羟乙基淀粉对急性胰腺炎患者组织灌注及血清肿瘤坏死因子、白细胞介素-6、-8水平的影响  

Effect of hydroxyethyl starch on tissue perfusion and serum TNF-α、IL-6、IL-8 levels in patients with severe acute pancreatitis

作　　者：高金亭[1] 齐柯[1] 缪丁丁[1] 程新生[1] 王甫誉[1] 郑永彬[1] 

机构地区：[1]广东医学院附属深圳南山医院肝胆外科,广东省深圳518052

出　　处：《中国基层医药》2011年第23期3198-3200,共3页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的观察羟乙基淀粉对重症急性胰腺炎（SAP）患者微循环及组织灌注的改善作用及对血清肿瘤坏死因子-α（TNF—α）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）水平的影响。方法60例保守治疗的SAP患者，在知情同意情况下，按人院单双号随机单盲方法分成V组和L组各30例，两组均给予常规治疗，V组每天给予羟乙基淀粉15ml／kg静脉滴注，疗程5d；L组每天给予复方氯化钠注射液20ml／kg静脉滴注，疗程5d。监测入院后患者血流动力学参数、组织灌注指标及入院后0、12、24、48、96h的TNF-α、IL-6、IL-8的水平。结果与L组相比，V组可以更快提高患者平均动脉压、中心静脉血氧饱和度、胃黏膜pH值，降低心率、红细胞比容（t=2．785、3．126、4．132、3．168、2．218，均P〈0．05）；治疗48h后，V组TNF-α、IL-6水平分别为（1．68±0．42）ng／L、（32．5．±3．57）ng／L，均明显低于L组的（2．65±0．56）．g／L、（65．3±4．81）ng／L（t=2．412、2．798，均P〈0．05）；治疗后96h，V组IL-8水平为（24．3±2．48）ng／L，明显低于L组的（66．9±5．67）ng／L，（t=5．326，P〈0．05）。结论羟乙基淀粉能快速有效地稳定血流动力学，改善血液流变及组织灌注，抑制炎性因子TNF-α、IL-6、IL-8等释放，对SPA有良好的治疗作用。Objective To observe effects of hydroxyethyl starch（130/0.4,voluven） on tissue perfusion and serum TNF-α,IL-6, IL-8 levels in patients with severe acute pancreatitis （SAP）. Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer＇s solution group（n = 30 per group）. In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d; Ringer＇s solution group daily 20ml/kg intravenously for 5d. Hemodynamic parameters and tissue perfusion indicators were monitored,TNF-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours. Results Compared with Ringer solution group, Voluven group therapy high efficiency,faster raise MAP, ScvO2, Phi value ,lower HR, Het（ t = 2. 785, 3. 126,4. 132,3. 168,2. 218, all P 〈 0. 05 ）. TNF-α, IL-6 after 48h treatment, IL-8 after 96h treatment, both groups were signifieantly decreased ,but the voluven group was significantly lower than Ringer＇s solution group （P 〈 0.05 ）. Conclusion Voluven could effectively and quickly maintain hemodynamie stability,improve the hemorheological and tissue perfusion, could be more conducive to improving the pancreatic mieroeirculation, thus inhibiting inflammatory cytokines TNF-α, IL-6,IL-8 release, and had favorable treatment effect on patients with SAP.

关 键 词：胰腺炎 羟乙基淀粉 肿瘤坏死因子α 白细胞介素6 白细胞介素8 

分 类 号：R57[医药卫生—消化系统]