经皮穿刺置管引流术治疗重症急性胰腺炎合并胰腺坏死感染临床效果  

Clinical effect of percutaneous puncture and drainage on treatment of severe acute pancreatitis patients complicated with pancreatic necrosis infection

作　　者：张昆鹏[1] 李少一[1] 甄品 张晓愉[2] ZHANG Kun-peng;LI Shao-yi;ZHEN Pin;ZHANG Xiao-yu(Xingtai People's Hospital,Xingtai,Hebei 054001,China)

机构地区：[1]邢台市人民医院肝胆外科,河北邢台054001 [2]邢台市人民医院神经内科,河北邢台054001

出　　处：《中华医院感染学杂志》2021年第8期1205-1210,共6页Chinese Journal of Nosocomiology

基　　金：河北省自然科学基金资助项目(2019865)。

摘　　要：目的分析经皮穿刺置管引流术(PCD)对重症急性胰腺炎(SAP)胰腺周围组织坏死感染患者Toll样受体4(TLR4)、髓样分化蛋白-88(MyD88)、p38丝裂原活化蛋白激酶(p38MAPK)信使核糖核酸(mRNA)表达水平及预后的影响。方法 2015年1月-2020年1月邢台市人民医院肝胆外科收治的92例SAP周围组织坏死患者,随机分为PCD组(n=49)和开腹手术组(n=43)。开腹手术组接受开腹手术治疗,PCD组接受PCD治疗,均随访1个月。比较两组术前及术后7 d生化指标、血清炎症因子水平;术前及术后3 d, 7 d临床指标;治疗期间并发症发生情况及随访预后情况。结果术后7 d,两组血淀粉酶、白细胞(WBC)、尿淀粉酶、血糖低于术前,PCD组低于开腹手术组,两组血钙水平高于术前,PCD组高于开腹手术组(P<0.05)。术后7 d两组血清白细胞介素-4(IL-4)、转化生长因子β(TGF-β)高于术前,PCD组高于开腹手术组;两组TLR4、MyD88、p38MAPK mRNA、血清降钙素原(PCT)水平低于术前,PCD组低于开腹手术组(P<0.05)。较术前,术后3、7 d两组腹内压、CT评分以及急性生理与慢性健康评分Ⅱ(APACHEⅡ)评分呈降低趋势,PCD组低于开腹手术组(P<0.05)。PCD组并发症总发生率低于开腹手术组(4.08%vs 25.58%,P<0.05)。随访1个月,PCD组死亡的比率显著低于开腹手术组(2.04%vs 13.95%,P<0.05)。结论相较开腹手术,PCD可抑制SAP胰腺周围组织坏死感染患者炎症反应,改善临床指标及生化指标,降低并发症发生率及病死率,改善患者预后。OBJECTIVE To analyze the effect of percutaneous puncture and drainage(PCD) on Toll-like receptor 4(TLR4), myeloid differentiation factor 88(MyD88) and P38 mitogen-activated protein kinase(p38 MAPK) messenger RNAs(mRNAs) and prognosis in severe acute pancreatitis(SAP) patients with periradicular tissue necrosis caused by infection. METHODS A total of 92 patients with necrosis around SAP treated in our hospital from Jan 2015 to Jan 2020 were randomly divided into the PCD group(n=49) and open surgery group(n=43). The open surgery group received open surgery, and the PCD group received PCD, all of whom were followed up for 1 month. The biochemical indicators, serum inflammatory factor levels before and 7 days after the surgery were compared between the two groups. The clinical indicators before, 3 days after and 7 days after the surgery were compared between the two groups. The occurrence of complications and the prognosis of follow-up during the treatment were compared between the two groups. RESULTS Seven days after the treatment, the blood amylase, white blood cells(WBC), urinary amylase and blood glucose levels between the two groups were significantly lower than those before the treatment;and these indicators in the PCD group was lower than that in the open surgery group(P<0.05). The serum levels of interleukin-4(IL-4) and transforming growth factor beta(TGF-β) between both groups after the treatment were significantly higher than those before the treatment and those in the PCD group were significantly higher than those in open operation group at 7 days after operation. The levels of TLR4, MyD88, p38 MAPK mRNA and serum procalcitonin(PCT) in the two groups were significantly lower than those before operation, and those in the PCD group were significantly lower than those in the open operation group(P<0.05). Compared with before the operation, the intra-abdominal pressure, CT score, and acute physiology and chronic health score Ⅱ(APACHEⅡ) score between the two groups decreased at 3 and 7 days after, and thos

关 键 词：重症急性胰腺炎 周围组织坏死感染 经皮穿刺置管引流术 白细胞介素-4 转化生长因子β 预后 

分 类 号：R657.51[医药卫生—外科学]