奥曲肽联合乌司他丁对重症急性胰腺炎的疗效及对血清炎症因子水平的影响

周学敏

[摘要] 目的 探討奥曲肽联合乌司他丁治疗重症急性胰腺炎（SAP）的效果及对血清炎症因子水平的影响。 方法 在我院2019年2月至2020年6月收诊的重症急性胰腺炎患者中选出188例为对象，以随机数字表法分成两组，对照组94例患者应用常规对症治疗和奥曲肽治疗，观察组94例在对照组基础上给予乌司他丁治疗，比较两组的总有效率、临床症状消失时间和血清炎症因子水平。 结果 观察组总有效率为96.81%，高于对照组的88.30%（P<0.05）。两组的腹痛消失时间、腹胀消失时间、肠鸣音消失时间、首次排气时间、血淀粉酶恢复正常时间比较，观察组均短于对照组（P<0.05）。治疗7 d后观察组的血清炎症因子IL-6、IL-8、TNF-α、hs-CRP、肠道屏障功能指标血浆D-乳酸水平和尿L/M比值水平比较，均低于对照组（P<0.05）。观察组的MODS发生率和ARDS发生率分别为0、2.13%，对照组分别为5.32%、10.64%，差异有统计学意义（P<0.05）。 结论 奥曲肽联合乌司他丁在SAP患者治疗中应用疗效肯定，控制炎症反应，改善肠道屏障功能，预防多器官功能障碍综合征（MODS）和急性呼吸窘迫综合征（ARDS）等严重并发症发生，值得推广。

[关键词] 重症急性胰腺炎;奥曲肽;乌司他丁;炎症因子;肠道屏障功能

[中图分类号] R576          [文献标识码] B          [文章编号] 1673-9701（2021）36-0088-04

Effect of octreotide combined with ulinastatin on severe acute pancreatitis and serum inflammatory factor levels

ZHOU Xuemin

Intensive Care Unit， Chaoyang Central Hospital in Liaoning Province， Chaoyang   122000， China

[Abstract] Objective To explore the effect of octreotide combined with ulinastatin in the treatment of severe acute pancreatitis （SAP） and on serum inflammatory factor levels. Methods A total number of 188 patients with severe acute pancreatitis admitted to our hospital from February 2019 to June 2020 were selected and divided into two groups by random number table， with 94 patients in each group. The control group were treated with conventional symptomatic treatment combined with octreotide. The observation group were treated with ulinastatin on the basis of the control group. The total effective rates， clinical symptom disappear time and serum inflammatory factor levels were compared between the two groups. Results The total effective rate of the observation group was 96.81%， which was higher than 88.30% of the control group （P<0.05）. Comparing the disappearance time of abdominal pain， the disappearance time of abdominal distension， the disappearance time of bowel sounds， the first exhaust time， and the time for blood amylase to return to normal between the two groups， the observation group was shorter than the control group （P<0.05）. After 7 days of treatment， the serum inflammatory factors IL-6， IL-8， TNF-α， hs-CRP， intestinal barrier function index plasma D-lactic acid levels and urine L/M ratio levels of the observation group were lower than those of the control group （P<0.05）. The incidence of MODS and ARDS in the observation group were 0 and 2.13%， respectively， and in the control group were 5.32% and 10.64%， and the difference between the groups was statistically significant （P<0.05）. Conclusion Octreotide combined with Ulinastatin has a positive effect in the treatment of SAP patients， which can control inflammation， improve intestinal barrier function， and prevent serious complications such as MODS and ARDS. It is worthy of promotion.

[Key words] Severe acute pancreatitis; Octreotide; Ulinastatin; Inflammatory factors; Intestinal barrier function

重症急性胰腺炎（Severe acute pancreatitis， SAP）是消化内科的急危重症，是胰腺因胰蛋白酶的自身消化作用而引发的疾病，多是因暴饮暴食、酗酒引起的[1-3]。主要表现为腹痛、腹胀、恶心呕吐、发热等症状，病情发展迅速，若不及时抢救极可能引起多器官组织功能衰竭，直接危及生命安全[4-5]。目前临床研究发现控制胰胆酶的活性，调节机体免疫功能和减轻炎症反应是促进患者康复的关键。……