持续静滴山莨菪碱治疗重症急性胰腺炎——60例病例对照研究

Continuous intravenous instillation of anisodamine as a treatment for severe acute pancreatitis: a controlled study of 60 cases

目的 探讨持续静滴山莨菪碱治疗重症急性胰腺炎 (SAP)的价值。方法 将 6 0例住院收治 SAP,随机分为治疗组 (n=31)及标准对照组 (n=2 9) ,(治疗组每日山莨菪碱 4 0 ～ 10 0 mg,对照组常规使用奥曲肽 /思他宁 0 .2 5 mg/ h) ,比较两组病例的平均腹痛缓解天数、治愈所需住院天数、病死率及平均住院医疗费用。结果 治疗组平均腹痛缓解天数 2 .1d,平均住院天数 14 .7d,病死率 0 (0 / 31) ,平均住院医疗费用 5 797元 ;标准对照组平均腹痛缓解天数 6 .2 9d,平均住院天数 33.4 d,病死率 14 .0 %(4 / 2 9) ,平均住院医疗费用 2 184 4元。两组在平均腹痛缓解天数 (t=7.90 ,P<0 .0 0 1)、住院天数 (t=4 .19,P<0 .0 0 1)及住院费用 (t=2 .90 ,P<0 .0 1)上的比较均有显著统计学差异 ,病死率亦有显著性差异(χ2 =4 .5 8,P<0 .0 5 )。结论 内科治疗 SAP时 ,在常规治疗基础上 ,持续静滴山莨菪碱 ,可及时控制或减少并发症 ,显著缩短病程及住院天数 ,显著降低病死率及医疗费用。

Objective To evaluate the outcome of using continuous intravenous instillation of anisodamine in the treatment of severe acute pancreatitis (SAP). Methods 60 SAP patients were randomly divided into the treatment group (n=31) receiving continuous intravenous instillation of anisodamine (654-2) and the control group (n=29) receiving intravenous octreotide/somatostatin (0.25 mg/h) as a routine treatment. Mean days of relief from abdominal pain, hospital stay, case-fatality rate and hospitalization cost were compared between the two groups to assess the efficacy of continuous intravenous instillation of anisodamine in the treatment of SAP. T-test and χ-test of Stata Software were used in statistics. Results Mean days of relief from abdominal pain, hospital stay, case-fatality rate and hospitalization cost between the treatment group and the control group were 2.1 days vs 6.3 days, 14.7 days vs 33.4 days, 0 vs 14.0% and 5 797 RMB vs 21 844 RMB, respectively. The differences between the two groups were statistically significant (t=7.90, P < 0.001, t=4.19, P < 0.001, χ2=4.58, P < 0.01, t=2.9, P < 0.05 respectively). Conclusions Continuous intravenous instillation of anisodamine on the basis of routine treatment helps control and reduce complications, shorten the course of disease and hospital stay, reduce case-fatality rate and medical cost.