CAJ | 학술논문

目的观察羟乙基淀粉对重症急性胰腺炎(SAP)患者微循环及组织灌注的改善作用及对血清肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)水平的影响.方法 60例保守治疗的SAP患者,在知情同意情况下,按入院单双号随机单盲方法分成V组和L组各30例,两组均给予常规治疗,V组每天给予羟乙基淀粉15ml/kg静脉滴注,疗程5 d;L组每天给予复方氯化钠注射液20 ml/kg静脉滴注,疗程5 d.监测入院后患者血流动力学参数、组织灌注指标及入院后0、12、24、48、96h的TNF-α、IL-6、IL-8的水平.结果与L组相比,V组可以更快提高患者平均动脉压、中心静脉血氧饱和度、胃黏膜pH值,降低心率、红细胞比容(t =2.785、3.126、4.132、3.168、2.218,均P＜0.05)；治疗48 h后,V组TNF-α、IL-6水平分别为(1.68±0.42)ng/L、(32.5.±3.57)ng/L,均明显低于L组的(2.65±0.56)ng/L、(65.3±4.81)ng/L(t=2.412、2.798,均P＜0.05)；治疗后96h,V组IL-8水平为(24.3±2.48)ng/L,明显低于L组的(66.9±5.67)ng/L,(t=5.326,P＜0.05).结论羟乙基淀粉能快速有效地稳定血流动力学,改善血液流变及组织灌注,抑制炎性因子TNF-α、IL-6、IL-8等释放,对SPA有良好的治疗作用.
목적 관찰간을기정분대중증급성이선염(SAP)환자미순배급조직관주적개선작용급대혈청종류배사인자-α(TNF-α)、백세포개소-6(IL-6)、백세포개소-8(IL-8)수평적영향.방법 60례보수치료적SAP환자,재지정동의정황하,안입원단쌍호수궤단맹방법분성V조화L조각30례,량조균급여상규치료,V조매천급여간을기정분15ml/kg정맥적주,료정5 d;L조매천급여복방록화납주사액20 ml/kg정맥적주,료정5 d.감측입원후환자혈류동역학삼수、조직관주지표급입원후0、12、24、48、96h적TNF-α、IL-6、IL-8적수평.결과 여L조상비,V조가이경쾌제고환자평균동맥압、중심정맥혈양포화도、위점막pH치,강저심솔、홍세포비용(t =2.785、3.126、4.132、3.168、2.218,균P＜0.05)；치료48 h후,V조TNF-α、IL-6수평분별위(1.68±0.42)ng/L、(32.5.±3.57)ng/L,균명현저우L조적(2.65±0.56)ng/L、(65.3±4.81)ng/L(t=2.412、2.798,균P＜0.05)；치료후96h,V조IL-8수평위(24.3±2.48)ng/L,명현저우L조적(66.9±5.67)ng/L,(t=5.326,P＜0.05).결론 간을기정분능쾌속유효지은정혈류동역학,개선혈액류변급조직관주,억제염성인자TNF-α、IL-6、IL-8등석방,대SPA유량호적치료작용.
Objective To observe effects of hydroxyethyl starch(130/0.4,voluven)on tissue perfusion and serum TNF-α,IL-6,IL-8 levels in patients with severe acute pancreatitis(SAP).Methods 60 SAP patients with non-operative treatment were randomly divided into voluven group and Ringer's solution group(n =30 per group).In addition to conventional drugs and treatment,of which voluven group daily 15ml/kg intravenously for 5 d;Ringer's solution group daily 20ml/kg intravenously for 5d.Hemodynamic parameters and tissue perfusion indicators were monitored,TN F-α,IL-6,IL-8 levels were examined after treatment 0,12,24,48,96 hours.Results Compared with Ringer solution group,Voluven group therapy high efficiency,faster raise MAP,ScvO2,Phi value,lower HR,Hct(t =2.785,3.126,4.132,3.168,2.218,all P ＜ 0.05).TNFα,IL-6 after 48h treatment,IL-8 after 96h treatment,both groups were significantly decreased,but the voluven group was significantly lower than Ringer's solution group(P ＜ 0.05).Conclusion Voluven could effectively and quickly maintain hemodynamic stability,improve the hemorheological and tissue perfusion,could be more conducive to improving the pancreatic microcirculation,thus inhibiting inflammatory cytokines TNF-α,IL-6,IL-8 release,and had favorable treatment effect on patients with SAP.