目的 探讨甲泼尼龙联合生长抑素治疗重症急性胰腺炎的临床疗效。方法 选取2011年3月—2014年3月海南省农垦总医院急诊科收治的重型急性胰腺炎患者120例,随机分为对照组和治疗组,每组各60例。对照组患者在基础治疗上给予注射用生长抑素,6 mg溶于生理盐水100 mL微量汞缓慢注入维持24 h。治疗组在对照组治疗方法的基础上静脉滴注注射用甲泼尼龙琥珀酸钠,500 mg/次,1次/d,3 d后剂量减半。两组均连续治疗14 d。观察两组的临床疗效,同时比较两组腹痛消失时间、腹水消失时间、排气恢复时间、血淀粉酶恢复时间、尿淀粉酶恢复时间。比较两组治疗前后血清钙、血淀粉酶、白细胞介素-6(IL-6)、IL-10、IL-18的变化情况。结果 治疗后,对照组和治疗组的总有效率分别为78.33%、91.67%,两组比较差异有统计学意义(P< 0.05)。治疗后,治疗组的腹痛消失时间、腹水消失时间、排气恢复时间、血淀粉酶恢复时间、尿淀粉酶恢复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)。治疗后,两组患者血清钙从治疗3 d开始升高,血清淀粉酶、IL-6、IL-10、IL-18均从治疗3 d开始下降,同组治疗前后差异有统计学意义(P< 0.05);且治疗组这些观察指标的改善程度显著优于对照组,两组比较差异具有统计学意义(P< 0.05)。两组并发症发生率分别为21.67%、8.33%,两组比较差异具有统计学意义(P< 0.05)。结论 甲泼尼龙联合生长抑素治疗重症急性胰腺炎具有较好的临床疗效,可缩短患者临床症状恢复时间,降低各炎症因子水平和并发症发生率,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of methylprednisolone combined with somatostatin in treatment of severe acute pancreatitis. Methods Patients (120 cases) with severe acute pancreatitis in Department of Emergency of Hainan Provincial Nongken Ceneral Hospital from March 2011 to March 2014 were randomly divided into control and treatment groups, and each group had 60 cases. The patients in the control group were treated with Somatostatin for injection (6 mg adding into 100 mL physiological saline) through 24 h continuous iv pump infusion on the basis of foundation treatment. The patients in the treatment group were iv administered with Methylprednisolone Sodium Succinate for injection, 500 mg/time, once daily, and after 3 d the dosage was by half. The patients in two groups were treated for 14 d. After treatment, the efficacy was evaluated, and the disappearing time of abdominal pain and ascites, and recovery time of exhaust, blood amylase and urine amylase in two groups were compared. The changes of serum calcium, blood amylase, interleukin-6, 10, and 18 (IL-6, IL-10, IL-18) in two groups before and after treatment were compared. Results After treatment, the efficacies in the control and treatment groups were 78.33% and 91.67%, respectively, and there was difference between two groups (P < 0.05). After treatment, the disappearing time of abdominal pain and ascites, and the recovery time of exhaust, blood amylase and urine amylase in treatment group was shorter than that in the control group, and there was difference between two groups (P < 0.05). After treatment, serum calcium began to rise after treatment for 3 d, and blood amylase, IL-6, IL-10, and IL-18 began to decline after treatment for 3 d, 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 difference between two groups (P < 0.05). The complications incidence in the control and treatment groups were 21.67% and 8.33%, with significant difference between two groups (P < 0.05). Conclusion Methylprednisolone combined with somatostatin has good clinical efficacy in treatment of severe acute pancreatitis, and can shorten recovery time of clinical symptoms, and also can reduce the levels of inflammatory factors and complications incidence, which has a certain clinical application value.