生长抑素对急性结石性胆囊炎手术患者能量消耗及炎症因子水平的影响  

Effects of adjuvant somatostatin on energy consumption and inflammatory cytokines in patients with acute calculous cholecystitis undergoing emergency operation

作　　者：蔡婷婷 周益峰 徐新 Cai Tingting;Zhou Yifeng;Xu Xin(Department of Emergency,the First People＇s Hospital of Tonglu Branch of Shanghai Ruijin Hospital,Shanghai 311500,China)

机构地区：[1]上海瑞金医院桐庐分院第一人民医院急诊科,311500

出　　处：《中国中西医结合急救杂志》2018年第4期375-378,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省桐庐县科技发展计划项目（桐科[2015]25）

摘　　要：目的探讨生长抑素辅助应用对急性结石性胆囊炎手术患者静态能量消耗（REE）及炎症细胞因子水平的影响。方法选择2015年1月至2017年6月上海瑞金医院桐庐分院第一人民医院收治的80例急性结石性胆囊炎患者，按治疗方法的不同分为两组，每组40例。两组患者均进行腹腔镜胆囊切除术；对照组给予头孢他啶静脉滴注（静滴）进行抗感染（1g加入100mL生理盐水，每日2次），解痉药物采用山莨菪碱静滴（20mg加100mL生理盐水）；试验组在对照组用药基础上给予生长抑素，首次肌肉注射250ug后给予3mg加500mL5％葡萄糖注射液静滴，每日1次；两组均在围术期连续用药，手术后连续用药3d。比较两组患者REE、炎症细胞因子水平、血常规、肝功能水平及中转开腹率的差异。结果治疗5d后，两组REE、超敏C-反应蛋白（hs—CRP）、肿瘤坏死因子-α（TNF-α）、白细胞介素-6（IL-6）、总胆红素（TBil）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、碱性磷酸酶（AKP）和血常规指标白细胞计数（WBC）、中性粒细胞比例（N）均较治疗前降低，补体c3和前白蛋白（PA）均较治疗前升高，且以试验组上述指标的变化较对照组更显著LREE（J）：4709．76±558．27比5153．30±562．16，hs—CRP（mg，L）：6．03±1．22比13．88±5．10，TNF—d（μg／L）：0．77±0．15比1．62±0．17，IL-6（ng／L）：18．47±7．39比51．36±7．61，TBil（μmol／L）：24．34±3．76比37．28±5．92，AST：（U／L）：32．81±5．32比74．19±9．97，ALT（U／L）：27．30±8．28比59．53±7．46，AKP（U／L）：76．83±13．50比124．97±17．43，WBC（×10’／L）：7．76±1．00比11．19±2．18，N：0．48±0．08比0．61±0．10，C3（g，L）：1．37±0．18比0．90±0．11，PA（m^L）：59．17±13．65比58．82±11．99，均P〈0．01]。试验组中转开腹率明显低于对照组[2．50％�Objective To investigate the effect of adjuvant somatostatin on resting energy expenditure （REE） and inflammatory cytokine levels in patients with acute calculous cholecystitis undergoing emergency surgery. Methods Eighty patients with acute calculous cholecysfitis admitted to the First People＇s Hospital of Tonglu Branch of Shanghai Ruijin Hospital from January 2015 to June 2017 were selected, and all patients were randomly divided into an experimental group （40 cases） and a control group （40 cases）. Laparoscopic cholecystectomy was performed for the patients in two groups, in the control group, intravenous drip of ceftazidime 1 g in 100 mL physiological saline, 2 times a day for anti-infection and anisodamine 20 mg plus 100 mL physiological saline intravenous drip for spasmolysis were applied; in the experimental group, on the basis of the control group treatment, somatostatin intramuscular injection of 250 p.g was firstly given, and afterwards 3 mg plus 500 mL 5% glucose intravenous drip, once a day, during the peri-operative period and 3 days after operation the above treatment was continued in two groups. The differences in REE, the levels of inflammatory cytokines, blood routine, liver function and the rate of conversion to laparotomy were compared between the two groups. Results After treatment for 5 days, the levels of REE, high sensitivity C-reactive protein （hs-CRP）, tumor necrosis factor-ct （TNF-ct）, interleukin-6 （IL-6）, total bilirubin （TBil）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT）, alkaline phosphatase （AKP）, blood routine indexes white blood cell count （WBC）, proportion of neutrophils （N） were lower than those before treatment, while the levels of complement C3 and prealbumin （PA） were higher than those before treatment, and the changes of the above indexes in the experimental group were more significant than those in the eontrd group [REE （J）： 4709.76 ± 558.27 vs. 5153.30± 562.16, hs-CRP （mg/L）： 6.03 ± 1.

关 键 词：生长抑素 结石性胆囊炎 炎症细胞因子 能量消耗 

分 类 号：R657.41[医药卫生—外科学]