短程甲泼尼龙冲击疗法在早期合并全身炎症反应综合征急性胰腺炎患者中的应用

目的 评价短程甲泼尼龙冲击疗法在早期合并全身炎症反应综合征(SIRS)急性胰腺炎(AP)患者中的应用效果.方法 选择我院消化内科2015年6月至2016年6月收治的89例住院合并SIRS的AP患者,采用数字表随机法分为两组,对照组44例给予内科综合治疗,观察组45例患者在此基础上给予1.5 mg/(kg·d)×3 d的甲泼尼龙治疗,疗程1周;治疗前、治疗3 d、5 d采用急性生理与慢性健康(APACHEⅡ)评分、全身炎症反应综合征(SIRS)评分评价疗效,并检测血清C-反应蛋白(CRP),记录两组急性肾衰竭、急性呼吸衰竭等器官衰竭发生情况.结果 两组患者治疗3 d、治疗5 d时的APACHEⅡ评分、SIRS评分、CRP水平均低于入院时,差异均有统计学意义(P<0.05);观察组和对照组患者治疗3 d时的APACHEⅡ评分(5.02±0.97)分vs(6.41±1.17)分]、SIRS评分(1.74±0.29)分vs(2.24±0.32)分]和CRP水平(162.9±27.2)mg/dL vs(192.4±36.9)mg/dL]比较,观察组均低于对照组,治疗5 d时的APACHEⅡ评分(4.33±0.96)分vs(5.24±1.03)分]、SIRS评分(1.32±0.24)分vs(1.75±0.30)分]、CRP水平(83.6±17.2)mg/dL vs(142.8±27.4)mg/dL]比较,观察组也均低于对照组,差异均有统计学意义(P<0.05);观察组患者的器官衰竭发生率为75.56%,明显低于对照组的90.91%,差异有统计学意义(P<0.05),观察组患者病死率为6.67%,对照组为9.09%,差异无统计学意义(P>0.05).结论 短程甲泼尼龙冲击疗法能快速控制AP患者炎症反应,降低病情严重程度,减少多器官功能障碍综合征的发生率.

Application of methylprednisolone shock therapy in patients with acute pancreatitis combined with systemic inflammatory response syndrome

Objective To analyze the effect of methylprednisolone shock therapy in patients with acute pancre-atitis (AP) combined with systemic inflammatory response syndrome (SIRS) in early stage. Methods From June 2015 to June 2016, 89 AP patients with SIRS in Department of Gastroenterology of our hospital were randomly divided into two groups by random number table. The control group (44 cases) were given comprehensive medicine treatment, and the observation group (45 cases) was treated with methylprednisolone (1.5 mg/(kg·d)×3 days) on the basis of the control group, with one week as a treatment course. Before treatment and 3 d, 5 d after treatment, acute physiology and chronic health (APACHE Ⅱ) score, systemic inflammatory response syndrome (SIRS) score were measured for evaluation of cu-rative effect. Serum C-reactive protein (CRP) levels were detected, and acute renal failure, acute respiratory failure were recorded. Results At 3 d, 5 d after treatment, APACHE Ⅱ score, SIRS score, CRP levels were significantly lower than those at admission (P<0.05). At 3 d after treatment, APACHE Ⅱ score, SIRS score and CRP level were (5.02 ± 0.97), (1.74±0.29), (162.9±27.2) in the observation group, as compared with (6.41±1.17), (2.24±0.32), (192.4±36.9) in the con-trol group (P<0.05). At 5 d after treatment, APACHE Ⅱ score, SIRS score, CRP level were (4.33 ± 0.96), (1.32 ± 0.24), (83.6±17.2) in the observation group, which were significantly lower than (5.24±1.03), (1.75±0.30), (142.8±27.4) in the control group (P<0.05). The incidence of organ failure rate was 75.56% in the observation group, significantly lower than 90.91% in the control group (P<0.05), and the case fatality rate was 6.67% in the observation group, significantly lower than 9.09% in the control group (P>0.05). Conclusion Methylprednisolone shock therapy can quickly control the inflammation in AP patients, alleviate disease severity, and reduce the incidence of multiple organ dysfunction syndrome.