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目的探讨低分子量肝素(low molecular weight heparin,LMWH)预防重症急性胰腺炎(severe acute pancreatitis,SAP)并发胰性脑病的临床价值。方法将265例SAP病例随机分为两组:(1)常规治疗组(C组)130例,(2)LMWH治疗组(常规治疗加LMWH治疗,LT组)135例。分析对比两组APACHEⅡ评分、胰腺CT坏死程度、血淀粉酶、尿淀粉酶、胰性脑病的发生率、死亡率、治愈率、平均住院日。结果(1)治疗2周后LT组APACHEⅡ评分明显低于C组(P<0.05)。(2)治疗1、2周后,LT组胰腺CT坏死程度均较C组明显减轻。(3)治疗1、2周后,LT组血、尿淀粉酶均明显低于C组(分别P<0．05,P<0．05,P<0．001,P％0．001)。(4)LT组胰性脑病的发生率(2．2％)显著低于C组(10．0％),LT组死于胰性脑病者(0．7％)亦显著低于C组(4．6％),分别P％0．01, P<0．05。(5)LT组死亡率(10．0％)显著低于C组(30．6％);LT组治愈率(90．0％)显著高于C组(69．4％)(均P<0．001)。(6)LT组平均住院日(30±8)d明显低于C组(43±11)d,P<0．001。结论LMWH可抑制胰酶的释放,减少脑神经元细胞凋亡和减少炎症因子的产生,从而降低胰性脑病的发生率和死亡率。
Objective To investigate the clinical value of low molecular weight heparin (LMWH) in preventing pancreatic encephalopathy in patients with severe acute pancreatitis (SAP). Methods A total of 265 patients with SAP were randomly divided into two groups: (1) 130 patients in the conventional treatment group (C group) and 135 patients in the LMWH treatment group (conventional treatment plus LMWH treatment, LT group). Analysis and comparison of two groups APACHE Ⅱ score, pancreatic CT necrosis, blood amylase, urinary amylase, pancreatic encephalopathy incidence, mortality, cure rate, average length of stay. Results (1) After 2 weeks of treatment, the APACHE Ⅱ score of LT group was significantly lower than that of C group (P <0.05). (2) After 1 and 2 weeks of treatment, the degree of pancreatic CT necrosis in LT group was significantly lower than that in C group. (3) After 1 and 2 weeks of treatment, blood and urine amylase in LT group were significantly lower than those in C group (P <0.05, P <0.05, P <0.001, P% 0.001, respectively). (4) The incidence of pancreatic encephalopathy in LT group was significantly lower than that in C group (10.0%), the incidence of pancreatic encephalopathy in LT group (0.7%) was also significantly lower than that in C group 4.6%), respectively P% 0.01, P <0.05. (5) Mortality in LT group (10.0%) was significantly lower than that in C group (30.6%). The cure rate in LT group was significantly higher than that in C group (69.4%, P < 0.001). (6) The average length of stay in LT group (30 ± 8) d was significantly lower than that in C group (43 ± 11) d, P <0.001. Conclusion LMWH can inhibit the release of pancreatic enzymes, reduce neuronal apoptosis and reduce the production of inflammatory cytokines, thereby reducing the incidence of pancreatic encephalopathy and mortality.