目的 探究乌司他丁联合连续肾脏替代疗法治疗重症急性胰腺炎的临床疗效。方法 选取2012年3月—2015年1月牡丹江医学院红旗医院收治的重症胰腺炎患者80例,随机分为对照组和治疗组,每组各40例。对照组在基础治疗之上采用连续肾脏替代疗法。治疗组在对照组基础之上给予乌司他丁注射液20万单位/次,3次/d,加入生理盐水或5%葡萄糖溶液至50 mL持续泵入。两组均连续治疗14 d。观察两组患者的临床疗效,同时比较两组治疗前后C反应蛋白(CPR)、肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)的变化,比较两组症状体征减轻时间、实验室检查改善时间和ICU住院时间。结果 治疗后,两组患者的总有效率分别为65.0%、87.5%,两组比差异有统计学意义(P <0.05)。治疗后,两组CPR、TNF-α、IL-6均显著降低,同组治疗前后差异有统计学意义(P <0.05);且治疗组的下降程度优于对照组,两组比较差异有统计学意义(P <0.05)。治疗组患者的临床症状体征减轻时间、实验室指标改善时间以及ICU住院时间均显著短于对照组,两组比较差异具有统计学意义(P <0.05)。结论 乌司他丁联合连续肾脏替代疗法治疗重症急性胰腺炎具有较好的临床疗效,可降低全身炎症反应和TNF-α、IL-6水平,具有一定的临床推广应用价值。

Objective To explore the clinical effects of ulinastatin combine with continuous renal replacement therapy in treatment of severe acute pancreatitis. Methods Patients (80 cases) with severe acute pancreatitis in Hongqi Hospital of Mudanjiang Medical College from March 2012 to January 2015 were randomly divided into control and treatment groups, and each group had 40 cases. Patients in control group were given continuous renal replacement therapy on the basis of foundation treatment. Patients in treatment group were iv administered with Ulinastatin Injection on the basis of the control group, three times daily, 200 000 U/time adding into saline solution or 5% glucose solution 50 mL, by iv continuous pumping. Two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the changes of CPR, TNF-α, and IL-6 in two groups before and after treatment were compared. At the same time, clinical symptoms and signs relieve time, laboratory indexes improve time and stay time in ICU between two groups were compared. Results After treatment, the efficacies in the control and treatment groups were 65.0% and 87.5%, respectively, and there were differences between two groups (P < 0.05). After treatment, CPR, TNF-α and IL-6 in two groups were significantly reduced, and the difference was statistically significant in the same group (P < 0.05). And these indicators in treatment group improved better than those in the control group, with significant differences between two groups (P < 0.05). Clinical symptoms and signs relieve time, laboratory indexes improve time and stay time in ICU in treatment group were shorter than those in the control group, with significant differences between two groups (P < 0.05). Conclusion Ulinastatin combine with continuous renal replacement therapy has good clinical efficacy in treatment of severe acute pancreatitis, and can reduce systemic inflammatory response and the level of TNF-α and IL-6, which has a certain clinical application value.