摘要
目的观察区域灌注加贝酯联合血必净治疗重症急性胰腺炎的疗效。方法44例重症急性胰腺炎患者按随机数字表法随机分为加贝酯与血必净全身静脉用药组（对照组，23例）和加贝酯与血必净区域灌注用药组（实验组，21例）。在第1、7、14天检测二胺氧化酶、IL-18、TNF-α、A—PACHE-Ⅱ评分、T淋巴细胞亚群百分比及单核细胞HLA—DR表达和单核细胞数目的变化，P〈0．05认为差异有统计学意义。结果2组患者在第1、7、14天二胺氧化酶、IL-18、TNF-α、A-PACHE-Ⅱ评分均呈递减趋势；T抑制细胞（Ts）百分比下降；总T淋巴细胞、T辅助细胞（Th）、单核细胞HLA-DR表达（百分比）和单核细胞数呈上升趋势，实验组与对照组相比差异均有统计学意义（P〈0．05）。实验组与对照组相比，腹痛缓解时间、肠道功能恢复时间、撤离呼吸机时间、败血症发病率、中转开腹率差异均具有统计学意义（P〈0．05）。结论SAP患者实施加贝酯联合血必净区域灌注法较全身静脉用药法更能降低SAP患者病程早期肠道通透性，减少内毒素的易位，对SAP患者肠屏障功能有保护作用，同时还可以提高患者的免疫功能、改善其症状和体征，降低败血症的发病率及中转手术率。
Objective To observe the treatment effect of severe acute pancreatitis （SAP） with gabexate combined with Xuebijing after local infusion. Methods Forty-four patients with SAP were randomly divided into receiving intravenous gabexate or Xuebijing alone （control group） group and receiving local infusion with gabexate combined with Xuebijing （ experimental group） group. At 1,7,14 days of testing in diamine oxidase （DAO）, lipopolysaccharide, IL-18, TNF-α、A-PACHE-Ⅱ score, T lymphocyte subpopulation and monocyte HLA-DR expression and single change in the number of nuclear cells were tested. Results Between two patients groups at 1,7,14 days diamine oxidase, lipopolysaccharide, IL- 18, TNF- α、A-PACHE-Ⅱ score showed a downward trend; T suppressor cells （Ts） reduced in their percentage; total T lymphoeytes, T helper cell （Th）, monocyte HLA-DR expression （percentage） and mononuclear cells showed an upward trend in the experimental group than control group, the differences being statistically significant （ P 〈 0.05 ）. In the experimental group and control group, the pain relief time, intestinal function recovery time, the withdrawal of ventilator time, the incidence of sepsis, the rate of conversion to open surgery were statistically significant different （P 〈 0.05 ）. Conclusions Compared with intravenous drug use alone the implementation of gabexate combined with Xuebijing local infusion can reduce the early course of SAP patients intestinal permeability and reduce endotoxin translocation, protect intestinal barrier function of patients with SAP, improve the patients＇ immune function, symptoms, signs and reduce the rate of sepsis and transit operations.
出处
《国际外科学杂志》
2011年第9期614-617,共4页
International Journal of Surgery
