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目的探讨乌司他丁联合谷氨酰胺在治疗重症急性胰腺炎(severe acute pancreatitis,SAP)时对急性胰腺炎相关性肺损伤(acute pancreatitis associated lung injury,APALI)的预防和治疗作用。方法我院收治的60例SAP患者随机分为两组,对照组30例行常规+乌司他丁治疗;研究组30例在对照组基础上加用谷氨酰胺治疗。分别于治疗后第0,3,7,10天分析患者动脉血气,以血Pa O_2与吸氧浓度比值(Pa O_2/Fi O_2)、呼吸频率和肺部X线检查等为观察指标,同时抽取静脉血以检测患者血清TNF-α、IL-8及DAO水平的变化,观察研究组和对照组之间肺损伤发生率和对肺损伤疗效的差异。结果研究组APALI的发生率为33.3%,对照组为57.1%,两者差异有统计学意义(P<0.05);治疗7 d后,研究组肺损伤程度较对照组显著减轻,且血清中TNF-α、IL-8及DAO的数值较对照组明显下降(P<0.05)。结论乌司他丁联合谷氨酰胺在治疗SAP时具有协同作用,对急性胰腺炎相关性肺损伤有显著预防和治疗作用。
Objective To investigate the preventive and therapeutic effects of ulinastatin combined with glutamine on acute pancreatitis associated lung injury (APALI) in the treatment of severe acute pancreatitis (SAP). Methods Sixty patients with SAP admitted to our hospital were randomly divided into two groups. The control group was treated with routine and ulinastatin. The study group was treated with glutamine on the basis of the control group. Arterial blood gas was analyzed on days 0, 3, 7, and 10 after treatment respectively. PaO2 / FO2 ratio, respiratory rate and pulmonary X-ray examination were used as the observation indexes. At the same time, Venous blood samples were collected to detect the changes of serum TNF-α, IL-8 and DAO levels. The differences between the two groups in the incidence of lung injury and lung injury were observed. Results The incidence of APALI was 33.3% in the study group and 57.1% in the control group, with significant difference between the two groups (P <0.05). After 7 days of treatment, the degree of lung injury in the study group was significantly lower than that in the control group, and the level of TNF α, IL-8 and DAO decreased significantly compared with the control group (P <0.05). Conclusion Ulinastatin combined with glutamine has a synergistic effect in the treatment of SAP and has a significant preventive and therapeutic effect on acute pancreatitis-associated lung injury.