文章摘要
秦玉刚,贾云,易文,张强.奥曲肽及乌司他丁联合微创治疗胰周残留脓肿的临床病历分析[J].中国药事,2019,33(8):929-935
奥曲肽及乌司他丁联合微创治疗胰周残留脓肿的临床病历分析
Analysis of Clinical Medical Records of Minimally Invasive Treatment of Residual Peripancreatic Abscess by Octreotide Together with Ulinastatin
投稿时间:2019-04-08  
DOI:10.16153/j.1002-7777.2019.08.013
中文关键词: 胰周残留脓肿  胆道镜  微创  奥曲肽  乌司他丁
英文关键词: residual peripancreatic abscess  choledochoscopy  minimally treatment  octreotide  ulinastatin
基金项目:北京市科学技术委员会资助项目(编号Z181100001718087)
作者单位
秦玉刚 航天中心医院, 北京 100049 
贾云 航天中心医院, 北京 100049 
易文 航天中心医院, 北京 100049 
张强 航天中心医院, 北京 100049 
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中文摘要:
      目的:研究奥曲肽及乌司他丁在胰周残留脓肿胆道镜下清创引流术治疗中的临床疗效。方法:回顾性分析了2014年4月-2018年6月在航天中心医院住院治疗的184例胰周残留脓肿病历,按治疗不同分为对照组、奥曲肽组、乌司他丁组、联合治疗组4组。对照组在常规治疗基础上给予胆道镜清创治疗,其余三组在对照组治疗基础上分别给予醋酸奥曲肽、乌司他丁、醋酸奥曲肽联合乌司他丁治疗。比较患者体温恢复与拔引流管时间、复发率和有效率,比较各组患者白细胞计数、中性粒细胞分类计数(N%)、C反应蛋白(CRP)和血清降钙素原(PCT)以及血清TNF-α、IL-6、IL-8的改变情况。结果:联合治疗组体温恢复正常和拔除引流管的时间及有效率均明显优于对照组(2.6±0.6 d,35.7±4 d,97% vs 4.7±1.5 d,70.8±12.6 d,82.6%,P<0.05),两组比较差异有统计学意义;各组间的复发率比较无显著性差异;3个用药组的WBC计数、N%、CRP、PCT恢复正常所需时间均优于对照组,且联合治疗组又优于奥曲肽组和乌司他丁组,比较差异均有统计学意义(P<0.05);血清TNF-α、IL-6、IL-8变化,在术后第3d、第7d,联合治疗组优于对照组,各组治疗后均优于治疗前,差异均有统计学意义。治疗1周疗效评估,联合治疗组均优于对照组、奥曲肽组、乌司他丁组。结论:在胰周残留脓肿胆道镜下清创引流术治疗中,无论单用还是联合应用醋酸奥曲肽和乌司他丁,WBC计数、N%、CRP、PCT以及血清TNF-α、IL-6、IL-8恢复时间均优于不用药组且联合用药组的临床疗效优于两药单用,而用药组均优于不用药组,因此,值得推荐临床进一步实践与应用。
英文摘要:
      Objective:To analyze the clinical efficacy of octreotide together with ulinastatin in the treatment of residual peripancreatic abscess after debridement and drainage under choledochoscopy. Methods:184 cases of residual peripancreatic abscess hospitalized in the Aerospace Center Hospital from April 2014 to June 2018 were retrospectively analyzed. According to different treatments, they were divided into control group, octreotide group, ulinastatin group and combination treatment group. The control group was given choledochoscopy debridement on the basis of conventional treatment. The other three groups were treated with octreotide acetate, ulinastatin, octreotide acetate together with ulinastatin respectively on the basis of the control group treatment. The temperature recovery time, the drainage tube removal time, the recurrence rate and clinical efficacy rate of the patients were compared. The changes of WBC count, neutrophil count (N%), C reactive protein (CRP) and serum procalcitonin (PCT) and serum TNF-α, IL-6 and IL-8 of the patients in the groups were also compared. Results:The temperature recovery time, the drainage tube removal time and clinical efficacy rate of the combination group were significantly better than those of the control group (2.6±0.6 days, 35.7±4 days,97% vs 4.7±1.5 days, 70.8±12.6 days,82.6%, P<0.05). The difference between the two groups was statistically significant. There was no significant difference in recurrence rates among the groups. The time required for WBC count, N%, CRP, and PCT to return to normal in the three treatment groups was superior to that of the control group, and the combination treatment group was superior to the octreotide group and the ulinastatin group. The changes of serum TNF-α, IL-6 and IL-8 of the combination treatment group were better than those of the control group on the 3rd and 7th day after treatment. The changes after treatments of each group were better than those before treatment, and the differences were statistically significant. Efficacy of the combination group after one-week treatment was better than that of the other three groups. Conclusion:The recovery time of WBC count, N%, CRP, PCT and serum NF-d, IL-6 and IL-8 in the treatment of peripancreatic residual abscess by debridement and drainage under choledochoscopy combined with single or combination of octreotide acetate and ulinastatin was better than that of the drug-free group. The clinical efficacy of the combination group was better than the treatment of the two drugs separately used, while the drug group was better than the drug-free group. Therefore, it is worthy to carry out further clinical practice and application.
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