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胰酶自身消化是急性出血性坏死性胰腺炎(AHNP)发病机制中的关键因素。因此.抑制胰腺外分泌是治疗 AHNP 一种重要方法。近年来陆续报道了生长抑素(SMS)、5氟脲嘧啶(5-FU)和雷尼替叮(Ranitidine)对急性胰腺炎的治疗效果。但结论不一,三者的比较性研究也未见报道。本实验用5%牛磺胆酸钠溶液加压注入犬的主胰管制成犬的 AHNP 模型。将24只犬随机分成四组。Ⅰ组为对照组,余为治疗组,分别于术后半小时给予 SMS、5-FU 和 Ranitidine 治疗。于术前0.5h 和术后1h、4h、7h、12h 和24h 采静脉血,并于术后4h、7h、12h 和24h 采腹水和胰液测定淀粉酶和脂肪酶的浓度。记录动物死亡时间,并测量胰腺坏死范围和观察病理变化。结果表明:动物造成 AHNP 后血清、腹水和胰液中淀粉酶和脂肪酶明显增高。应用 SMS、5-FU和 Ranitidine 不同程度的降低了体液中酶的浓度。SMS 和5-FU 不仅降低了体液中酶的浓度,还缩小了胰腺的坏死范围,病理变化减轻,胰液分泌量也明显减少,使犬存活时间延长。实验结果表明:生长抑素降低体液中酶浓度效果较早,血清淀粉酶于术后1h 就与另三组有显著差异。但于术后7h 开始又有增高的趋势,这可能是 SMS 停药后的反跳现象,而酶的浓度仍明显低于对照组。因此,我们认为 SMS 对犬 AHNP 治疗效果较好,而5-FU 次之。它们可以做为AHNP 综合治疗的辅助方法。
Trypsin digestion is a key factor in the pathogenesis of acute hemorrhagic necrotizing pancreatitis (AHNP). Therefore, the inhibition of pancreatic exocrine is an important method of treatment of AHNP. In recent years, one after another reported the effects of somatostatin (SMS), 5-fluorouracil (5-FU) and ranitidine on acute pancreatitis. But the conclusions are different, the comparative study of the three has not been reported. In this experiment, 5% sodium taurocholate solution was injected into the dog’s canine AHNP model. 24 dogs were randomly divided into four groups. Group Ⅰ was the control group, while the remaining patients were treated with SMS, 5-FU and Ranitidine at half an hour after operation. Venous blood was collected at 0.5h and 1h, 4h, 7h, 12h and 24h after operation, and amylase and lipase concentrations were measured at 4h, 7h, 12h and 24h after operation. Animal death time was recorded, and the extent of pancreatic necrosis was measured and pathological changes were observed. The results showed that the amylase and lipase in serum, ascites and pancreatic juice of AHNP animals were significantly increased. The application of SMS, 5-FU and Ranitidine reduced the body fluid enzyme concentration to varying degrees. SMS and 5-FU not only reduce the body fluid enzyme concentration, but also reduce the extent of necrosis of the pancreas, reduce pathological changes, pancreatic secretion was significantly reduced, so that the survival of dogs extended. The experimental results show that: somatostatin reduce the body fluid enzyme concentration earlier, serum amylase 1h after surgery and the other three groups were significantly different. However, there was an increasing tendency at 7h after operation, which may be the rebound phenomenon after SMS withdrawal, but the enzyme concentration was still significantly lower than that of the control group. Therefore, we think that SMS can treat AHNP better than 5-FU. They can be used as an adjunct to AHNP.