不同剂量乌司他丁协同谷氨酰胺治疗急性胰腺炎患者的临床效果

Clinical Effects of Different Doses of Ulinastatin Combined with Glutamine in the Treatment of Patients with Acute Pancreatitis

目的:评估谷氨酰胺配合不同剂量的乌司他丁对急性胰腺炎患者治疗效果与安全性的影响。方法:选取甘肃省第三人民医院2020年8月—2023年7月收治的87例急性胰腺炎患者作为研究对象,根据治疗方式分为四组,其中对照组(21例)予以谷氨酰胺注射液治疗,A组(23例)予以谷氨酰胺+20万U乌司他丁,B组(22例)予以谷氨酰胺+40万U乌司他丁,C组(21例)予以谷氨酰胺+60万U乌司他丁。比较四组的临床康复进展情况(腹痛缓解时间、呼吸频率恢复时间、心率恢复时间)、炎症因子[血清淀粉酶、C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]及治疗期间的不良反应发生率,记录并比较四组治疗前后的急性生理学和慢性健康状况评价Ⅱ(APACHEⅡ)评分及急性胰腺炎严重程度床边指数(BISAP)评分。结果:B组和C组腹痛缓解时间均早于对照组和A组,B组和C组呼吸频率恢复时间早于对照组,且C组显著早于A组,差异均有统计学意义(P<0.05)。治疗2周后,四组血清淀粉酶、CRP、TNF-α均较治疗前降低,A组血清淀粉酶、CRP、TNF-α均低于对照组,B组、C组的血清淀粉酶、CRP、IL-6和TNF-α均低于对照组与A组,C组血清淀粉酶、CRP、TNF-α均低于B组,差异均有统计学意义(P<0.05)。各组治疗期间出现的不良反应发生率差异无统计学意义(P>0.05)。相较于对照组,B组、C组患者治疗2周后的APACHEⅡ评分及BISAP评分均降低(P<0.05),B组和C组APACHEⅡ评分及BISAP评分均低于A组(P<0.05)。结论:谷氨酰胺联合中高剂量乌司他丁显著改善急性胰腺炎患者的治疗效果,缩短康复时间,降低炎症反应,且安全性良好。

Objective:To evaluate the effects and safety of Glutamine combined with different doses of Ulinastatin in the treatment of patients with acute pancreatitis.Method:A total of 87 patients with acute pancreatitis admitted to the Third People's Hospital of Gansu Province from August 2020 to July 2023 were selected as the study subjects.According to the treatment methods,they were divided into four groups,control group(21 cases)was treated with Glutamine Injection,group A(23 cases)was treated with Glutamine+200,000 U Ulinastatin,group B(22 cases)was treated with Glutamine+400,000 U Ulinastatin,and group C(21 cases)was treated with Glutamine+600,000 U Ulinastatin.The clinical recovery progress(time of abdominal pain relief,respiratory rate recovery time,heart rate recovery time),inflammatory factors[blood amylase,C reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)],and the incidence of adverse reactions during treatment were compared among the four groups.The acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and the bedside index of severity in acute pancreatitis(BISAP)score before and after treatment were recorded and compared among the four groups.Result:The duration of abdominal pain relief in group B and group C were earlier than those in the control group and group A,the recovery time of respiratory rate in group B and group C were earlier than that in the control group,and the recovery time in group C was significantly earlier than that in group A,the differences were statistically significant(P<0.05).After two weeks of treatment,serum amylase,CRP and TNF-αin the four groups were decreased compared with those before treatment,serum amylase,CRP,and TNF-αlevels in group A were lower than those in the control group,serum amylase,CRP,IL-6,and TNF-αlevels in group B and group C were lower than those in the control group and group A,serum amylase,CRP,and TNF-αlevels in group C were lower than those in group B,the differences were statistically significant(P<0.05).The incidence of adverse reactions during the treatment period did not differ significantly among the groups(P>0.05).Compared to the control group,APACHEⅡscores and BISAP scores of patients in group B and group C decreased after two weeks of treatment(P<0.05),and both APACHEⅡand BISAP scores in group B and group C were lower than those in group A(P<0.05).Conclusion:Glutamine combined with medium and high doses of Ulinastatin significantly improves the treatment effect of patients with acute pancreatitis,shortens recovery time,reduces inflammatory response,and has good safety.