阶梯式引流术与开放手术对重症急性胰腺炎患者肠黏膜屏障功能及氧化应激介质的影响

Effect of stepped drainage and open surgery on intestinal mucosal barrier function damage and oxidative stress mediator improvement in patients with severe acute pancreatitis

目的对比观察阶梯式引流术与开放手术对重症急性胰腺炎(SAP)患者肠黏膜屏障功能及氧化应激介质的影响。方法抽取2017年10月至2019年10月晋城市第二人民医院收治的SAP患者48例,根据手术方案分为两组,每组24例。A组行阶梯式引流术,B组行开放手术。比较两组围术期指标、并发症、氧化应激介质及肠黏膜屏障功能情况。结果 A组住院时间、肛门排气、排便时间短于B组(P<0.05)。A组并发症发生率低于B组,但差异未见统计学意义(P>0.05)。术后1、3、7 d, A组血清丙二醛、促肾上腺皮质激素水平低于B组(t=6.617、3.634、6.284、6.277、9.013、6.007,P均<0.05)。术后1、3个月,A组血清二胺氧化酶、D-乳酸水平低于B组(t=4.135、4.901、7.460、8.203,P均<0.05)。结论阶梯式引流术相较于开放手术,可改善SAP患者围术期指标,降低并发症,减轻肠黏膜屏障功能损伤,且对机体氧化应激影响较小。

Objective To investigate the effects of stepped drainage and open surgery on intestinal mucosal barrier function damage and improvement of oxidative stress mediators in severe acute pancreatitis(SAP)patients.Methods From October 2017 to October 2019,48 SAP patients in the Second People’s Hospital of Jincheng were selected and divided into two groups according to the surgical plan,with 24 cases in each group.Group A underwent stepped drainage,group B underwent open surgery.The perioperative indicators,complications,oxidative stress mediators and intestinal mucosal barrier function were compared between the two groups.Results The time for hospitalization time,anal exhaust and defecation time were shorter than those in group B(P<0.05).The incidence of complication in group A was lower than those in group B,but there was no significant differences between group A and group B(P>0.05).The serum malondialdehyde and adrenocorticotropic hormone levels in group A were lower than those in group B at 1 day,3 days,and 7 days after operation(t=6.617、3.634、6.284、6.277、9.013、6.007,all P<0.05).The serum diamine oxidase and D-Lactate levels of group A were lower than those of group B at 1 month and 3 months after operation(t=4.135、4.901、7.460、8.203,all P<0.05).Conclusions Stepped drainage applied to SAP patients can improve perioperative indicators,reduce complications,reduce intestinal mucosal barrier function damage,and have little effect on oxidative stress.