论文部分内容阅读
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(P<0.05)。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P<0.05)。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P<0.05)。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P<0.05)。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(P>0.05)。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。
Objective To investigate the effects of ulinastatin on serum levels of D-lactate, tumor necrosis factor-α (TNF-α) 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, 60 cases in each group. The control group was given somatostatin for injection, the first dose of 250μg, then 250μg · h ~ (-1) maintenance, omeprazole 40 mg + 0.9% NaCl injection 100 mL, intravenous infusion twice daily. The experimental group was given ulinastatin 1.0 × 10 ~ 5U + 5% glucose injection 250 mL intravenously on the basis of the control group, twice daily. Patients in both groups continued to be treated for 1 week. The levels of D-lactate, TNF-α, IL-6, amylase and lipase and the time of symptom relief, clinical efficacy and safety were observed before and after treatment. Results After treatment, the effective rate of the control group was 75.00% (45 cases / 60 cases) and the experimental group was 93.34% (56 cases / 60 cases), the difference was statistically significant (P <0.05). After treatment, the levels of serum D-lactic acid in the control group and experimental group were (8.16 ± 0.93) and (6.24 ± 0.77) μg · L -1, respectively, and the levels of TNF-α were (261.13 ± 32.34) and (216.32 ± 25.54) pg · mL -1 and CRP were (36.84 ± 5.18) and (19.66 ± 2.78) mg · L -1, IL-6 was (74.82 ± 10.21) and 52.51 ± 7.12) pg · mL ~ (-1), the difference was statistically significant (all P <0.05). After treatment, the levels of amylase in the control group and the experimental group were (264.41 ± 31.12), (134.64 ± 18.81) U · L -1, and those of urine amylase were (1864.42 ± 233.43) and (1019.53 ± 135.42) U · L -1 and lipase were (73.23 ± 10.11) and (34.43 ± 4.65) U · L -1, respectively (all P <0.05). The time to relieve abdominal pain in the control group and the experimental group were (4.63 ± 0.63) days and (3.18 ± 0.44) days respectively, and the time to relieve abdominal distension was (5.71 ± 0.76) and (4.28 ± 0.61) days, respectively. The first defecation times were (32.64 ± 4.27 ), And (17.82 ± 2.43) d respectively. The recovery time of bowel sounds were (29.56 ± 4.06) and (14.39 ± 2.02) days, respectively, with significant differences between the two groups (all P <0.05). The incidence of adverse drug reactions in the control group was nausea, rash and adverse drug reactions occurred in 13.33% (8 cases / 60 cases). The adverse drug reaction occurred in the experimental group was nausea, rash and injection site pain, the incidence of adverse drug reactions was 8.33% (5 cases / 60 cases), the difference was not statistically significant (P> 0.05). Conclusion Ulinastatin has better clinical effect on senile acute severe pancreatitis, protects the function of intestinal mucosal barrier, promotes the recovery of gastrointestinal function, and significantly reduces the levels of serum D-lactate, TNF-α and IL-6. High security.