目的 探究烏司他丁聯(lián)合連續(xù)腎臟替代療法治療重癥急性胰腺炎的臨床療效。方法 選取2012年3月—2015年1月牡丹江醫(yī)學(xué)院紅旗醫(yī)院收治的重癥胰腺炎患者80例,隨機(jī)分為對照組和治療組,每組各40例。對照組在基礎(chǔ)治療之上采用連續(xù)腎臟替代療法。治療組在對照組基礎(chǔ)之上給予烏司他丁注射液20萬單位/次,3次/d,加入生理鹽水或5%葡萄糖溶液至50 mL持續(xù)泵入。兩組均連續(xù)治療14 d。觀察兩組患者的臨床療效,同時比較兩組治療前后C反應(yīng)蛋白(CPR)、腫瘤壞死因子(TNF-α)、白細(xì)胞介素6(IL-6)的變化,比較兩組癥狀體征減輕時間、實驗室檢查改善時間和ICU住院時間。結(jié)果 治療后,兩組患者的總有效率分別為65.0%、87.5%,兩組比差異有統(tǒng)計學(xué)意義(P <0.05)。治療后,兩組CPR、TNF-α、IL-6均顯著降低,同組治療前后差異有統(tǒng)計學(xué)意義(P <0.05);且治療組的下降程度優(yōu)于對照組,兩組比較差異有統(tǒng)計學(xué)意義(P <0.05)。治療組患者的臨床癥狀體征減輕時間、實驗室指標(biāo)改善時間以及ICU住院時間均顯著短于對照組,兩組比較差異具有統(tǒng)計學(xué)意義(P <0.05)。結(jié)論 烏司他丁聯(lián)合連續(xù)腎臟替代療法治療重癥急性胰腺炎具有較好的臨床療效,可降低全身炎癥反應(yīng)和TNF-α、IL-6水平,具有一定的臨床推廣應(yīng)用價值。

Objective To explore the clinical effects of ulinastatin combine with continuous renal replacement therapy in treatment of severe acute pancreatitis. Methods Patients (80 cases) with severe acute pancreatitis in Hongqi Hospital of Mudanjiang Medical College from March 2012 to January 2015 were randomly divided into control and treatment groups, and each group had 40 cases. Patients in control group were given continuous renal replacement therapy on the basis of foundation treatment. Patients in treatment group were iv administered with Ulinastatin Injection on the basis of the control group, three times daily, 200 000 U/time adding into saline solution or 5% glucose solution 50 mL, by iv continuous pumping. Two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the changes of CPR, TNF-α, and IL-6 in two groups before and after treatment were compared. At the same time, clinical symptoms and signs relieve time, laboratory indexes improve time and stay time in ICU between two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 65.0% and 87.5%, respectively, and there were differences between two groups (P < 0.05). After treatment, CPR, TNF-α and IL-6 in two groups were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). Clinical symptoms and signs relieve time, laboratory indexes improve time and stay time in ICU in treatment group were shorter than those in the control group, with significant differences between two groups (P < 0.05). Conclusion Ulinastatin combine with continuous renal replacement therapy has good clinical efficacy in treatment of severe acute pancreatitis, and can reduce systemic inflammatory response and the level of TNF-α and IL-6, which has a certain clinical application value.