目的 探討甲潑尼龍聯(lián)合生長抑素治療重癥急性胰腺炎的臨床療效。方法 選取2011年3月—2014年3月海南省農(nóng)墾總醫(yī)院急診科收治的重型急性胰腺炎患者120例,隨機分為對照組和治療組,每組各60例。對照組患者在基礎(chǔ)治療上給予注射用生長抑素,6 mg溶于生理鹽水100 mL微量汞緩慢注入維持24 h。治療組在對照組治療方法的基礎(chǔ)上靜脈滴注注射用甲潑尼龍琥珀酸鈉,500 mg/次,1次/d,3 d后劑量減半。兩組均連續(xù)治療14 d。觀察兩組的臨床療效,同時比較兩組腹痛消失時間、腹水消失時間、排氣恢復(fù)時間、血淀粉酶恢復(fù)時間、尿淀粉酶恢復(fù)時間。比較兩組治療前后血清鈣、血淀粉酶、白細胞介素-6(IL-6)、IL-10、IL-18的變化情況。結(jié)果 治療后,對照組和治療組的總有效率分別為78.33%、91.67%,兩組比較差異有統(tǒng)計學(xué)意義(P< 0.05)。治療后,治療組的腹痛消失時間、腹水消失時間、排氣恢復(fù)時間、血淀粉酶恢復(fù)時間、尿淀粉酶恢復(fù)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)。治療后,兩組患者血清鈣從治療3 d開始升高,血清淀粉酶、IL-6、IL-10、IL-18均從治療3 d開始下降,同組治療前后差異有統(tǒng)計學(xué)意義(P< 0.05);且治療組這些觀察指標(biāo)的改善程度顯著優(yōu)于對照組,兩組比較差異具有統(tǒng)計學(xué)意義(P< 0.05)。兩組并發(fā)癥發(fā)生率分別為21.67%、8.33%,兩組比較差異具有統(tǒng)計學(xué)意義(P< 0.05)。結(jié)論 甲潑尼龍聯(lián)合生長抑素治療重癥急性胰腺炎具有較好的臨床療效,可縮短患者臨床癥狀恢復(fù)時間,降低各炎癥因子水平和并發(fā)癥發(fā)生率,具有一定的臨床推廣應(yīng)用價值。

Objective To investigate the clinical effect of methylprednisolone combined with somatostatin in treatment of severe acute pancreatitis. Methods Patients (120 cases) with severe acute pancreatitis in Department of Emergency of Hainan Provincial Nongken Ceneral Hospital from March 2011 to March 2014 were randomly divided into control and treatment groups, and each group had 60 cases. The patients in the control group were treated with Somatostatin for injection (6 mg adding into 100 mL physiological saline) through 24 h continuous iv pump infusion on the basis of foundation treatment. The patients in the treatment group were iv administered with Methylprednisolone Sodium Succinate for injection, 500 mg/time, once daily, and after 3 d the dosage was by half. The patients in two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the disappearing time of abdominal pain and ascites, and recovery time of exhaust, blood amylase and urine amylase in two groups were compared. The changes of serum calcium, blood amylase, interleukin-6, 10, and 18 (IL-6, IL-10, IL-18) in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 78.33% and 91.67%, respectively, and there was difference between two groups (P < 0.05). After treatment, the disappearing time of abdominal pain and ascites, and the recovery time of exhaust, blood amylase and urine amylase in treatment group was shorter than that in the control group, and there was difference between two groups (P < 0.05). After treatment, serum calcium began to rise after treatment for 3 d, and blood amylase, IL-6, IL-10, and IL-18 began to decline after treatment for 3 d, 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 difference between two groups (P < 0.05). The complications incidence in the control and treatment groups were 21.67% and 8.33%, with significant difference between two groups (P < 0.05). Conclusion Methylprednisolone combined with somatostatin has good clinical efficacy in treatment of severe acute pancreatitis, and can shorten recovery time of clinical symptoms, and also can reduce the levels of inflammatory factors and complications incidence, which has a certain clinical application value.