摘要
目的探讨乌司他丁联合不同穿刺时机治疗伴有腹腔积液的重症急性胰腺炎(severe acute pancreatitis,SAP)疗效及安全性。方法选择2018年2月—2020年3月河北北方学院附属第一医院收治的72例伴有腹腔积液的SAP患者为研究对象。根据患者腹腔穿刺置管引流(abdominal paracentesis drainage,APD)穿刺时机分为甲组(发病0~2 d,n=30)、乙组(发病3~5 d,n=25)、丙组(发病6~7 d,n=17),三组患者采用乌司他丁联合APD治疗,三组均治疗2周。比较三组患者临床疗效、治疗前后血清白介素-8(interleukin-8,IL-8)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白介素-6(interleukin-6,IL-6)水平及并发症发生情况,比较甲组、乙组、丙组手术时间、住院时间、进阶率[住院4周内按照升阶梯治疗方案,行经皮穿刺置管引流(percutaneous catheter drainage,PCD)的患者占比]、病死率。结果甲组总有效率比乙组、丙组均高(P<0.05),乙组和丙组总有效率对比,差异无统计学意义(P>0.05);治疗前,三组血清IL-6、IL-8、TNF-α水平对比差异无统计学意义(P>0.05);治疗后,三组血清IL-6、IL-8、TNF-α水平均降低(P<0.05),且甲组血清IL-6、IL-8、TNF-α水平低于乙组、丙组(P<0.05),乙组血清IL-6、IL-8、TNF-α水平低于丙组(P<0.05);甲组、乙组、丙组手术时间、病死率对比差异无统计学意义(P>0.05);甲组、乙组、丙组住院时间、进阶率对比差异有统计学意义(P<0.05),甲组住院时间、进阶率低于乙组、丙组(P<0.05),乙组住院时间、进阶率低于丙组(P<0.05);三组并发症发生率比较,差异无统计学意义(校正χ^(2)=0.283,P=0.829)。结论在伴有腹腔积液的SAP患者发病2 d内采用乌司他丁联合APD治疗,疗效确切,可减轻机体炎症反应,可减少患者住院时间及进阶率,且安全可靠。
Objective To investigate the efficacy and safety of ulinastatin combined with abdominal paracentesis drainage(APD)punctured at different timings in the treatment of severe acute pancreatitis(SAP)with ascites.Methods 72 SAP patients with abdominal effusion were treated by intravenous drip of ulinastatin for 2 weeks and were randomLy divided into 3 groups according to the puncture timing of APD:Group A(punctured within 0~2d after onset,n=30),Group B(within 3~5 d,n=25),and Group C(within 6~7 d,n=17).The clinical efficacy,serum interleukin-8(IL-8),tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)levels before and after treatment and the incidence of complications were compared among the three groups.The occurrence of complications,operation time,hospitalization time,advancement rate[proportion of patients who underwent percutaneous catheter drainage(PCD)according to the ascending step treatment plan within 4 weeks of hospitalization],and mortality were compared.Results The total effective rate of Group A was 90.00%,significantly higher than those of Groups B and C(64.00%and 64.71%respectively,both P<0.05),and there was not significant difference in the total effective rate between Group B and Group C(P>0.05).The levels of IL-6,IL-8 and TNF-αlevels of these 3 groups showed no significant differences before treatment(P>0.05),however,14 days after treatment,they all significantly decreased(all P<0.05).The serum levels of IL-6,IL-8 and TNF-αafter treatment of Group A were all significantly lower than those of Groups B and C(all P<0.05),and the serum levels of IL-6,IL-8 and TNF-αof Group B were all significantly lower than those of Group C(all P<0.05).There was a statistically significant difference in the length of stay and progression rate between groups A,B and C(P<0.05).The length of hospital stay of Group A was significantly shorter than those of Groups B and C(both P<0.05);and the progression rate of Group A was significantly lower than those of Groups B and C(both P<0.05).The length of hospital stay of Group B was significantly shorter than that of Group C,and the progression rate of Group B was significantly lower than that of Groups C(both P<0.05).There was no statistically significant difference in the incidence of complications among the three groups(correctedχ^(2)=0.283,P=0.829).Conclusion Safe and reliable,ulinastatin combined with APD treatment beginning within 2 days after the onset of SAP with abdominal effusion has a definite effect,reduces the body’s inflammatory response,shortens the hospital stay,and lower the progression rate.
作者
武雪琴
张婷婷
王会娟
WU Xueqin;ZHANG Tingting;WANG Huijuan(Department of Emergency Medicine,First Affiliated Hospital of Hebei North College,Zhangjiakou Hebei 075000,China)
出处
《中国急救复苏与灾害医学杂志》
2023年第2期224-227,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
河北省卫计委医学科学研究重点课题计划(编号:ZD20140383)。
关键词
乌司他丁
不同穿刺时机
腹腔积液
重症急性胰腺炎
临床疗效
安全性
腹腔穿刺置管引流
Ulinastatin
Timing of puncture
Peritoneal effusion
Severe acute pancreatitis(SAP)
Clinical efficacy
Safety
Peritoneal puncture and drainage
作者简介
通信作者:武雪琴,E-mail:a15230325924@163.com。
