乌司他丁治疗老年急性重症胰腺炎的临床研究

发布时间：2018-04-27 08:31

本文选题：急性胰腺炎 + 乌司他丁　；参考：《中国临床药理学杂志》2017年21期

【摘要】：目的观察乌司他丁对老年急性重症胰腺炎患者血清D-乳酸、肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平的影响。方法将120例老年急性重症胰腺炎患者随机分为试验组和对照组,每组60例。对照组给予注射用生长抑素,首次剂量250μg,然后以250μg·h~(-1)维持,奥美拉唑40 mg+0.9%NaCl注射液100 mL,静脉滴注,每日2次。试验组在对照组的基础上给予乌司他丁1.0×10~5U+5%葡萄糖注射液250 mL,静脉滴注,每日2次。2组患者均持续治疗1周。观察患者治疗前后血清D-乳酸、TNF-α、IL-6、淀粉酶及脂肪酶水平和症状缓解时间、临床疗效及安全性。结果治疗后,对照组有效率为75.00%(45例/60例),试验组为93.34%(56例/60例),差异有统计学意义(P0.05)。治疗后,对照组和试验组血清D-乳酸分别为(8.16±0.93),(6.24±0.77)μg·L~(-1),TNF-α分别为(261.13±32.34),(216.32±25.54)pg·mL~(-1),C-反应蛋白(CRP)分别为(36.84±5.18),(19.66±2.78)mg·L~(-1),IL-6分别为(74.82±10.21),(52.51±7.12)pg·mL~(-1),差异均有统计学意义(均P0.05)。治疗后,对照组和试验组血淀粉酶分别为(264.41±31.12),(134.64±18.81)U·L~(-1),尿淀粉酶分别为(1864.42±233.43),(1019.53±135.42)U·L~(-1),脂肪酶分别为(73.23±10.11),(34.43±4.65)U·L~(-1),差异均有统计学意义(均P0.05)。对照组和试验组腹痛缓解时间分别为(4.63±0.63),(3.18±0.44)d,腹胀缓解时间分别为(5.71±0.76),(4.28±0.61)d,首次排便时间分别为(32.64±4.27),(17.82±2.43)d,肠鸣音恢复时间分别为(29.56±4.06),(14.39±2.02)d,差异均有统计学意义(均P0.05)。对照组发生的药物不良反应有恶心、皮疹,药物不良反应发生率为13.33%(8例/60例);试验组发生的药物不良反应有恶心、皮疹和注射部位疼痛,药物不良反应发生率为8.33%(5例/60例),差异无统计学意义(P0.05)。结论乌司他丁对老年急性重症胰腺炎有较好的临床疗效,保护肠道黏膜屏障功能,促进胃肠功能恢复,且明显降低血清D-乳酸、TNF-α及IL-6水平,具有较高的安全性。
[Abstract]:Objective to observe the effects of ulinastatin on serum levels of D-lactic acid, tumor necrosis factor- 伪 (TNF- 伪) and interleukin-6 (IL-6) in elderly patients with severe acute pancreatitis. Methods 120 elderly patients with severe acute pancreatitis were randomly divided into experimental group and control group with 60 cases in each group. In the control group, the first dose of somatostatin was 250 渭 g, then maintained with 250 渭 g 0.9%NaCl. Omeprazole 40 mg 0.9%NaCl was injected intravenously twice a day. The experimental group was given urinastatin 1.0 脳 10 ~ (5) U 5% glucose injection 250 mL by intravenous drip on the basis of the control group. The patients in group 2 were treated continuously for 1 week twice a day. The levels of serum D- lactic acid TNF- 伪 IL-6, amylase, lipase, symptom remission time, clinical efficacy and safety were observed before and after treatment. Results after the treatment, the effective rate of the control group was 75.00% and that of the experimental group was 93.34 cases / 56 cases / 60 cases respectively. The difference was statistically significant (P 0.05). After treatment, the serum levels of D- lactic acid in the control group and the experimental group were respectively 8.16 卤0.93ng / L and 6.24 卤0.77 渭 g / L, respectively, and the TNF- 伪 was 261.13 卤32.34 卤32.34 卤316.32 卤25.54)pg / L ~ (-1), respectively (36.84 卤5.18) and 19.66 卤2.78)mg / L ~ (-1), respectively (74.82 卤10.21 卤5.21 卤52.51 卤7.12)pg / mL-1), respectively (P 0.05). After treatment, the serum amylase levels in the control group and the experimental group were 264.41 卤31.12U, 134.64 卤18.81U / L, 186.42 卤233.43U / L, 1019.53 卤135.42U / L, and 73.23 卤10.111U / L, respectively, with statistical significance (P 0.05). The relief time of abdominal pain in the control group and the experimental group was 4.63 卤0.63 卤0.44 卤3.18 卤0.44 days, respectively, and the relief time of abdominal distension was 5.71 卤0.76, 4.28 卤0.61, the first defecation time was 32.64 卤4.27, 17.82 卤2.43 days, and the recovery time of the bowel sound was 29.56 卤4.06, 14.39 卤2.02, respectively, with statistical significance (P 0.05). Adverse drug reactions in the control group included nausea, rash, and adverse drug reactions. The incidence of adverse drug reactions in the control group was 13.33 / 60, and the adverse drug reactions in the trial group were nausea, rash and pain at the injection site. The incidence of adverse drug reactions was 8.33% in 5 / 60 cases with no significant difference (P 0.05). Conclusion ulinastatin has a good clinical effect on the elderly patients with severe acute pancreatitis. It can protect the intestinal mucosal barrier function, promote the recovery of gastrointestinal function, and reduce the levels of serum D- lactic acid TNF- 伪 and IL-6.
【作者单位】：佛山市高明区人民医院重症医学科;
【基金】：广东省科技厅医学科研基金资助项目(2014A020221068)
【分类号】：R576

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