奥曲肽联合乌司他丁治疗急性重症胰腺炎疗效及安全性分析

Clinical efficacy and safety of octreotide combined with ulinastatin in treatment of acute severe pancreatitis

目的探讨奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效及安全性分析。方法将2013年10月至2018年10月治疗的90例急性重症胰腺炎患者随机分为对照组和观察组,每组45例。2组均给予内科规范化治疗,在此基础上,对照组使用奥曲肽治疗,观察组使用奥曲肽联合乌司他丁治疗,比较2组患者的临床疗效、症状体征消失时间及血淀粉酶恢复正常时间、各项血清炎症及免疫指标变化、并发症发生率、不良反应发生率。结果观察组治疗有效率为91.11%,明显高于对照组的73.33%(P<0.05);观察组腹痛腹胀消失时间、恶心呕吐消失时间、腹膜刺激征消失时间、胃肠减压时间、血淀粉酶恢复正常时间、治愈时间均明显短于对照组(P<0.05);观察组治疗后IL-6、IL-8、TNF-α、CRP、WBC水平明显低于对照组,而CD^(+)_(4)、CD^(+)_(8)、CD^(+)_(4)/CD^(+)_(8)水平明显高于对照组(P<0.05);观察组菌血症、脓毒血症、腹腔严重感染、MODS、肝功能衰竭、休克等并发症发生率明显低于对照组(P<0.05);2组在头痛、恶心呕吐、皮肤过敏、嗜酸粒细胞增多等不良反应发生率上差异无统计学意义(P>0.05)。结论奥曲肽联合乌司他丁治疗急性重症胰腺炎临床疗效显著,能有效促进症状缓解,抑制炎性因子水平,调节机体免疫,缩短治疗时间,降低并发症发生率,且药物安全性高,能改善预后,具有积极的临床意义。

Objective To investigate the clinical efficacy and safety of octreotide combined with ulinastatin in treatment of acute severe pancreatitis.Methods A total of 90 patients with severe acute pancreatitis who were treated in our hospital from October 2013 to October 2018 were randomly divided into two groups,with 45 cases in each group.The patients in both groups were given internal medicine standardized treatment,on this basis,the patients in control group were treated by octreotide,however,the patients in observation group were treated by octreotide combined ulinastatin.The clinical efficacy,and disappearing time of symptomes and signs,the time of blood amylase returning to normal levels,the serum levels of inflammatory and immune indexes,and the incidence rates of complications and adverse reactions were observed and compared between the two groups.Results The effective rate in observation group was 91.11%,which was significantly higher than that(73.33%)in control group(P<0.05).The disappearance time of abdominal pain and distension,nausea and vomiting,peritoneal stimulation,gastrointestinal decompression,blood amylase recovery and cure time in observation group were significantly shorter than those in control group(P<0.05).After treatment,the levels of IL-6,IL-8,TNF-α,CRP,WBC in observation group were significantly lower than those in control group,however,the levels of CD^(+)_(4),CD^(+)_(8),CD^(+)_(4)/CD^(+)_(8 )were significantly higher than those in control group(P<0.05).Moreover the incidence rates of complications including bacteremia,sepsis,severe abdominal infection,MODS,liver failure and shock in observation group were significantly lower than those in control group(P<0.05).However there were no significant difference in the incidence rates of adverse reactions including headache,nausea and vomiting,skin allergy,and eosinophilia between the two groups(P>0.05).Conclusion The octreotide combined with ulinastatin has significant clinical efficacy in treatment of acute severe pancreatitis,which can effectively promote symptom relief,inhibit the levels of inflammatory factors,regulate the immune system,shorten the treatment time,reduce the incidence of complications,with good safety,which can improve the prognosis and has positive clinical significance.