前列地尔治疗高脂血症性重症急性胰腺炎的临床价值  

Clinical value of alprostadil in the treatment of severe acute pancreatitis caused by hyperlipemia

作　　者：李刚[1] 张素巧[1] 练睿[1] 孙力超[1] 

机构地区：[1]中日友好医院急诊科,北京100029

出　　处：《中华胰腺病杂志》2017年第5期298-301,共4页Chinese Journal of Pancreatology

基　　金：首都临床特色应用研究与成果推广项目（Z151100004015071）

摘　　要：目的探讨前列地尔治疗高脂血症性重症急性胰腺炎（HSAP）的临床价值。方法采用前瞻性随机对照研究方法，选取2015年5月至2016年11月中日友好医院急诊重症监护病房收治的56例HSAP患者，按照随机数字表法将患者分为常规治疗组和前列地尔治疗组，常规治疗组给予内科常规治疗，前列地尔组在常规治疗基础上给予前列地尔注射液20 μg静脉滴注，每日1次，连用7 d。检测两组患者治疗前及治疗后3、8 d的血清淀粉酶、三酰甘油、血栓素A2（TXA2）、IL－6水平；进行修正CT严重指数（MCTSI）评分、改良Marshall评分；记录患者全身炎症反应综合征（SIRS）持续时间、腹痛缓解时间、发病至开始肠内营养时间、平均住院时间及病死率。结果两组患者性别、年龄、体重的差异均无统计学意义。治疗前两组患者血清淀粉酶、三酰甘油、TXA2、IL－6水平及MCTSI评分、改良Marshall评分的差异均无统计学意义，治疗后两组上述指标均较治疗前显著下降，差异有统计学意义。治疗后8 d，两组间血淀粉酶及三酰甘油水平的差异无统计学意义，但前列地尔组TXA2水平[（85.3±26.8）ng/L比（138.3±34.3）ng/L]、IL－6水平[（6.99±1.85）ng/L比（10.58±2.46）ng/L）]、MCTSI评分[（2.36±1.10）分比（3.21±1.37）分]、改良Marshall评分[（1.99±0.57）分比（2.64±0.73）分]均较常规治疗组显著下降，差异有统计学意义（P值均〈0.05）。前列地尔组的SIRS持续时间[（5.02±1.81）d比（6.79±1.17）d]、腹痛缓解时间[（4.89±1.47）d比（6.14±1.58）d]、发病至开始肠内营养时间[（4.68±0.86）d比（6.39±1.11）d]、平均住院时间[（29.30±8.61）d比（34.31±9.33）d]均较常规治疗组显著缩短，差异有统计学意义（P值均〈0.05），但两组患者的住院病死率差异无统计学意义。结论前列地尔可能是通过改善HASP患者的胰腺微循环状态减轻SObjectiveTo explore the clinical value of alprostadil in the treatment of hyperlipidemic severe acute pancreatitis （HSAP）.MethodsA prospective randomized controlled study method was used. 56 HSAP cases admitted in emergency intensive care unit （ICU）from May 2015 to November 2016 were enrolled and divided randomly into routine group and alprostadil group using random number method. All the patients in routine group received the routine conservative treatments. Alprostadil group was given both routine treatments and the intravenous injection of 20 μg alprostadil once a day for 7 days. Serum amylase, triglyceride, thromboxane A2（TXA2） and IL-6 level were detected before, 3 d and 8 d after the treatment. MCTSI score and modified Marshall score were calculated. The duration of SIRS, abdominal pain relief time, the start time of enteral nutrition, the average hospitalization days and mortality were recorded.ResultsThere was no significant difference between the two groups on gender, age and body mass. There were no significant statistical differences between the two groups on serum amylase, triglyceride, TXA2,IL-6, MCTSI score and modified Marshall score before treatment, which were all obviously decreased after treatment, and the differences were statistically significant. Serum amylase and triglyceride levels were not statistically different between two groups on 8 days after the treatment, but TXA2 [（85.3±26.8）ng/L vs （138.3±34.3）ng/L], IL-6 [（6.99±1.85）ng/L vs （10.58±2.46）ng/L）], MCTSI score[（2.36±1.10） vs （3.21±1.37 ）], and modified Marshall score [（1.99±0.57 ） vs （2.64±0.73）] were all obviously lower than those in routine group, and the differences were statistically significant （P value 〈0.05）. The duration of SIRS [（5.02±1.81）d vs （6.79±1.17）d], abdominal pain relief time [（4.89±1.47）d vs （6.14±1.58）d], the starting time of enteral nutrition [（4.68±0.86）d vs （6.39±1.11）d], and the average hospitalization ay [（29.30±8.6

关 键 词：胰腺炎 急性坏死性 前列地尔 高脂血症 微循环 

分 类 号：R576[医药卫生—消化系统] R589.2[医药卫生—内科学]