乌司他丁联合血液灌流治疗重症胰腺炎的效果观察

Effect of ulinastatin combined with hemoperfusion in the treatment of severe pancreatitis

目的探讨乌司他丁联合血液灌流治疗重症胰腺炎的效果。方法抽取2018年8月至2020年7月首都医科大学附属北京同仁医院收治的重症胰腺炎患者76例,按照治疗方案将其分为两组,每组38例。对照组在常规治疗基础上给予乌司他丁,观察组在对照组治疗基础上联合血液灌流。分析两组疗效、炎症相关分子值、肠道屏障功能指标值、临床症状消失时间。结果观察组治疗总有效率为94.75%(36/38),高于对照组的78.95%(30/38),χ2=4.146,P=0.042。观察组腹痛消失、发热消失、肠蠕动恢复时间短于对照组(t=3.415、2.435、2.318,P<0.05)。治疗后,观察组核苷酸结合寡聚化结构域样受体蛋白3(NLRP3)蛋白、NLRP3 mRNA、白细胞介素1β、D-乳酸、二胺氧化酶、乳果糖/甘露醇值小于对照组(t=2.651、2.888、2.233、3.198、3.406、2.368,P<0.05)。结论乌司他丁联合血液灌流治疗重症胰腺炎有效率高,其通过抑制NLRP3炎症小体信号通路减轻机体炎症反应,并能改善肠道屏障功能,缓解临床症状。

Objective To investigate the effect of ulinastatin combined with hemoperfusion in the treatment of severe pancreatitis.Methods A total of 76 patients with severe pancreatitis admitted to Beijing Tongren Hospital of Capital Medical University from August 2018 to July 2020 were divided into two groups according to the treatment plan,with 38 cases in each group.The control group was given ulinastatin on the basis of conventional treatment,and the observation group was combined with hemoperfusion on the basis of the treatment of the control group.The efficacy,inflammation-related molecular values,intestinal barrier function index values,and clinical symptoms disappeared time in the two groupswere analyzed.Results The total effective rate of treatment in the observation group was 94.75%(36/38),which was higher than 78.95%(30/38)in the control group,χ2=4.146,P=0.042.The abdominal pain disappeared,fever disappeared,and the recovery time of bowel movement in the control group were shorter than those in the control group(t=3.415,2.435,2.318,P<0.05).After treatment,the values of nucleotide-binding oligomerization domain-like receptor protein 3(NLRP3)protein,NLRP3 mRNA,interleukin 1β,D-lactic acid,diamine oxidase,and lactulose to mannitol in the observation group were lower than those in the control group(t=2.651,2.888,2.233,3.198,3.406,2.368,P<0.05).Conclusions The response rate of ulinastatin combined with hemoperfusion is high in the treatment of severe pancreatitis,which can alleviate inflammatory response by inhibiting NLRP3 inflammasome signaling pathway,improve intestinal barrier function and relieve clinical symptoms.