异甘草酸镁联合生长抑素治疗重症急性胰腺炎疗效观察
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摘要
目的观察异甘草酸镁联合生长抑素治疗重症急性胰腺炎(SAP)的临床疗效。方法选取2015年7月5日至2017年8月12日中国人民解放军第一七四医院急诊医学科内科收治的SPA患者114例,按随机数表法分为异甘草酸镁组、生长抑素组及联合组三组,每组38例。异甘草酸镁组采用异甘草酸镁治疗,生长抑素组采用生长抑素治疗,联合组采用异甘草酸镁联合生长抑素治疗,持续用药1周。治疗后评价治疗效果,抽取所有患者的血液样本,测定高敏C反应蛋白(hs-CRP)、白介素-1β(IL-1β)、白介素-6(IL-6)、氧合指数(OI)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酸酐(Cr)数值,动态监测病情变化,记录腹痛缓解时间、胃肠功能恢复时间及撤呼吸机时间,观察不良反应事件。结果异甘草酸镁组、生长抑素组患者的改善率分别为65.79%、71.06%,明显低于联合组的92.10%,差异有统计学意义(P<0.05);与治疗前比较,三组患者治疗后的血清hs-CRP、IL-1β、IL-6水平均明显降低,OI、ALT、AST、CR水平也均明显降低,差异均有统计学意义(P<0.05);与异甘草酸镁组、生长抑素组比较,联合组治疗后的血清hs-CRP、IL-1β、IL-6水平明显降低,OI、ALT、AST、CR水平也明显降低,差异均有统计学意义(P<0.05);联合组患者在腹痛缓解时间、胃肠功能恢复时间及撤呼吸机时间方面均明显低于异甘草酸镁组和生长抑素组,差异均有统计学意义(P<0.05)。结论异甘草酸镁联合生长抑素治疗SAP能降低患者的炎症因子水平,保护重要脏器功能,安全性高,疗效确切,可以作为一种治疗方案。
Objective To investigate the clinical efficacy of magnesium isoglycyrrhizinate combined with somatostatin in the treatment of severe acute pancreatitis(SAP). Methods A total of 114 patients with SAP were selected in Department of Emergency Medicine, the 174 thHospital of Chinese People Liberation Army from July 5, 2015 to August 12, 2017. They were randomly divided into 3 groups, magnesium isoglycyrrhizinate group, somatostatin group and combined group, with 38 patients in each group, which were treated by magnesium isoglycyrrhizinate, somatostatin, and magnesium isoglycyrrhizinate combined with somatostatin treatment, respectively, continuously for 1 week. The therapeutic effect after treatment was evaluated, and the blood samples of all patients were extracted. The levels of high sensitive C-reactive protein(hs-CRP), interleukin-1β(IL-1β), interleukin-6(IL-6), oxygenation index(OI), alanine aminotransferase(ALT), aspertate aminotransferase(AST) and creatinine(Cr) were tested. Dynamic monitoring of the change of illness, and the abdominal pain relief time, gastrointestinal function recovery time, and ventilator weaning time were recorded. The adverse events were observed. Results The improved rate in the magnesium isoglycyrrhizinate group, somatostatin group were 65.79%, 71.06%, respectively, which were significantly lower than 92.10% in the combined group(P<0.05). Compared with before treatment, the levels of hs-CRP, IL-1β, IL-6, OI, ALT, AST and CR showed a significant decrease after treatment among the 3 groups(P<0.05). Compared with magnesium isoglycyrrhizinate group and somatostatin group, the levels of hs-CRP, IL-1β, IL-6, OI, ALT, AST and CR showed a significant decrease(P<0.05). The abdominal pain relief time, gastrointestinal function recovery time and ventilator weaning time in combined group were significantly lower than those in magnesium isoglycyrrhizinate group and somatostatin group(P<0.05). Conclusion Magnesium isoglycyrrhizinate combined with somatostatin in the treatment of SAP can reduce the level of inflammatory factors, and protect important organ function. It has high safety and definite curative effect, which can be used as a therapeutic scheme.
Objective To investigate the clinical efficacy of magnesium isoglycyrrhizinate combined with somatostatin in the treatment of severe acute pancreatitis(SAP). Methods A total of 114 patients with SAP were selected in Department of Emergency Medicine, the 174 thHospital of Chinese People Liberation Army from July 5, 2015 to August 12, 2017. They were randomly divided into 3 groups, magnesium isoglycyrrhizinate group, somatostatin group and combined group, with 38 patients in each group, which were treated by magnesium isoglycyrrhizinate, somatostatin, and magnesium isoglycyrrhizinate combined with somatostatin treatment, respectively, continuously for 1 week. The therapeutic effect after treatment was evaluated, and the blood samples of all patients were extracted. The levels of high sensitive C-reactive protein(hs-CRP), interleukin-1β(IL-1β), interleukin-6(IL-6), oxygenation index(OI), alanine aminotransferase(ALT), aspertate aminotransferase(AST) and creatinine(Cr) were tested. Dynamic monitoring of the change of illness, and the abdominal pain relief time, gastrointestinal function recovery time, and ventilator weaning time were recorded. The adverse events were observed. Results The improved rate in the magnesium isoglycyrrhizinate group, somatostatin group were 65.79%, 71.06%, respectively, which were significantly lower than 92.10% in the combined group(P<0.05). Compared with before treatment, the levels of hs-CRP, IL-1β, IL-6, OI, ALT, AST and CR showed a significant decrease after treatment among the 3 groups(P<0.05). Compared with magnesium isoglycyrrhizinate group and somatostatin group, the levels of hs-CRP, IL-1β, IL-6, OI, ALT, AST and CR showed a significant decrease(P<0.05). The abdominal pain relief time, gastrointestinal function recovery time and ventilator weaning time in combined group were significantly lower than those in magnesium isoglycyrrhizinate group and somatostatin group(P<0.05). Conclusion Magnesium isoglycyrrhizinate combined with somatostatin in the treatment of SAP can reduce the level of inflammatory factors, and protect important organ function. It has high safety and definite curative effect, which can be used as a therapeutic scheme.
引文
[1]吕昊泽,吕宁宁,刘仲祥.生长抑素联合乌司他丁应用于重症急性胰腺炎患者治疗对其血清炎性因子的影响[J].中国实验诊断学,2016,20(8):1315-1317.
[2]肖锋,陈隆望,郑辛甜.重症急性胰腺炎[J].中华急诊医学杂志,2016,25(10):1348-1350.
[3]孔繁静.乌司他丁对重症急性胰腺炎全身炎症反应的抑制作用及对疗效的影响[J].山西医药杂志,2015,44(1):27-29.
[4]白云磊.甲泼尼龙联合生长抑素治疗重症急性胰腺炎的效果[J].中国医药导报,2016,13(5):161-164.
[5]彭玄杰,黄慧峰,陈文晓,等.异甘草酸镁对重症急性胰腺炎患者的临床疗效研究[J].中国临床药理学杂志,2015,31(14):1387-1389.
[6]王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[S].中华外科杂志,2015,53(1):50-53.
[7]中国医师协会胰腺病学专业委员会.中国急性胰腺炎多学科(MDT)诊治共识意见(草案)[J].中华胰腺病杂志,2015,15(4):217-224.
[8]Greenberg JA,Hsu J,Bawazeer M,et al.Clinical practice guideline:management of acute pancreatitis[J].Can J Surg,2016,59(2):128-140.
[9]徐彦立.联合血液净化治疗对重症急性胰腺炎患者炎症因子和疗效的影响[J].重庆医学,2015,44(18):2553-2556.
[10]王宇,蒋晓青.重症急性胰腺炎的治疗体会[J].现代消化及介入诊疗,2015,20(1):65-67.
[11]赵向宁,刘兴贵.前列地尔联合生长抑素治疗重症急性胰腺炎的临床观察[J].实用药物与临床,2013,16(1):20-21.
[12]王晓锋,张秀锦.异甘草酸镁及泮托拉唑钠联合生长抑素治疗重症急性胰腺炎的效果观察[J].国际医药卫生导报,2017,23(10):1584-1587.
[13]叶美玲,彭燕.胰腺坏死组织感染诊断及其微创治疗[J].海南医学,2017,28(10):1661-1664.
[14]王峰.异甘草酸镁在大鼠胰腺炎肝损害治疗中的作用[J].中国药物与临床,2014,14(2):180-182.
[15]李科军,向正国,陈旭峰,等.早期大剂量乌司他丁联合奥曲肽治疗对重症急性胰腺炎患者炎症因子和T淋巴细胞的影响[J].海南医学院学报,2015,21(7):929-932.
[16]秦林燕,王国兴.乌司他丁联合生长抑素对重症急性胰腺炎大鼠血清炎性细胞因子的影响[J].临床和实验医学杂志,2015,14(15):1225-1228.
[17]张立海,王娇,孙国娟,等.早期肠内营养对重症急性胰腺炎患者炎症细胞因子水平及免疫功能的影响[J].海南医学院学报,2015,21(6):758-761.
[18]王鑫,刘爱香,郑贞苍,等.生长抑素联合加贝酯对老年重症急性胰腺炎患者细胞因子及肠黏膜功能的影响[J].中国中西医结合消化杂志,2015,23(8):553-555.
[19]陈胜全,杨全德,王绪山,等.异甘草酸镁治疗急性胰腺炎的临床研究[J].重庆医学,2015,44(28):3985-3987.
[20]赵建,刘红辉,谭波宇.异甘草酸镁对重症急性胰腺炎肝损伤治疗作用的实验研究[J].医学研究杂志,2014,43(11):147-149.
[2]肖锋,陈隆望,郑辛甜.重症急性胰腺炎[J].中华急诊医学杂志,2016,25(10):1348-1350.
[3]孔繁静.乌司他丁对重症急性胰腺炎全身炎症反应的抑制作用及对疗效的影响[J].山西医药杂志,2015,44(1):27-29.
[4]白云磊.甲泼尼龙联合生长抑素治疗重症急性胰腺炎的效果[J].中国医药导报,2016,13(5):161-164.
[5]彭玄杰,黄慧峰,陈文晓,等.异甘草酸镁对重症急性胰腺炎患者的临床疗效研究[J].中国临床药理学杂志,2015,31(14):1387-1389.
[6]王春友,李非,赵玉沛,等.急性胰腺炎诊治指南(2014)[S].中华外科杂志,2015,53(1):50-53.
[7]中国医师协会胰腺病学专业委员会.中国急性胰腺炎多学科(MDT)诊治共识意见(草案)[J].中华胰腺病杂志,2015,15(4):217-224.
[8]Greenberg JA,Hsu J,Bawazeer M,et al.Clinical practice guideline:management of acute pancreatitis[J].Can J Surg,2016,59(2):128-140.
[9]徐彦立.联合血液净化治疗对重症急性胰腺炎患者炎症因子和疗效的影响[J].重庆医学,2015,44(18):2553-2556.
[10]王宇,蒋晓青.重症急性胰腺炎的治疗体会[J].现代消化及介入诊疗,2015,20(1):65-67.
[11]赵向宁,刘兴贵.前列地尔联合生长抑素治疗重症急性胰腺炎的临床观察[J].实用药物与临床,2013,16(1):20-21.
[12]王晓锋,张秀锦.异甘草酸镁及泮托拉唑钠联合生长抑素治疗重症急性胰腺炎的效果观察[J].国际医药卫生导报,2017,23(10):1584-1587.
[13]叶美玲,彭燕.胰腺坏死组织感染诊断及其微创治疗[J].海南医学,2017,28(10):1661-1664.
[14]王峰.异甘草酸镁在大鼠胰腺炎肝损害治疗中的作用[J].中国药物与临床,2014,14(2):180-182.
[15]李科军,向正国,陈旭峰,等.早期大剂量乌司他丁联合奥曲肽治疗对重症急性胰腺炎患者炎症因子和T淋巴细胞的影响[J].海南医学院学报,2015,21(7):929-932.
[16]秦林燕,王国兴.乌司他丁联合生长抑素对重症急性胰腺炎大鼠血清炎性细胞因子的影响[J].临床和实验医学杂志,2015,14(15):1225-1228.
[17]张立海,王娇,孙国娟,等.早期肠内营养对重症急性胰腺炎患者炎症细胞因子水平及免疫功能的影响[J].海南医学院学报,2015,21(6):758-761.
[18]王鑫,刘爱香,郑贞苍,等.生长抑素联合加贝酯对老年重症急性胰腺炎患者细胞因子及肠黏膜功能的影响[J].中国中西医结合消化杂志,2015,23(8):553-555.
[19]陈胜全,杨全德,王绪山,等.异甘草酸镁治疗急性胰腺炎的临床研究[J].重庆医学,2015,44(28):3985-3987.
[20]赵建,刘红辉,谭波宇.异甘草酸镁对重症急性胰腺炎肝损伤治疗作用的实验研究[J].医学研究杂志,2014,43(11):147-149.