or ulinastatin cannot improve the cure rate,but can improve clinical symptoms,shorten the length of hospital stay,and reduce the cost of hospitalization.The combination of the two can further improve the efficacy.