血液灌流吸附联合直肠吲哚美辛对急性重症胰腺炎的临床疗效观察  

Clinical efficacy of blood perfusion adsorption combined with rectal indomethacin in the treatment of acute severe pancreatitis

作　　者：沈天伦 陈洁 张丽雯 吴迪 黄翔 SHEN Tianlun;CHEN Jie;ZHANG Liwen;WU Di;HUANG Xiang(Intensive Care Medicine,Changshu Traditional Chinese Medicine Hospital(Changshu New District Hospital),Suzhou Jiangsu 215500,China)

机构地区：[1]常熟市中医院(常熟市新区医院)重症医学科,江苏苏州215500

出　　处：《中国急救复苏与灾害医学杂志》2025年第3期366-369,374,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：苏州市吴门医派研究专项科研基金科技项目(SYSD2020198)。

摘　　要：目的观察血液灌流吸附联合直肠吲哚美辛对重症急性胰腺炎(SAP)的临床疗效。方法选择常熟市中医院重症医学科2020年1月—2023年12月收治的SAP患者,按照随机数表法分为两组:对照组给予血液灌流吸附治疗,观察组给予血液灌流吸附联合直肠吲哚美辛治疗。对比两组症状缓解时间、治疗前后酶类指标及肠道屏障功能[脂肪酶(LPS)、淀粉酶(AMS)、D乳酸(DLA)、二胺氧化酶(DAO)]、血清白细胞介素-18(IL-18)、微小RNA-21-3p(miR-21-3p)等临床疗效及安全性指标。结果共104例SAP患者,观察组与对照组各52例,观察组各项症状(主要:腹痛、腹胀、腹膜刺激征)消失时间短于对照组(P<0.05)。治疗前两组LPS、AMS、DLA、DAO对比无差异(P>0.05),治疗后两组LPS、AMS、DLA、DAO均低于治疗前,且观察组治疗后LPS、AMS、DLA、DAO水平均低于对照组,LPS、AMS、DLA、DAO水平下降幅度大于对照组(P<0.05)。治疗前两组miR-21-3p、IL-18对比无差异(P>0.05),治疗后两组miR-21-3p、IL-18均低于治疗前,且观察组治疗后miR-21-3p、IL-18水平均低于对照组,miR-21-3p、IL-18水平下降幅度大于对照组(P<0.05)。观察组临床有效率96.15%高于对照组80.77%(P<0.05),而两组安全性(9.62%vs.3.85%)对比无差异(P>0.05)。结论血液灌流吸附联合直肠吲哚美辛应用于SAP中效果显著,可有效降低酶类指标,提高肠道屏障功能,改善miR-21-3p、IL-18水平,缩短康复时间,且未明显增加不良反应发生率。Objective To observe the clinical efficacy of blood perfusion adsorption combined with rectal indomethacin in the treatment of severe acute pancreatitis(SAP).Methods SAP patients admitted to the Intensive Care Medicine Department of Changshu Traditional Chinese Medicine Hospital from January 2020 to December 2023 were randomly divided into two groups according to a random number table:the control group received blood perfusion adsorption treatment,and the observation group received blood perfusion adsorption combined with rectal indomethacin treatment.Compare the clinical efficacy and safety indicators of two groups in terms of symptom relief time,enzyme indicators before and after treatment,and intestinal barrier function[lipase(LPS),amylase(AMS),D-lactic acid(DLA),diamine oxidase(DAO)],serum interleukin-18(IL-18),microRNA-21-3p(miR-21-3p),etc.Results A total of 104 SAP patients were included,with 52 in the observation group and 52 in the control group.The disappearance time of various symptoms(mainly abdominal pain,bloating,and peritoneal irritation)in the observation group was shorter than that in the control group(P<0.05).There was no significant difference in LPS,AMS,DLA,and DAO between the two groups before treatment(P>0.05).After treatment,LPS,AMS,DLA,and DAO in both groups were lower than before treatment,and the levels of LPS,AMS,DLA,and DAO in the observation group were lower than those in the control group after treatment.The decrease in LPS,AMS,DLA,and DAO levels was greater than that in the control group(P<0.05).There was no significant difference in miR-21-3p and IL-18 levels between the two groups before treatment(P>0.05).After treatment,miR-21-3p and IL-18 levels in both groups were lower than before treatment,and the observation group had lower levels of miR-21-3p and IL-18 than the control group after treatment.The decrease in miR-21-3p and IL-18 levels was greater than that in the control group(P<0.05).The clinical effective rate of the observation group was 96.15%,which was higher than the con

关 键 词：重症急性胰腺炎 吲哚美辛 血液灌流 miR-21-3p IL-18 

分 类 号：R657.51[医药卫生—外科学]