低分子肝素及乌司他丁单用及联合治疗急性胰腺炎的效果及对肠道损伤保护分析

Effects of low molecular weight heparin and ulinastatin alone and combined use in the treatment of acute pancreatitis and the protection effect in intestinal injury

目的:研究低分子肝素和乌司他丁单用及联合治疗急性胰腺炎的疗效。方法:135例急性胰腺炎患者随机平均分为A、B、C三组,均行常规治疗,A组加服低分子肝素,B组加服乌司他丁,C组联合应用两药,对比三组症状治愈时间、转归、肠道黏膜屏障功能和炎症因子变化。结果:C组腹痛、呕吐、进食、体温、白细胞和血尿淀粉酶改善时间显著高于A、B两组,B组腹痛、呕吐、体温和血尿淀粉酶改善显著高于A组;A组缓解率80%,重症化13.33%,手术6.67%,B组分别为82.22%、11.11%和6.67%,C组分别为95.56%、2.22%和2.22%,C组缓解率显著高于A、B两组;治疗后三组DAO、D-乳酸和尿L/M值显著降低,且降低幅度由高至低依次为C、B和A组;治疗后三组TNF-α和IL-1含量显著降低,IL-10含量显著升高,C组降低或升高幅度显著高于A、B两组,A、B两组TNF-α、IL-1差异显著。结论:低分子肝素联合乌司他丁治疗急性胰腺炎疗效较单用两药效果显著,可显著改善患者肠道黏膜屏障功能,降低炎症反应,值得临床推广。

[Abstact]Objective To study the effects of low molecular weight heparin and ulinastatin alone and combined use in the treatment of acute pancreatitis.Methods 135 patients with acute pancreatitis were randomly divided into group A,B and C,and all the patients were given routine treatment.Group A was additionally treated with low molecular weight heparin,while group B was treated with ulinastatin,and group C was treated with the combination of the two.The cure time of symptoms,outcome,intestinal mucosal barrier function and inflammatory factors were compared between groups.Results The relief of abdominal pain and vomiting,improvement of feeding,body temperature,white blood cell and urine amylase in group C were more significant than those in group A and group B,and the relief of abdominal pain,vomiting,fever and urine amylase in group B was more significant than that in group A;The remission rate,aggravation rate and operation rate in group A were 80%,13.33%and 6.67%,respectively while those in group B were 82.22%,11.11%and 6.67%respectively,and in group C were 95.56%,2.22%and2.22%,respectively.Theremission rate in group C was significantly higher than that in group A and that in group B;After treatment,DAO,D-lactic acid and urinary L/M were significantly decreased,and the reduction range from high to low was group C,group B and group A;The contents of TNF-αand IL-2 decreased significantly after treatment,while the content of IL-10increased significantly.The decrease and increase in group C were more significant than those in group A and group B.TNF-αand IL-2 showed significant differences between group A and group B.Conclusion Compared with single drug,the effect of low molecular weight heparin combined with ulinastatin is significant in the treatment of acute pancreatitis.It can significantly improve the intestinal mucosal barrier function,and reduce inflammation in patients.