善宁与加贝酯治疗急性胰腺炎的疗效观察

目的比较善宁与加贝酯对急性胰腺炎的疗效. 方法急性胰腺炎168例(急性水肿型108例,急性出血坏死型60例),随机分为2组.     

国产乌司他丁治疗急性胰腺炎临床疗效观察

观察国产乌司他丁治疗急性胰腺炎的临床疗效。回顾性分析2001年至2003年在我院诊断急性胰腺炎 199例,按不同治疗方法分为乌司他丁组(n=63)、善宁组(n=70)、加贝酯组(n=66)。分别观察药物疗效。比较总 有效率,乌司他丁组为88．8％(56／63);善宁组为90．0％(63／70);加贝酯组为72．7%(48／66)。乌司他丁组明显优于 加贝酯组,统计学上有显著性差异(P<0．05),但与善宁组比较,差异无显著性(P>0．05)。乌司他丁是治疗急性胰 腺炎的安全而有效的药物。     

奥曲肽联合加贝酯治疗重症急性胰腺炎的疗效及对患者胃肠功能和血清细胞因子的影响

目的探讨奥曲肽联合加贝酯治疗重症急性胰腺炎的疗效及其对患者胃肠功能和血清细胞因子的影响。方法选择2009年11月至2014年5月在该院接受治疗的重症急性胰腺炎患者130例为研究对象,采用随机数字表法分为两组,各65例。两组患者均给予重症急性胰腺炎的基础治疗,对照组同时加用奥曲肽治疗,观察组加用奥曲肽联合加贝酯治疗。结果观察组患者排便与排气恢复正常时间、肠鸣音消失时间以及腹痛与腹胀缓解时间短于对照组(P<0.05)。治疗后,两组患者的血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-6、IL-8水平都下降,然而观察组患者下降幅度大于对照组(P<0.05)。观察组的总有效率为87.69%,高于对照组的70.77%(P<0.05)。结论常规治疗的基础上联合奥曲肽、加贝酯治疗重症急性胰腺炎疗效显著,可以改善机体的炎症反应,改善血清TNF-α、IL-6、IL-8水平。     

加贝酯治疗轻症急性胰腺炎的疗效观察

加贝酯(gabexate mesilate, GM)是非肽类的蛋白酶抑制剂,可抑制多种蛋白酶的活性.为观察加贝酯对轻症急性胰腺炎(mild acute pancreatitis, MAP)的治疗效果,我们于2003年6月～ 2005年3月,在常规治疗的基础上,运用国产加贝酯治疗MAP 45例,取得了良好疗效,现报道如下.     

国产乌司他丁治疗急性胰腺炎的多中心临床研究

目的：评价国产乌司他丁（尿抑制素，Ulinastatin)治疗急性胰腺炎病人的疗效和不良反应，及该药对急性出血坏死型胰腺炎的临床疗效。方法：采用多中心随机对照研究，按是否出血坏死型随机分为试验组和对照组，并分别接受乌司他丁和甲磺酸加贝酯或奥曲肽治疗，并进行随访。临床症状及体征按无，轻、中、重度不同分为4级，实验室指标包括血淀粉酶、肝功能、血常规、血糖、血钙、肾功能、血PH及氧饱和度等。按痊愈、显效，有效和无效四级评定疗效。记录治疗中出现的全部不良事件。结果：自2000年4－7月共有94例急性腺炎患者进入本研究，其中男50例，女44例，轻型68例，重型26例。根据入选和排除标准以及研究设计，共有7例剔除，最终共有87例患者进入研究和分析。结果显示，乌司他丁用于治疗急性水肿型胰腺炎，总有效率达100．0％，痊愈率达83．3％，略高于对照组加贝酯（71．4％），但差异无显著性（P＞0．05），腹痛、上腹胀等症状均能在3－5d内基本缓解或消失。乌司他丁用于治疗急性出血坏死型胰腺炎，总有效率与奥曲肽相似（78．6％比81．9％，P＝0．840）。治疗出血坏死型胰腺炎出现的并发症主要为假性囊肿。仅1例丙氨酸转氨酶轻度升高，未发现过敏，皮疹、白细胞明显下降等明显不良反应，肝、肾功能和电解质等生化指标和血常规监测显示具有较好的安全性。结论：乌司他丁用于治疗急性水肿型朱炎和出血坏死型胰腺炎均有较好的疗效，不良反应较少。     

国产加贝酯预防ERCP术后胰腺炎的临床研究

目的探讨国产加贝酯预防ERCP术后胰腺炎、高淀粉酶血症和腹痛的疗效和安全性。方法按随机双盲法将拟行ERCP术的患者分为加贝酯组和对照组。加贝酯组患者在ERCP术前30～90min起开始静脉滴注加贝酯至术后12h为止，总剂量为1000mg。对照组仅静脉常规补液。结果共有77例患者完成研究，其中加贝酯组39例，对照组38例。加贝酯组有2例（5％）、对照组有8例（21％）患者发生了胰腺炎（P=0．038）；高淀粉酶血症的发生率两组分别为9例（23％）和18例（47％）（P=0．013）；腹痛的发生率两组分别为9例（23％）和13例（34％）（P=0．280）。结论加贝酯持续静脉滴注能有效减少ERCP术后胰腺炎发生率，减少高淀粉酶血症的发生。     

丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎的疗效

[目的]探讨丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎的临床疗效。[方法]纳入如皋市人民医院2017年2月~2019年2月收治的符合条件的急性胰腺炎患者共120例,按随机数字表法分为对照组和观察组,每组各60例。对照组在常规治疗基础上给予注射用甲磺酸加贝酯静脉滴注,前3 d为300 mg/d,3 d后为100 mg/d,1次/d。观察组在对照组基础上给予丙氨酰谷氨酰胺注射液静脉滴注,20 g/次,1次/d。2组均治疗14 d,比较2组患者的临床疗效、症状改善时间、血淀粉酶(AMY)、尿淀粉酶(UAMY)、血尿素氮(BUN)水平及免疫功能、肠道菌群和不良反应情况。[结果]治疗后,对照组和观察组的总有效率分别为75.86%、91.67%,2组差异有统计学意义(P<0.05);观察组腹胀、腹痛缓解和肠鸣音、体温恢复时间以及AMY、UAMY、BUN水平明显少于对照组(P<0.01);治疗后,观察组患者血IgA、IgG、CD4^+/CD8^+水平以及乳酸杆菌、双歧杆菌明显高于对照组,大肠杆菌、肠球菌明显低于对照组(P<0.01)。[结论]丙氨酰谷氨酰胺联合甲磺酸加贝酯治疗老年急性胰腺炎疗效确切、安全性好,可改善患者的免疫功能以及肠道菌群。     

加贝酯在ERCP诊治术后的临床应用评价

目的观察加贝酯在预防ERCP术后引起的高淀粉酶血症和急性胰腺炎的有效性。方法两组行ERCP的病人,试验组应用加贝酯。观察试验组和对照组患者术后血清淀粉酶的变化。结果试验组术后高淀粉酶血症及急性胰腺炎发生率明显低于对照组(P<0.05)。结论加贝酯能有效预防ERCP术后高淀粉酶血症及急性胰腺炎的发生。     

国产甲磺酸加贝酯治疗急性水肿型胰腺炎556例临床研究

自1993年5月－1994年5月，我们应用国产注射用甲磺酸加贝酯（gabexate mesllate,GM;日本商品为Foy)治疗556例急性水肿型胰腺炎。380例单独应用GM（GA组），176例除GM外合并应用H2受体拮抗剂（GB组），另设C组为对照组。三组基础治疗相同，疗程7－10天。治疗结果：GA组血，尿淀粉酶3天内复常者占70．24％，55．79％。GB组占74．43％，50％。7天内复常者两组分别为96．58％，92．37％，97．16％，90．35％。主要症状如恶心，呕吐，上腹部痛，三天内消失率GA组分别为83．8％，87．11％，47％；GB组分别为：88．7％，96．48％，47．7％。7天内消失率两组为94．100％。化验检查及主要症状的恢复两组相比（P＞0．05）差异无显著性。与对照组相比差异显著（P＜0．05）。治疗中少数患者（3．06％）发生静脉炎及注射部位疼痛等一些不良反应。以上结果表明：单独应用GM治疗与加用H2受体拮抗剂二组疗效相同，总有效率显著高于对照组。GM治疗急性水肿型胰腺炎具有缓解症状迅速，血尿淀粉酶恢复正常需时短的优点。而且不易复发，不良反应发生率低。因此GM可作为急性水肿型胰腺炎的首选药物，疗效可靠而又安全。     

加贝酯治疗轻症急性胰腺炎的疗效观察

加贝酯（gabexate mesilate，GM）是非肽类的蛋白酶抑制剂，可抑制多种蛋白酶的活性。为观察加贝酯对轻症急性胰腺炎（mild acute pancreatitis，MAP）的治疗效果，我们于2003年6月～2005年3月，在常规治疗的基础上，运用国产加贝酯治疗MAP45例，取得了良好疗效，现报道如下。     

加贝酯预防急性胰腺炎的作用机制研究

目的通过观察加贝酯对胰腺细胞凋亡及Bax、Bcl-2蛋白表达的影响,探讨加贝酯预防大鼠胰管注射法诱导的急性胰腺炎(AP)的相关机制。方法16只SD大鼠随机分为假手术组(4只)、AP组和加贝酯治疗组(各6只)。以50mmHg(1mmHg=0.133kPa)的恒压向胰胆管内注入30%泛影葡胺诱导SD大鼠AP模型,制模前15～20min加贝酯(4mg.h-1.kg-1体重)静脉持续滴注60min进行预防。组织病理检查观察胰腺炎症程度,应用TUNEL染色、免疫组化检测胰腺细胞凋亡和Bcl-2、Bax蛋白表达。结果加贝酯治疗组的胰腺组织病理改变较AP组减轻(P<0.05)。治疗组凋亡指数(AI)、Bax和Bcl-2表达值分别为8.00±1.80,10.12±1.52和1.83±0.39,前两者较AP组显著增高,而Bcl-2蛋白无显著差别。治疗组AI、Bax表达与胰腺的炎症程度呈负相关。结论加贝酯静脉滴注对大鼠胰管注射法诱导的AP有一定的预防作用。其机制可能与促进细胞凋亡和Bax蛋白表达上调有关。     

Manifestations of experimental acute pancreatitis in young and old rats

Two kinds of experimental pancreatitis were induced in young (4-6 month) and old (25-27 month) female Wistar rats: acute edematous pancreatitis was induced by intraperitoneal administration of a high dose of cerulein (40 micro/kg x 2) and acute hemorrhagic pancreatitis was intraductal injection of 1% deoxycholic acid. After these treatments, the plasma amylase concentration and pancreatic wet weight were determined and the pancreas was examined histologically. In the groups with cerulein induced pancreatitis one of eight old rats died, whereas all five young rats survived. There was no specific finding macroscopically in the liver, kidney, lung or heart of old rats at autopsy after cerulein injection. The plasma amylase concentration and the pancreatic wet weight were significantly increased by administration of cerulein or deoxycholic acid in both young and old rats. There was no significant difference in the plasma amylase concentrations in young and old rats after the induction of acute pancreatitis. The increase in pancreatic wet weight was less in old rats than in young ones after deoxycholic acid treatment, but similar in the two groups after cerulein injection. The extents of histological changes were also similar in young and old rats. Thus, no evidence that aging increases susceptibility to pancreatitis was obtained.     

单味大黄治疗急性胰腺炎临床与基础研究报告

目的 研究单味大黄对急性胰腺炎的疗效与机理。 方法 单味大黄治疗水肿型胰腺炎428例,单味大黄制剂与复方西药随机对比治疗225例。重用单昧大黄加西医药治疗出血坏死型胰腺炎125例与单纯西医药治疗107例作回顾性对比。作动物模型及大黄对厌氧杆菌、内毒素血症、血液流变性的作用等研究。 结果 水肿型胰腺炎的有效率为100％,其中显效率达83.2％,各种大黄制剂疗效相似,但在腹痛消失、退热、尿淀粉酶恢复正常时间方面比复方西药优(P<0.01或0.05)。重用单味大黄加西医药治疗出血坏死型胰腺炎的手术率死亡率均比单纯西医药明显降低。大黄治疗后在电镜下观察到胰腺细胞的修复及紧密连接处恢复正常。另有抑制厌氧杆菌和内毒素吸收、解除微循环障碍等作用。 结论 单味大黄治疗急性胰腺炎优于同类中西药物,能缩短疗程,减少并发症,降低手术率与死亡率,具有“廉、简、验、便”的特点。大黄治疗急性胰腺炎的直接机理是对胰腺细胞具有保护作用。大黄对内毒素血症、血液流变学、前列腺素、血栓素及厌氧杆菌等多方面作用表明了防治急性胰腺炎的间接作用。     

Morphological and Functional Evaluation of the Pancreatic Duct with Secretin-Stimulated Magnetic Resonance Cholangiopancreatography in Alcoholic Pancreatitis Patients

Objectives The aim of this investigation was to evaluate the pancreatographic findings and dynamics of pancreatic duct diameter, as determined by secretin-enhanced magnetic resonance cholangiopancreatography (S-MRCP), in patients with acute alcoholic pancreatitis or chronic alcoholic pancreatitis and in a control group. Methods S-MRCP was performed in patients with acute alcoholic pancreatitis who did not manifest the functional and radiological (ultrasonography and computed tomography) criteria of chronic pancreatitis (n = 21), in patients with chronic alcoholic pancreatitis (n = 28) and in a control group (n = 16). The diameter of the main pancreatic duct (MPD) was monitored before secretin administration and at 3 and 10 min after secretin administration. Morphological features were also assessed before and after the administration of secretin. Results All ductal diameters were significantly larger in chronic alcoholic pancreatitis (P < 0.0001). There were no differences in MPD caliber between patients with acute alcoholic pancreatitis and the control group. The percentage of variation between basal MPD diameter and at 3 min post-secretin administration was lower in patients with chronic (35.5%) pancreatitis than in those with acute alcoholic pancreatitis (52.3%) and the control group (52.5%). There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of the frequency of visualization of side branches, ductal narrowing, intraluminal filling defects, and ductal irregularity. One patient with acute alcoholic pancreatitis presented ductal criteria of chronic pancreatitis following the administration of secretin. Conclusions The dynamics of MPD visualized on S-MRCP in patients with acute alcoholic pancreatitis is similar to that observed in the control group and different from that observed in patients with chronic alcoholic pancreatitis. There were no significant differences between patients with acute alcoholic pancreatitis and the control group in terms of morphological pancreatographic features.     

老年重症急性胰腺炎患者空肠营养时肠道不耐受原因及处理

目的探讨老年（年龄≥60岁）重症急性胰腺炎（SAP）患者营养治疗中肠道不耐受的原因和防治。方法回顾研究2006年1月至2007年11月128例重症急性胰腺炎行空肠营养治疗出现的肠道不耐受现象。其中老年患者56例，非老年72例。结果56例老年SAP，11例出现肠道不耐受，对照组（年龄〈60岁）72例，4例出现肠道不耐受；老年组肠道不耐受发生率与对照组比较差异有统计学意义。老年组肠道不耐受患者经非手术处理，5例肠道不耐受症状消失：其中3例使用肠内输液泵（flocare 800 pump）、一次性肠内营养输注器以及加热器，2例降低营养液滴注浓度。老年组6例转为手术治疗，发现5例伴小肠充血水肿，1例小肠部分缺血坏死；5例存在胰周感染，术后5例耐受肠内营养支持治疗。结论老年SAP肠内营养治疗中，肠道不耐受的发生率较高，其原因与营养液滴注速度、浓度和温度有关。老年SAP肠内营养使用过程中应特别注意肠功能障碍的发生，及时行胰腺坏死组织清创引流减压是防治肠功能障碍及恢复肠道营养治疗的重要措施。     

急性胰腺炎复发诱因及内镜治疗

目的 探讨急性胰腺炎(AP)复发的诱因及其内镜治疗效果.方法 杏阅2002年1月至2008年12月长海医院收治的AP患者.详细记录患者临床资料;是否行内镜逆行胰胆管造影术(ERCP)治疗、治疗方法及并发症.电话随访后根据是否AP复发将患者分为无复发组与复发组.分析两组致病因素及内镜治疗疗效.结果 804患者入组,其中无复发组512例(63.68%),复发组292例(36.32%).无复发组平均年龄52岁,复发组平均年龄44岁,相差显著(P<0.01).201例重症胰腺炎中,无复发组104例(20.31%),复发组97例(33.22%),复发组显著高于无复发组(P<0.01).无复发组并发胰腺假性囊肿46例,复发组44例,两组胰腺假性囊肿发生率差异显著(P<0.05).AP病因为胆源性、高三酰甘油血症是胰腺炎反复发作的危险因素.139例复发性AP患者行ERCP治疗,15例(5.15%)并发ERCP术后胰腺炎,1例(0.34%)出现十二指肠乳头切开后出血.成功随访内镜介入治疗的118例复发性AP患者,内镜治疗总缓解率为78.8%.结论 复发组发病年龄较小,重症急性胰腺炎发生率及胰腺假性囊肿发生率均高,胆源性及高三酰甘油血症为诱发AP复发的危险因素.内镜介入治疗对复发性AP同样有效.     

善得定治疗急性胰腺炎的体会

作者对比观察了善得定对急性胰腺炎的治疗作用，其剂量为0.1-0.15mg，每4－6h一次，皮一注射。在85例水肿型胰腺炎中，15例应用善得定治疗。结果显示，善得定治疗组转手术率显著低于非善得定组（P＜0．05），未合并感染的12例坏死性胰腺炎均采取非手术治疗，其中3例应用善得定治疗，其合并症全部消失，明显优于对照组。合并感染的67例坏死性胰腺炎均予以手术治疗，病情严重的14例，用善得定治疗，结果显示可减少并发症及其严重度。     

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.     

Indwelling catheter and conservative measures in the treatment of abdominal compartment syndrome in fulminant acute pancreatitis

AIM: To study the effect of combined indwelling catheter, hemofiltration, respiration support and traditional Chinese medicine (e.g. Dahuang) in treating abdominal compartment syndrome of fulminant acute pancreatitis. METHODS: Patients with fulminant acute pancreatitis were divided randomly into 2 groups of combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring and routine conservative measures group (group 1) and control group (group 2). Routine non-operative conservative treatments including hemofiltration, respiration support, gastrointestinal TCM ablution were also applied in control group patients. Effectiveness of the two groups was observed, and APACHE II scores were applied for analysis. RESULTS: On the second and fifth days after treatment, APACHE II scores of group 1 and 2 patients were significantly different. Comparison of effectiveness (abdomi-nalgia and burbulence relief time, hospitalization time) between groups 1 and 2 showed significant difference, as well as incidence rates of cysts formation. Mortality rates of groups 1 and 2 were 10.0% and 20.7%, respectively. For patients in group 1, celiac drainage quantity and intra-abdominal pressure, and hospitalization time were positively correlated (r = 0.552, 0.748, 0.923, P < 0.01) with APACHE II scores. CONCLUSION: Combined indwelling catheter celiac drainage and intra-abdominal pressure monitoring, short veno-venous hemofiltration (SVVH), gastrointestinal TCM ablution, respiration support have preventive and treatment effects on abdominal compartment syndrome of fulminant acute pancreatitis.     

乌司他丁治疗胰腺炎的疗效分析

目的:评价乌司他丁对胰腺炎的临床疗效。方法:68例胰腺炎患者随机分为两组,治疗组30例(急性23例,慢性7例),对照组38例(急性29例,慢性9例)。对照组采用常规治疗。治疗组在常规治疗的基础上加用乌司他丁20万u/d静脉滴注,持续10d。结果:急性胰腺炎患者应用乌司他丁后,症状、体征的缓解及血尿淀粉酶的恢复明显早于对照组,总有效率优于对照组(P<0.05);慢性胰腺炎患者治疗组也优于对照组,但无统计学意义(P>0.05)。结论:乌司他丁对急性胰腺炎有较好疗效,可作为急性胰腺炎的有效治疗措施之一,对慢性胰腺炎的疗效有待进一步研究。