摘要
目的探析早期微创置管持续腹腔灌洗引流治疗重症急性胰腺炎(SAP)的疗效。方法选取衢州市人民医院2016年1月至2020年6月收治的170例SAP患者,用随机数字表法将患者分为观察组(85例)与对照组(85例)。对照组接受综合内科治疗,观察组在对照组治疗基础上加以早期微创置管持续腹腔灌洗引流干预。治疗1周后评价疗效、并发症,且对治疗前、治疗1周后腹腔压力(IAP)、急性生理与慢性健康II(APACHEII)评分、肝肺功能指标[氧合指数、动脉血氧分压(PaO2)、谷草转氨酶(AST)、谷丙转氨酶(ALT)]、炎症指标[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、巨噬细胞炎性蛋白-1α(MIP-1α)]进行测定。结果观察组治疗总有效率91.77%,显著高于对照组的77.65%(P<0.05);与治疗前对比,两组治疗1周后IAP、APACHEII评分、AST、ALT、CRP、TNF-α、MIP-1α水平均明显下降,氧合指数、PaO2均明显上升,且观察组治疗1周后IAP、APACHEII评分、AST、ALT、CRP、TNF-α、MIP-1α水平均低于对照组,氧合指数、PaO2均高于对照组,差异均有统计学意义(P<0.05);观察组多器官功能障碍综合征(MODS)、脓毒血症、全身炎症反应综合征(SIRS)发生率分别为8.24%、11.76%、15.29%,均显著低于对照组的21.18%、29.41%、30.59%(P<0.05)。结论早期微创置管持续腹腔灌洗引流治疗SAP安全有效,能明显抑制促炎因子,对肝肺功能起保护作用。
Objective To investigate the efficacy of early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of severe acute pancreatitis(SAP).Methods 170 SAP patients admitted to Quzhou People’s Hospital from Jan.2016 to Jun.2020 were divided into the observation group and the control group,with 85 cases in each group,according to the random number table method.The control group received comprehensive medical treatment,while the observation group received early minimally invasive catheterization continuous abdominal lavage and drainage intervention based on the control group.The efficacy and complications after 1 week of treatment were evaluated.Besides,the intra-abdominal pressure(IAP)and acute physiology and chronic health II(APACHEII)were scored,liver and lung function indexes[oxygenation indexes,oxygen partial pressure(PaO2),aspartate aminotransferase(AST),alanine aminotransferase(ALT)],and inflammation indexes[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),macrophage inflammatory protein-1α(MIP-1α)]were measured before and 1 week after the treatment.Results The total effective rate of the treatment in the observation group was 91.77%,which was significantly higher than 77.65%in the control group(P<0.05).The level of IAP,APACHEII score,AST,ALT,CRP,TNF-α,MIP-1αof the two groups after 1 week of treatment decreased significantly compared with those before treatment,while the oxygenation index and PaO2 increased significantly.The levels of IAP,APACHEII score,AST,ALT,CRP,TNF-α,and MIP-1αin the observation group were lower than those in the control group after 1 week of treatment,while the oxygenation index and PaO2 in the observation group were higher than those in the control group,with statistically significant difference(P<0.05).The incidence rates of multiple organ dysfunction syndrome(MODS),sepsis and systemic inflammatory response syndrome(SIRS)in the observation group were:8.24%,11.76%and 15.29%,significantly lower than 21.18%,29.41%and 30.59%in the control group(P<0.05).Conclusion Early minimally invasive catheterization continuous abdominal lavage and drainage in treatment of SAP is safe and effective,which can significantly inhibit pro-inflammatory factors,and protect liver and lung function.
作者
姜明
金晶
郑杰
沈红波
王金
周一农
Jiang Ming;Jin Jing;Zheng Jie;Shen Hongbo;Wang Jin;Zhou Yinong(Department of Hepatobiliary Surgery,Quzhou People’s Hospital,Quzhou 324000,China)
出处
《中华内分泌外科杂志》
CAS
2021年第2期193-196,共4页
Chinese Journal of Endocrine Surgery
基金
2020年浙江省医药卫生科技计划项目(创新人才支持项目)(2020RC076)。
关键词
微创腹腔灌洗引流
急性胰腺炎
炎症
肝肺功能
Minimally invasive abdominal lavage and drainage
Acute pancreatitis
Inflammation
Liver and lung function
