马骁, 唐承薇, 黄志寅, 等.抑制胃酸分泌治疗重症急性胰腺炎的前瞻性随机临床对照研究.四川大学学报(医学版),2017,48(6):933-936
抑制胃酸分泌治疗重症急性胰腺炎的前瞻性随机临床对照研究
Effect of Proton Pump Inhibitors on Severe Acute Pancreatitis a Prospective Randomized Trial
  
中文关键词:  重症急性胰腺炎质子泵抑制剂炎症介质临床评分应激性溃疡
英文关键词:Severe acute pancreatitisProton pump inhibitorsInflammatory factors Clinical scoresStress ulcers
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中文摘要:
      目的 探讨抑制胃酸分泌在重症急性胰腺炎(SAP)治疗中的作用。方法 收集2015年10月至2016年10月四川大学华西医院消化内科诊治的45例SAP患者,将患者随机分为常规治疗组(C组,21例)与常规治疗+40 mg/d艾司奥美拉唑组(C+E组,24例),疗程7 d。前瞻性比较1 d(基线)、7 d血炎症介质〔C-反应蛋白(CRP)、白介素-6(IL-6)、白介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)及降钙素原(PCT)〕,1 d(基线)、3 d、7 d的临床评分〔急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)、全身炎症反应综合征评分(SIRS评分)、改良Marshall评分〕,7 d的胃酸水平、大便便血及溃疡的发生(胃镜下)。结果 两组患者基线数据具有可比性;抑酸治疗7 d,C+E组胃内pH值高于C组(5.02±1.61 vs. 2.83±1.08, P<0.001);两组患者在血炎症介质水平、各项临床评分、应激溃疡发生及大便隐血诸方面差异均统计学意义( P>0.05)。结论 抑制胃酸不能改善SAP患者全身炎症反应程度及临床各项评分,亦益于预防应激性溃疡及消化道出血。
英文摘要:
      ObjectiveTo evaluate the effect of proton pump inhibitors (PPIs) therapy on severe acute pancreatitis (SAP) patients. MethodsForty five patients with SAP recruited in our center from October 2015 to October 2016, were randomly assigned into two groups: convention group (C group, n=21) and convention+esomeprazole group (C+E group, n=24). C+E group received esomeprazole 40 mg/d intravenously for 1 week, whereas C group only received baseline treatment. Serum C-reactive protein (CRP), interleukin-6 (IL-6) and interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α) and procalcitonin (PCT) were detected by ELISA on the first day (baseline) and the seventh day. Acute physiology and chronic health evaluation Ⅱ scores (APACHE Ⅱ), systemic inflammatory response syndrome scores (SIRS) and modified Marshall scoring system (Marshall) were obtained at 1 d (baseline), 3 d and 7 d. Upper gastrointestinal manifestation (peptic ulcer) and gastric pH were detected by endoscopic examination at 7 d. Fecal occult blood test was performed at 7 d. ResultsNo significant difference was found in CRP, IL-6, IL-8, TNF-α and PCT between the two groups ( P>0.05), also no difference in APACHE Ⅱ, SIRS and Marshall scores ( P>0.05). The gastric pH was remarkably higher in C+E group when compared to C group (5.02±1.61 vs.2.83±1.08, P<0.001). There was no significant difference in the incidence of peptic ulcer and the rate of positive fecal occult blood between the two groups. ConclusionPPIs therapy did not show benefit on alleviating systemic inflammatory response and clinical scores in SAP patients, and didn’t improve the prevention of peptic ulcer and gastrointestinal hemorrhage.
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