医学综述
醫學綜述
의학종술
MEDICAL RECAPITULATE
2015年
8期
1517-1519
,共3页
急性胰腺炎%重症疾病%腹腔%抗生素
急性胰腺炎%重癥疾病%腹腔%抗生素
급성이선염%중증질병%복강%항생소
Acute pancreatitis%Severe disease%Abdominal cavity%Antibiotic
目的：探讨腹腔置管引流联合抗生素治疗重症急性胰腺炎（ SAP）的临床疗效评及安全性。方法选择2011年5月至2012年5月解放军第九二医院收治的SAP患者54例，依据随机数字表法分为观察组和对照组，各27例。对照组患者在常规治疗的基础上早期腹腔置管引流，观察组在对照组的基础上给予联合抗生素治疗。测定腹腔灌洗前、灌洗后24、48、72 h的腹水淀粉酶、血清淀粉酶、血清肿瘤坏死因子α（ TNF-α）、白细胞介素8（ IL-8）和C反应蛋白水平。观察两组患者肠道功能恢复时间、全身炎症反应综合征（ SIRS）持续时间和多器官功能障碍综合征（ MODS）的发生率。结果治疗后24、48、72 h，两组患者腹水淀粉酶、急性生理和慢性健康状况评分系统Ⅱ评分、血清淀粉酶，血清TNF-α、IL-8和C反应蛋白均呈下降趋势（P＜0.05），且观察组改善情况优于对照组（P＜0.05）。观察组患者肠道功能恢复时间、SIRS持续时间显著短于对照组，MODS发生率显著低于对照组，差异均有统计学意义（均P＜0.05）。结论胰腺炎相关性腹水在SAP病情进展过程中起重要作用，早期腹腔内置管引流可明显改善患者病情，减轻炎症反应，联合抗生素灌洗可有效清除血清中促炎因子，控制腹腔内感染，降低并发症发生率。
目的：探討腹腔置管引流聯閤抗生素治療重癥急性胰腺炎（ SAP）的臨床療效評及安全性。方法選擇2011年5月至2012年5月解放軍第九二醫院收治的SAP患者54例，依據隨機數字錶法分為觀察組和對照組，各27例。對照組患者在常規治療的基礎上早期腹腔置管引流，觀察組在對照組的基礎上給予聯閤抗生素治療。測定腹腔灌洗前、灌洗後24、48、72 h的腹水澱粉酶、血清澱粉酶、血清腫瘤壞死因子α（ TNF-α）、白細胞介素8（ IL-8）和C反應蛋白水平。觀察兩組患者腸道功能恢複時間、全身炎癥反應綜閤徵（ SIRS）持續時間和多器官功能障礙綜閤徵（ MODS）的髮生率。結果治療後24、48、72 h，兩組患者腹水澱粉酶、急性生理和慢性健康狀況評分繫統Ⅱ評分、血清澱粉酶，血清TNF-α、IL-8和C反應蛋白均呈下降趨勢（P＜0.05），且觀察組改善情況優于對照組（P＜0.05）。觀察組患者腸道功能恢複時間、SIRS持續時間顯著短于對照組，MODS髮生率顯著低于對照組，差異均有統計學意義（均P＜0.05）。結論胰腺炎相關性腹水在SAP病情進展過程中起重要作用，早期腹腔內置管引流可明顯改善患者病情，減輕炎癥反應，聯閤抗生素灌洗可有效清除血清中促炎因子，控製腹腔內感染，降低併髮癥髮生率。
목적：탐토복강치관인류연합항생소치료중증급성이선염（ SAP）적림상료효평급안전성。방법선택2011년5월지2012년5월해방군제구이의원수치적SAP환자54례，의거수궤수자표법분위관찰조화대조조，각27례。대조조환자재상규치료적기출상조기복강치관인류，관찰조재대조조적기출상급여연합항생소치료。측정복강관세전、관세후24、48、72 h적복수정분매、혈청정분매、혈청종류배사인자α（ TNF-α）、백세포개소8（ IL-8）화C반응단백수평。관찰량조환자장도공능회복시간、전신염증반응종합정（ SIRS）지속시간화다기관공능장애종합정（ MODS）적발생솔。결과치료후24、48、72 h，량조환자복수정분매、급성생리화만성건강상황평분계통Ⅱ평분、혈청정분매，혈청TNF-α、IL-8화C반응단백균정하강추세（P＜0.05），차관찰조개선정황우우대조조（P＜0.05）。관찰조환자장도공능회복시간、SIRS지속시간현저단우대조조，MODS발생솔현저저우대조조，차이균유통계학의의（균P＜0.05）。결론이선염상관성복수재SAP병정진전과정중기중요작용，조기복강내치관인류가명현개선환자병정，감경염증반응，연합항생소관세가유효청제혈청중촉염인자，공제복강내감염，강저병발증발생솔。
Objective To observe the clinical effects and safety of peritoneal catheter drainage com-bined with antibiotics in the treatment for severe acute pancreatitis ( SAP) .Methods A total of 54 patients with SAP admitted in No.92 Hospital of Chinese People′s Liberation Army from May 2011 to May 2012 were divided into the observation group and control group by random number table method ,with 27 cases in each group.Patients in the control group were treated with early peritoneal catheter drainage on the basis of con-ventional therapy,while patients in the observation group were given antibiotic therapy on the basis of treat-ment in the control group.Levels of ascetic amylase,serum amylase,serum tumor necrosis factor-α( TNF-α) ,interleukin-8(IL-8) and C reactive protein(CRP) before peritoneal lavage and 24,48,72 h after lavage of all the patients were detected .Recovery time of intestinal function ,duration of systemic inflammatory response syndrome(SIRS) and incidences of multiple organ dysfunction syndrome(MODS) of the two groups were observed.Results 24,48,72 h after treatment,levels of ascites amylase,score,serum amylase,TNF-α,IL-8 and CRP,of two groups were lower than before trentment, and thoses the observation group were improved more significantly,there were statistically significant differences between the two groups(P<0.05).Recover-y time of intestinal function,SIRS duration of the observation group were significantly shorter than the control group,incidence of MODS was significantly lower than the control group ,the differences were statistically sig-nificant(P<0.05).Conclusion Pancreatitis associated ascetic fluid plays an important role in the progres-sion of SAP.Early peritoneal catheter drainage combined with antibiotics in the treatment for severe acute pancreatitis can improve the condition of the patients,lessen the early inflammatory response,accelerate bow-el function recovery,and reduce the incidence and mortality of complications.
