大剂量山莨菪碱联合乌司他丁治疗重症胰腺炎  

The study of treating acute pancreatitis with large dose of anisodamine combined with ulinastain

作　　者：张更伟[1] 单爱军[1] 柳勋法[1] 龙连宫[1] 王进[1] 

机构地区：[1]深圳市人民医院急诊外科,广东省深圳518020

出　　处：《中华急诊医学杂志》2014年第2期187-190,共4页Chinese Journal of Emergency Medicine

摘　　要：目的 研究大剂量山莨菪碱联合乌司他丁对急性胰腺炎大鼠的治疗效果.方法 健康成年SD大鼠100只,实验前12 h禁食,自由饮水,随机（随机数字法）分为5组：健康对照组、SAP组、SAP＋乌司他丁治疗对照组、SAP＋山莨菪碱治疗组、SAP乌司他丁加大剂量山莨菪碱治疗组各20只.观察各组大鼠的淀粉酶、磷脂酶A2、内毒素检测结果和组织学变化.另外再取SD大鼠60只,随机分为3组：SAP组、SAP＋乌司他丁治疗对照组、SAP＋乌司他丁及大剂量山莨菪碱治疗组,制作方法同前,观察生存情况.结果 SAP的血淀粉酶、PLA2、内毒素水平比三个治疗组明显升高（P＜0.05）,同时组织学破坏最严重；而其他三个治疗组的各项指标明显降低,单独应用山莨菪碱治疗SAP也有一定效果,其中以SAP＋ UTI＋ 654-2组最明显,病理学改变也最轻,生存时间也是最长.结论 山莨菪碱能够有效松弛Oddi括约肌,乌司他丁属蛋白酶抑制剂,对多种酶有抑制作用,联合应用可抑制SAP的炎性介质过度表达,对治疗SAP具有创新意义.Objective To study the effects of large dose anisodamine （654-2） combined with ulinastain on severe acute pancreatitis （SAP）.Methods 100 healthy adult SD rats which were fasted 12 hours before experiment and were allowed drinking water freely,were divided to 5 groups randomly （random number）：normal control group,SAPgroup,SAP ＋ Ulinastain group,SAP ＋ Anisodamine group,SAP ＋Ulinastain ＋ Anisodamine,there were 20 rats in every group.To observe the levels of diastase,phospholipase A2 （PLA2） and endotoxin and pathology of rats in every group.Another cohort of 60 SD rats were divided into 3 groups：SAP group,SAP ＋ Ulinastain group,SAP ＋ Ulinastain ＋ large dose Anisodamine group,survival periods were observed.Results The levels of diastase,PLA2 and endotoxin in SAP rats were higher than those in 3 SAP with treatment groups （P ＜ 0.05）.The histopathological changes were most severe in SAP group.All of 3 markers in 3 SAP with treatment groups decreased obviously,and anisodamine alone was effective to treat SAP,but the effect of UTI ＋ 654-2 was better than UTI or 654-2 alone,and histopathological changes were mild in this group treated with UTI ＋ 654-2.Conclusions Anisodamine could effectively relax the Oddi sphincter thereby decreasing the hydrostatic pressure inside the bile duct and pancreatic duct.Ulinastain is a kind of proteinase inhibitor suppressing many kinds of enzymes and in tern to stabilize lysosomal membrane and inhibit the release of lysosomal enzyme.Combination of the large dose Anisodamine with Ulinastain could inhibit the overexpression of inflammationarv factors in SAP,thereby lessening the severity of viscera injury.

关 键 词：胰腺炎 山莨菪碱 乌司他丁 磷脂酶A2 内毒素 全身炎性反应综合征 淀粉酶 炎性介质 蛋白酶抑制剂 

分 类 号：R576[医药卫生—消化系统]