2018 年第 9 期 第 13 卷

前列地尔治疗重症急性胰腺炎的临床效果及对肠道黏膜屏障功能和胃肠动力的影响

Clinical effect of alprostadil on severe acute pancreatitis, intestinal mucosa barrier function and gastrointestinal motility

作者：韩坤

英文作者：

单位：710003西安市中心医院消化内科

英文单位：

关键词：重症急性胰腺炎；前列地尔；肠道黏膜屏障；胃肠动力

英文关键词：

• 摘要：

• 【摘要】目的    观察前列地尔治疗重症急性胰腺炎（SAP）的临床效果及对肠道黏膜屏障功能、胃肠动力的影响。方法    选取2016年1月至2018年1月西安市中心医院消化内科收治的94例SAP患者，按随机数字表法分为对照组和观察组，各47例。对照组接受常规治疗，观察组在对照组基础上给予前列地尔注射液治疗，10 d为1个疗程。比较2组患者临床症状改善情况，血、尿淀粉酶恢复正常时间，肠道黏膜屏障功能指标，胃肠激素、胃电图指标，以及并发症发生率、手术中转率及病死率。结果    治疗后，观察组腹痛腹胀缓解时间、肠鸣音恢复时间、首次排便时间及血、尿淀粉酶恢复正常时间均短于对照组［（3.3±0.5）d比（4.9±0.7）d、（3.7±0.9）d比（5.2±0.7）d、（2.1±0.4）d比（3.1±0.6）d、（5.1±0.9）d比（7.3±1.2）d、（5.6±1.0）d比（7.9±1.5）d］，D-乳酸、二胺氧化酶、内毒素、胃泌素、血管活性肠肽水平均明显低于对照组［（2.68±0.24）mg/L比（3.70±0.82）mg/L、（7.8±1.2）U/L比（13.0±3.2）U/L、（32±6）EU/L比（47±9）EU/L、（135±15）μmol/L比（176±25）μmol/L、（5.3±0.9）μmol/L比（6.5±1.7）μmol/L］，胃动素、胆囊收缩素、平均振幅、主频率高于对照组［（214±27）ng/L比（180±32）ng/L、（131±25）ng/L比（106±15）ng/L、（169±27）μV比（143±13）μV、（2.89±0.37）CPM比（2.60±0.25）CPM］，差异均有统计学意义（均P＜0.05）。观察组治疗过程中并发症发生率明显低于对照组，差异有统计学意义（P＜0.05）。2组手术中转率及病死率比较，差异无统计学意义（均P＞0.05）。结论    前列地尔治疗有助于改善SAP患者临床症状，减少并发症发生，可能与其促进患者肠道黏膜屏障功能和胃肠动力恢复有关。

• 【Abstract】Objective    To observe the curative effect of alprostadil on patients with severe acute pancreatitis(SAP) and the impact on intestinal mucosa barrier function and gastrointestinal motility. Methods    Totally 94 SAP patients admitted from January 2016 to January 2018 in Xi′an Central Hospital were randomly divided into control group and observation group, with 47 cases in each group. The control group had traditional therapy; the observation group was treated with alprostadil injection additionally, 10 d was 1 course. Clinical symptoms recovery time, blood and urine amylase recovery time, intestinal mucosal barrier function and gastrointestinal motility indicators, electrogastrographic parameters, complications, surgical transfer rate and mortality were analyzed. Results    After treatment, abdominal pain and distension relief time, bowel sound recovery time, the first defecation time, blood and urine amylase recovery time in the observation group were significantly shorter than those in the control group［（3.3±0.5）d vs （4.9±0.7）d, （3.7±0.9）d vs （5.2±0.7）d, （2.1±0.4）d vs （3.1±0.6）d, （5.1±0.9）d vs （7.3±1.2）d, （5.6±1.0）d vs （7.9±1.5）d］(P＜0.05); levels of D-lactic acid, diamine oxidase, endotoxin, gastrin and vasoactive intestinal peptide in the observation group were significantly lower than those in the control group［（2.68±0.24）mg/L vs （3.70±0.82）mg/L, （7.8±1.2）U/L vs （13.0±3.2）U/L, （32±6）EU/L vs （47±9）EU/L, （135±15）μmol/L vs （176±25）μmol/L, （5.3±0.9）μmol/L vs （6.5±1.7）μmol/L］; motilin and cholecystokinin levels, mean amplitude and principal frequency of electrogastrogram in the observation group were significantly higher than those in the control group［（214±27）ng/L vs （180±32）ng/L, （131±25）ng/L vs （106±15）ng/L, （169±27）μV vs （143±13）μV, （2.89±0.37）CPM vs （2.60±0.25）CPM］(P＜0.05). Incidence of complications in the observation was significantly lower than that in the control group(P＜0.05). There were no significant differences of surgical transfer rate and mortality between the two groups(P＞0.05). Conclusion    Alprostadil is effective in treatment of SAP; it can promote the recovery of intestinal mucosa barrier function and gastrointestinal motility and reduce the incidence of complications.