生长抑素及其类似物治疗胸部术后乳糜胸的应用现状  

Application of somatostatin and its analogues in the treatment of postoperative chylothorax

作　　者：商晶媛 刘一[1] 王向宇 梁馨玉 刘彦国[2] 樊榕榕[2] 黄琳[1] 封宇飞 SHANG Jing-yuan;LIU Yi;WANG Xiang-yu;LIANG Xin-yu;LIU Yan-guo;FAN Rong-rong;HUANG Lin;FENG Yu-fei(Department of Pharmacy,Peking University People’s Hospital,Beijing 100044,China;Department of Thoracic Surgery,Peking University People’s Hospital,Beijing 100044,China;Shenyang Pharmaceutical University,Liaoning Shenyang 110016,China;Beijing Key Laboratory of Molecular Pharmaceutics&New Drug Delivery Systems,School of Pharmaceutical Sciences,Peking Univer-sity,Beijing 100191,China)

机构地区：[1]北京大学人民医院药剂科,北京100044 [2]北京大学人民医院胸外科,北京100044 [3]沈阳药科大学生命科学与生物制药学院,辽宁沈阳110016 [4]北京市分子药物与新药输送系统重点实验室,北京大学药学院,北京100191

出　　处：《中国医院药学杂志》2021年第22期2315-2321,共7页Chinese Journal of Hospital Pharmacy

基　　金：北京大学人民医院研究与发展基金(编号:RDY2019-39);白求恩·求索—药学科研能力建设项目(编号:B-19-H20200622)。

摘　　要：目的:探讨生长抑素(somatostatin, SST)及其类似物奥曲肽在胸部术后乳糜胸治疗中的应用价值,为临床合理用药提供依据。方法:系统检索PubMed、Embase、Cochrane Library、CNKI和万方数据库,以"乳糜胸"、"生长抑素"、"奥曲肽"等中文检索词以及对应的英文检索词"chylothorax"、"somatostatin"、"octreotide"等为关键词,检索时限截至2021年4月22日,纳入生长抑素或奥曲肽治疗胸部手术后乳糜胸的相关病例报告及研究。结果:最终纳入32篇文献,包括4篇实验性研究及28篇描述性研究,共计345例胸部术后乳糜胸患者。实验性研究包括2项随机对照试验及2项非随机对照试验,结果均表明在保守治疗的基础上加用生长抑素或奥曲肽有利于减少乳糜流出量,缩短治疗时间,提高治愈率。描述性研究包括9篇病例系列分析及19篇病例报告,结果显示生长抑素或奥曲肽明显减少乳糜流出量的成功率为82.8%~100%。最常用的给药方案为:持续静脉输注生长抑素6 mg·d^(-1),分1~2次给药;皮下注射或静脉注射奥曲肽每次100μg, 2~3次/天。无严重的不良反应报告。结论:在饮食管理等保守治疗基础上加用生长抑素或其类似物奥曲肽可作为术后乳糜胸的一种治疗选择。OBJECTIVE To explore the application value of somatostatin and its analogues octreotide for chylothorax after thoracic surgery and provide references for rational clinical use.METHODS The databases of PubMed, Embase, Cochrane Library, CNKI and WanFang were searched with such key words as “chylothorax”,“somatostatin” and “octreotide”.Search time was up to April 22,2021,including case reports and retrospective studies regarding somatostatin or octreotide treatment of chylothorax after chest surgery.RESULTS Finally 32 literatures were retrieved, including 4 experimental studies and 28 descriptive studies involving a total of 345 patients with chylothorax after thoracic surgery.The experimental study included 2 randomized controlled trials and 2 non-randomized controlled trials.The results showed that adding somatostatin or octreotide to conservative treatment helped to reduce chyle outflow, shorten treatment time and improve cure rate.Descriptive studies included 9 case series analysis and 19 case reports.The results indicated that somatostatin or octreotide significantly reduced chyle outflow with a success rate of 82.8%-100%.The most commonly used dosage regimen of continuous intravenous infusion of somatostatin 6 mg·d^(-1) was divided into once or twice dosing and a subcutaneous injection of octreotide 100 μg, bid/tid.No serious adverse reactions were reported.CONCLUSION On the basis of conservative diet management, using somatostatin or octreotide is indicated for postoperative chylothorax patients.

关 键 词：生长抑素 奥曲肽 乳糜胸 术后 

分 类 号：R977[医药卫生—药品]