善得定治疗急性胰腺炎临床对照分析

目的 探讨善得定治疗急性胰腺炎的临床疗效。方法 将34例急性胰腺炎患者随机分为2组,17例用善得定每小时25μg,另17例不用善得定,对照临床症状改善情况及Ranson预后指标。结果 善得定治疗组中腹痛完全消失者较多,镇痛药应用较少,且48h后不良预后指标较少,包括血球压积降低10％以上和血钙＜8mg/dL的患者显著少于对照组。结论 用善得定治疗急性胰腺炎可减轻症状,减少并发症,并防止病情恶化。     

善得定治疗急性胰腺炎临床对照分析

目的探讨善得定治疗急性胰腺炎的临床疗效。方法将３４例急性胰腺炎患者随机分为２组,１７例用善得定每ｈｒ２５ｕｇ,另１７例不用善得定,对照临床症状改善情况及Ｒａｎｓｏｎ预后指标。结果善得定治疗组中腹痛完全消失者较多,镇痛药应用较少,且４８ｈｒ后不良预后指标较少,包括血球压积降低１０％以上和血钙＜８ｍｇ／ｄｌ的患者显著少于对照组。结论用善得定治疗急性胰腺炎可减轻症状,减少并发症,并防止病情恶化。     

胰腺炎136例治疗

目的探讨急性胰腺炎的治疗方法.方法急性胰腺炎136例,其中手术16例,其他为保守治疗,年龄15岁～76岁,分类水肿型胰腺炎96例,出血坏死性胰腺炎50例,按发病原因分为酒后、高脂肪饮食后、胆道病史、胃手术后等.出血坏死型胰腺炎、胆囊炎胆石症、胆道蛔虫合并化脓性胆管所致的重症胰腺炎,手术行胆总管切开,置"T”管引流,胰腺被膜、十二指肠间沟、左侧侧腹膜切开冲洗引流大部分保守治疗病例,行胃肠减压、补液、抗炎、支持、免疫、激素疗法,尤其是胰酶抑制剂善得定的应用.同时口服中药"清胰汤”以去滞解毒、通里攻下来治疗,中西结合.结果16例手术病例中,6例合并胰腺囊肿,3例死亡;除手术外,经保守治疗的病例均痊愈,发病与饮酒、饱餐、冷食有关,有过胆道疾病及胃手术史的人易患胰腺炎.结论易感人群注意病因,急性胰腺炎首选保守治疗.     

生长抑素联合生长激素治疗急性重症胰腺炎临床研究

目的:探讨生长激素和生长抑素治疗急性坏死性胰腺炎的疗效.方法:对60例重症急性胰腺炎(SAP),随机分为善宁治疗组(n=30),生长激素和善宁联合治疗组(n=30).观察并对比两组治疗后住院天数、严重并发症的发生率、中转手术率、病死率和住院费用;APACHE Ⅱ评分;血清IL-1,IL-6和TNF-α水平;测定入院时和入院后2周的血浆清蛋白水平.结果:联合治疗组的住院天数、并发症发生率、中转手术率、病死率、均明显低于善宁组(P＜0.05);联合组抑制SAP的炎性细胞因子高表达及促进清蛋白合成的作用亦优于善宁组(均P＜0.05).结论:联合应用生长抑素和生长激素是早期治疗急性坏死性胰腺炎的一种有效治疗方法.     

急性出血坏死性胰腺炎64例

目的观察近8a间治疗急性出血坏死性胰腺炎（AHNP）64例（其中非手术综合治疗9例，先行非手术治疗后再手术24例，早期手术治疗31例）的治疗效果．方法非手术综合治疗为尽早行快速扩容，应用血管活性药物，抑制胰腺分泌（善得定效果较好），有效的抗生素，营养支持和防治并发症的发生．根据有无感染确定手术时机．手术方式根据病情和术中所见，分别采用胰床灌洗引流，坏死组织清除，规则性胰腺切除和肢肿切开引流．结果非手术综合治疗9例，死亡率11．1％，先行非手术综合治疗后再手术24例，死亡率为12．5％，早期手术治疗31例，死亡率为25．8％．结论对AHNP先行非手术治疗可明显降低死亡率，晚期手术较早期手术可提高其治愈率．积极防治并发症是提高治疗效果的重要一环．     

善得定治疗术后胰瘘30例临床分析

本文报告了善得定对30例胰瘘的治疗效果，其中急性坏死性胰腺炎行胰及胰周坏死组织清除术后胰瘘21例，胰及十二指肠切除术后胰瘘6例；无功能胰岛细胞瘤行胰尾切除术后胰瘘1例，腹外伤后胰瘘2例。善得定的剂量100－150μg,每8h一次，皮下注射，结果表明，应用善得定治疗后，胰瘘引流量迅速减少，26例病人（86．7％）胰瘘引流量减少至20％，14例病人（13．3％）减少至50％，胰瘘闭合度为76．7％。闭合时间为用药后5－19天。对9例引流液淀粉酶测定表明，治疗后引流淀粉酶浓度较治疗前明显下降（P＜0．05）。     

善得定治疗急性胰腺炎67例

目的总结了我院1994/1997间善得定治疗急性水肿型胰腺炎67例.方法急性水肿型胰腺炎对照组按传统方法予以禁食水、胃肠减压、抗生素和抑制胃酸分泌,减少胰液分泌治疗.治疗组在传统治疗基础上同时用瑞士山德士药厂生产的善得定0.1mg每8h一次静脉维持3d,尔后善得定0.1mg每8h一次皮下注射3d.以腹痛缓解天数,淀粉酶恢复正常的天数,B超或CT示胰腺水肿改善天数及住院天数作为观察项目.结果治疗组及对照组治愈率均为100%,均无死亡.对照组1例并发胰腺假性囊肿,两组详细指标见表1.     

善得定与垂体后叶素治疗食管静脉曲张破裂大出血的比较研究

应用善得定和垂体后叶素治疗肝硬化合并静脉曲张破裂大出血58例。治疗结果显示善得定止血显效率（22/32,68.8％）及总有效率（26/32,81.3％）明显高于垂体后叶素,两组有显著性差异（显效和总有效率分别为P<0.01和P<0.05）,且大部分病例（18/32）能在60min内快速止血。在治疗过程中,善得定几无副作用,患者并发症少,人均输血量也明显减少。     

垂体后叶素和善得定治疗食道静脉曲张破裂出血临床观察

我院自1996年1月至1998年2月应用善得定和垂体后叶素治疗肝硬化食道静脉曲张破裂出血43例，其中垂体后叶素组23例，善得定组20例，结果垂体后叶素组48小时的止血率为60．8%，善得定组48小时止血率为85．0％，停药后一周内再出血率垂体后叶素组52．1％，善得定组20％。二相比均有显性差异(止血率：P相似文献   

善得定治疗食管静脉曲张出血的临床对照研究

作者将71例肝硬化食管静脉曲张出血患者分为3组，分别用善得定，垂体后叶素及三腔管填塞治疗。结果：善得定的止血率为91．2％（31／34），平均止血时间25．5分，垂体后叶素止血率41．2％（7／17），平均止血时间37．1分，而三腔管填塞：90％（18／20），6小时。善得定组，垂体后叶素组和填塞组的平均输血量分别为566ml,918ml和550ml。此结果显示善得定在止血率，平均止血时间和平均输血量方面均优于垂体后叶素（P＜0．001）。善得定组的平均止血时间显著短于填塞组（P＜0．001），但在止血率与平均输血量方面与之无明显差异（P＜0．05）。此外，善得定的副反应轻微，观察中仅3例患者有恶心症状。所以，作者认为，善得定是治疗食管静脉曲张出血的最佳选择之一。     

急性胰腺炎的电解质酸碱失衡及TPN治疗

本文报道25例急性出血坏死性胰腺炎（ANP），30例急性水肿性胰腺炎（AEP）的电解质与酸碱失调分析结果，以ANP表现显著，有低钾，低钠，低氯，低钙，低磷，代酸与代酸呼碱，低氧血症，低蛋白血症的表现,与AEP比较有显著性差异（P＜0．01）。16例ANP型采用全肠外营养（TPN）治疗，其中13例存活，与过去未用TPN治疗22例，14例死亡有显著差异（P＜0．01）。作者认为TPN协同治疗ANP患者，对于提供营养，抑胰分泌，促进胰腺组织修复，纠正水盐代谢紊乱，防止并发症与提高存活率有重要意义。对TPN的用法及热原供给作了简要讨论。     

Role of Ghrelin and Leptin in Predicting the Severity of Acute Pancreatitis

Ghrelin and leptin are the hormones that influence endocrine and exocrine functions of the pancreas and regulate feeding behaviors and energy metabolism. The aim of this study was to investigate the levels of ghrelin and leptin in pancreatitis of different severities and the relation of these hormones with blood glucose level and proinflammatory cytokines. The study was performed on 90 Wistar Albino rats. Three experimental groups composed of 30 rats were established: control group, 0.9% NaCl solution was injected intraperitoneally (i.p); acute edematous pancreatitis (AEP) group, 1 μg/100 g cerulein was injected i.p. five times, at 1-hr intervals; and acute necrotizing pancreatitis (ANP) group, 500 mg/100 g l-arginine was injected i.p. Ten animals in each group were sacrificed under anesthesia 12, 24 and 48 hr after the last injection. After blood withdrawal, the pancreas was totally excised. The levels of blood sugar, lipase, serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), ghrelin, and leptin were investigated and histopathologic examination was performed. Following pancreatitis induction, serum ghrelin levels increased at 24 hr and reached the peak level at 48 hr. Its level in the AEP group was higher than in the ANP group. Serum leptin levels in the AEP and ANP groups increased after 12 hr and stayed at high levels until 48 hr compared with the control group. Similarly to ghrelin and leptin, blood glucose levels increased in both pancreatitis groups, but the increase was more prominent in the ANP group, with levels >200 mg/ml at 48 hr. The levels of TNF-α and IL-1β in the AEP and ANP groups reached the peak level at 24 hr and then decreased to a level close to that of the control group at 48 hr. We conclude that serum leptin and ghrelin levels increase in the first 48 hr of AEP and ANP. As the serum ghrelin levels in ANP are higher than in AEP, it can be used as a marker to show the severity of pancreatitis. While TNF-α and IL-1β can be used as a prognostic factor in the first 24 hr, ghrelin and leptin can be used subsequently.     

急性胰腺炎患者生长抑素治疗后血小板的形态特征

目的研究急性水肿型（AEP）和出血坏死型（AHNP）胰腺炎血小板形态特征的变化特点及生长抑素（SS）治疗的影响方法应用血细胞自动分析仪检测血小板计数（Pt）、平均血小板体积（MPV）和血小板分布宽度（PDW）．结果AEP患者血小板形态特性无明显变化，1wk后，MPV和PDW有显著性升高（t＝-2．35，－2．40，P＜0．05）；常规治疗对血小板形态参数无影响；SS治疗后，MPV和PDW明显升高（t＝－3．46，－4．14，P＜0．01）．AHNP患者Pt明显降抵（t＝3．03，P＜0．01），MPV和PDW明显升高（t＝－2．65，－2．63，P＜0．05）．1Wk后Pt明显升高（t＝4．79，P＜0．001），但MPV和PDW无明显降低；常规治疗后，Pt升高，MPV，PDW均降低（t＝－3．67，5．08，3．13，P＜0．05）；SS治疗后Pt明显升高（t＝－3．50，P＜0．01），MPV，PDW无明显变化．结论AEP与AHNP患者血小板形态特性的变化有明显的不同，可反映病情变化．SS治疗对Pt无明显影响，但可增加血小板的活性，对AHNP者有一定的治疗和预防作用．     

Ulinastatin in the treatment of acute pancreatitis: A multicenter clinical trial

OBJECTIVE: To assess the effectiveness of Chinese‐made ulinastatin in the treatment of patients with acute edematous pancreatitis (AEP) and acute hemorrhagic and necrotic pancreatitis (AHNP). METHODS: A multicenter randomized controlled clinical trial was performed. Stratified by AHNP or AEP, patients were randomly allocated into either the treatment group (with ulinastatin) or the control group (treatment with cabexate or octreotide). Clinical symptoms and signs were scored as none, mild, moderate or severe. Laboratory tests included serum amylase, liver and renal function tests, routine blood tests, serum glucose, calcium, blood pH and PaO₂. Clinical results were assessed as cured, significantly effective, effective and non‐effective. All adverse effects were recorded. RESULTS: From April to July 2000, a total of 94 patients with acute pancreatitis were enrolled into the study (50 males; 44 females). In this patient group, there were 68 cases of mild pancreatitis and 26 cases of severe pancreatitis. The study showed that the global effective rates of ulinastatin and cabexate in treating AEP were 100%, whereas the cured rate for ulinastatin was 83.3%, which was a little higher than that for cabexate (71.4%), but this difference was not statistically significant. Clinical symptoms, such as abdominal pain and distension, almost disappeared within 3?5 days in both groups for both treatment protocols. The global effective rate of ulinastatin in treating AHNP was similar to that of octreotide (78.6 vs 81.9%; P= 0.840). The main complication in AHNP was pancreatic pseudocyst. Only one case showed increased levels of alanine aminotransferase. No adverse effects, including allergy, skin rash and decreases in the white blood cell count, were noted. No abnormalities in liver and renal function, electrolytes or routine blood tests were noted. CONCLUSIONS: Ulinastatin was shown to be effective in treating AEP and AHNP with few adverse effects.     

Continuous regional arterial infusion (CRAI) therapy reduces the mortality rate of acute necrotizing pancreatitis: results of a cooperative survey in Japan

We evaluated the usefulness of continuous regional arterial infusion (CRAI) of protease inhibitors and antibiotics in 156 patients with acute necrotizing pancreatitis (ANP) collected in a cooperative survey carried out in 1997 in Japan. The overall mortality rate was 18.6%, and the frequency of infected pancreatic necrosis was 12.8%. There was no significant difference in mortality rates between patients who received the protease inhibitor via CRAI and the antibiotics intravenously (group A) and patients who received both the protease inhibitor and the antibiotics via CRAI (group B), but the frequency of infected pancreatic necrosis was significantly lower in group B (7.6%) than in group A (23.5%). The mortality rate in patients in whom CRAI therapy was initiated within 48 h after the onset of ANP (11.9%) was significantly lower than that in patients in whom CRAI therapy was initiated more than 48 h after the onset (23.6%). These results suggested that CRAI of both protease inhibitors and antibiotics was effective in reducing mortality and preventing the development of pancreatic infection in ANP when initiated within 48 h after the onset of ANP.     

急性胰腺炎大鼠血清蛋白质组学分析

目的 分析急性水肿型胰腺炎(AEP)和急性坏死型胰腺炎(ANP)大鼠血清蛋白质表达的差异,寻找判断AP病情的血清指标.方法 采用4％或5％牛磺胆酸钠逆行注入胆胰管法分别制备AEP和ANP大鼠模型.应用血清蛋白质谱弱阳离子交换芯片(WCX2),采用表面增强激光解析离子化飞行时间质谱(surface-enhanced laser desorption/ionization time-of-flight mass spectrometry,SELDI-TOFMS)技术分析AEP和ANP大鼠血清蛋白质谱的差异.结果 AEP和ANP大鼠血清蛋白质在质荷比为1000 ～50000分子量之间有38个蛋白质差异表达(P＜0.05),其中AEP大鼠血清中分子量为9500和9700的两种蛋白质表达明显高于ANP大鼠.结论 用SELDI-TOF-MS技术能检测出AEP与ANP大鼠血清蛋白质的差异表达.分子量9500和9700蛋白质的表达下降可能是AEP向ANP转化的征兆.     

Effects of emodin and baicalein on rats with severe acute pancreatitis

AIM: To investigate the therapeutic effects of emodin in combination with baicalein on severe acute pancreatitis (SAP) rats and to explore the mechanism of SAP. METHODS: A total of 112 SAP rats induced by retrograde injection of 5% sodium taurocholate into the biliary-pancreatic duct, randomly assigned to a untreated group and three treated groups emodin group, combined emodin and baicalein group, and sandostatin group. Meanwhile, another 28 other rats were selected as sham operation (SO) group. There were 28 rats in each group, 8 rats were in 3 and 6 h groups respectively, and 12 rats in 12 h group. At each time-points, survival rates,ascites volumes, pathological lesion scores of pancreas tissues,serum amylase, tumor necrosis factor-α and IL-6 levels were determined as the indexes of therapeutic effects. RESULTS: The survival rate at 12 h was significantly higher in three treated groups than in untreated group.The ascites volume at 12 h was remarkably less in combined and sandostatin groups than in emodin group,but there was no difference between combined group and sandostatin group (P>0.05). Serum amylase levels at all time-points were significantly lower in three treated groups than in untreated group. However, they had no difference among treated groups (P>0.05).Serum TNF-α were lower in three treated groups than in untreated group at all time points. Among the three treated groups, at 6 h, the TNF-α levels of combination and sandostatin groups were lower than those of emodin group. These was no difference between combined and sandostantin. Serum IL-6 concentration at 3 h were lower in combined and sandostatin groups than in untreated group, but at 6 and 12 h they were lower in all treated groups than in untreated group and the combined and sandostatin groups and in emodin group, no difference was found between combined and sandostatin groups at all time-points (P>0.05). The pathological scores of pancreas at all time points were significantly lower in three treated groups than in the untreated group, and at 6, 12 h, the scores of combined and sandostatin groups were lower than in emodin group. There was no difference between combined and sandostatin groups (P>0.05). CONCLUSION: Combination of emodin with baicalein has significant therapeutic effects on SAP rats.     

急性胰腺炎大鼠胰腺组织中Smac/DIABLO、XIAP mRNA的表达及其意义

目的 检测急性胰腺炎(AP)大鼠胰腺组织中促凋亡基因Smac/DIABLO和凋亡抑制基因XIAP的mRNA表达,分析其与疾病严重程度的关系.方法 54只SD大鼠按数字表法随机分成假手术组、急性水肿性胰腺炎(AEP)组、急性坏死性胰腺炎(ANP)组.通过胰胆管逆行注射1%、3.5%脱氧胆酸钠方法分别制备AEP、ANP模型.收集制模后3、6、12 h胰腺标本,常规病理检查;TUNEL法检测细胞凋亡;实时定量PCR法检测Smac/DIABLO、XIAP mRNA的表达.结果 胰腺病理改变表示模型制备成功.术后6 h假手术组、AEP组、ANP组胰腺腺泡细胞凋亡指数分别为0.67±0.82、6.62±0.78和4.70±0.82,各组间相差显著(P＜0.05).AEP组Smac/DIABLO mRNA的表达随时间延长而逐渐增加,ANP组则随时间延长而逐渐下降,以假手术组为参考,6 h时AEP组和ANP组的表达量分别为2.41±0.92和1.47±0.53,相差显著(P＜0.05).相反,AEP组XIAP mRNA的表达随时间延长逐渐下降,而ANP组表达逐渐增加,6 h时表达量分别为5.51±1.07和6.99±1.00,相差显著(P＜0.05).结论 AP时胰腺组织Smac/DIABLO mRNA的表达与细胞凋亡指数一致,与病情严重程度相反,而XIAP mRNA的表达与病情严重程度一致.XIAP、Smac/DIABLO基因参与细胞凋亡的调节.     

A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England

BACKGROUND: The incidence of acute pancreatitis shows regional variations in the UK. AIMS: To document the incidence and presentation of acute pancreatitis in hospitals in Wessex, and to audit the process and outcome of management of patients against the UK guidelines. METHODS: A prospective survey was carried out of all patients with acute pancreatitis in a one year period, in eight geographically adjacent acute hospitals in the Wessex region. RESULTS: 186 patients with acute pancreatitis were identified, an incidence of 152 per million in the adult population. Aetiology was: gallstones 33%, alcohol 20%, idiopathic 32%, other 15%. There were 60 severe cases with 17 deaths. Age and APACHE-II score had significant relations to outcome, but delay to admission, serum amylase level, aetiology, and sex did not. The mortality rate (9.1%) was within the audit standard of 10%. Some management goals were not met: in mild cases, only one third of patients with gallstone pancreatitis had definitive treatment within four weeks. In severe cases, there was poor use of objective severity stratification (19%), low admission rates to a high dependency unit or intensive care unit (67%), and only 33% of patients had computed tomography. Only seven of 17 patients with severe gallstone pancreatitis had an urgent endoscopic retrograde cholangiopancreatography. CONCLUSIONS: The incidence of clinically diagnosed acute pancreatitis in England continues to rise. Current management of acute pancreatitis is suboptimal when compared with evidence based UK guidelines but the mortality rate was within the guideline standard.     

Free fatty acids in serum of patients with acute necrotizing or edematous pancreatitis

Serum concentrations of free fatty acids (FFA) were assayed in 20 patients with acute necrotizing pancreatitis (ANP). Pancreatic and peripancreatic fat necrosis was verified on operation and/or by contrast-enhanced computed tomography. For comparison, 20 patients with acute edematous pancreatitis (AEP) were examined. On admission, FFA serum levels were 1.14±0.12 (SEM) mmol/L in ANP and, thus, significantly (p<0.03) higher than in AEP (0.78±0.09 mmol/L). The two groups also differed in the later course: in ANP, the FFA values remained raised (d 5–11∶0.86±0.13 mmol/L;p>0.05 vs day 1), whereas in AEP, the FFA concentrations normalized within 1 wk (d 2–4∶0.52±0.11 mmol/L; d 5–11∶0.39±0.05 mmol/L;p<0.05 vs day 1 andp<0.01 vs ANP). Serum FFA correlated positively with C-reactive protein levels (r _s=0.42;p<0.01), but has less discriminating potency between ANP and AEP. In AEP, the initial peak may correspond to the disease out-burst itself and to unspecific stress. In ANP, the higher and sustained elevation of FFA may predominantly mirror the ongoing pancreatic parenchymal and extrapancreatic fat necrosis, and be pathophysiologically relevant, especially in view of significantly reduced serum albumin levels in ANP.