不同剂量奥曲肽治疗重症急性胰腺炎患者的临床效果

Clinical effect of different doses of octreotide in treatment of patients with severe acute pancreatitis

目的探讨不同剂量奥曲肽治疗重症急性胰腺炎(severe acute pancreatitis,SAP)患者的临床效果。方法选取我院2018年10月-2022年10月收治的SAP患者154例,随机分为观察组和对照组,每组各77例。两组患者在接受乌司他丁等常规治疗的基础上,对照组患者接受0.6 mg奥曲肽静脉滴注治疗,观察组患者则接受1.2 mg奥曲肽静脉滴注治疗,均每天1次,连续治疗12 d,比较两组患者治疗12 d时的治疗总有效比例、不良反应发生比例、临床症状消失时间及血淀粉酶复常时间,同时比较两组患者治疗前后血清炎性因子C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、T淋巴细胞水平及急性生理与慢性健康评分(APACHEⅡ评分)、改良CT严重指数(MCTSI)评分的变化。结果观察组患者治疗总有效比例明显高于对照组(χ2=5.140,P<0.05);治疗12 d时,观察组患者发热、腹胀及腹痛症状消失时间及血淀粉酶复常时间明显少于对照组(t=14.703~22.543,P<0.01);观察组患者治疗前后CRP、TNF-α、IL-6、CD8^(+)、CD4^(+)水平及CD4^(+)/CD8^(+)比值的差值明显高于对照组(t=4.706~17.498,P<0.05);观察组治疗前后APACHEⅡ及MCTSI评分差值均显著高于对照组(t=15.629、19.676,P<0.01);两组不良反应发生比例比较差异无显著性(P>0.05)。结论大剂量奥曲肽可有效提高SAP患者的疗效,增强患者机体免疫功能,减轻患者的炎症反应水平,且安全性较高,值得临床推广应用。

Objective To investigate the clinical effect of different doses of octreotide in the treatment of patients with severe acute pancreatitis(SAP).Methods A total of 154 patients with SAP who were admitted to our hospital from October 2018 to October 2022 were enrolled and randomly divided into observation group and control group,with 77 patients in each group.In addition to the conventional treatment methods including ulinastatin,the patients in the control group received intravenous drip of 0.6 mg octreotide,and those in the observation group received intravenous drip of 1.2 mg octreotide,once a day for 12 consecutive days.The two groups were compared in terms of overall response rate,proportion of patients with adverse reactions,time to clinical symptom disappearance,and time to normalization of blood amylase on day 12 of treatment,as well as the changes in the serum levels of inflammatory factors\,the levels of T lymphocytes,Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,and modified CT severity index(MCTSI)score.Results The observation group had a significantly higher overall response rate than the control group(χ^(2)=5.140,P<0.05),and compared with the control group on day 12 of treatment,the observation group had significantly shorter time to symptom disappearance(pyrexia,abdominal distension,and abdominal pain)and time to normalization of blood amy-lase(t=14.703-22.543,P<0.01).Compared with the control group,the observation group had significantly greater changes in CRP,TNF-α,IL-6,CD8^(+),CD4^(+),and CD4^(+)/CD8^(+)ratio after treatment(t=4.706-17.498,P<0.05),as well as significantly greater changes in APACHEⅡand MCTSI scores after treatment(t=15.629,19.676,P<0.01).There was no significant diffe-rence in the proportion of patients with adverse reactions between the two groups(P>0.05).Conclusion High-dose octreotide can effectively improve the treatment outcome of patients with SAP,enhance their immune function,and reduce inflammatory response with a favorable safety profile,and therefore,it holds promise for clinical application.