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强化胰岛素治疗联合低分子肝素抗凝治疗对重症胰腺炎的影响。

Effects of intensive insulin therapy combined with low molecular weight heparin anticoagulant therapy on severe pancreatitis.

作者信息

DU Jun-Dong, Zheng Xi, Huang Zhi-Qiang, Cai Shou-Wang, Tan Jing-Wang, Li Zhan-Liang, Yao Yong-Ming, Jiao Hua-Bo, Yin Hui-Nan, Zhu Zi-Man

机构信息

Departments of Heptapobiliary Surgery, The First Affiliated Hospital to General Hospital of PLA, Beijing 100048, P.R. China.

Division Three for Senior Officers, The First Affiliated Hospital to General Hospital of PLA, Beijing 100048, P.R. China.

出版信息

Exp Ther Med. 2014 Jul;8(1):141-146. doi: 10.3892/etm.2014.1694. Epub 2014 Apr 25.

Abstract

The current study explored the effects of intensive insulin therapy (IIT) combined with low molecular weight heparin (LMWH) anticoagulant therapy on severe acute pancreatitis (SAP). A total of 134 patients with SAP that received treatment between June 2008 and June 2012 were divided randomly into groups A (control; n=33), B (IIT; n=33), C (LMWH; n=34) and D (IIT + LMWH; n=34). Group A were treated routinely. Group B received continuous pumped insulin, as well as the routine treatment, to maintain the blood sugar level between 4.4 and 6.1 mmol/l. Group C received a subcutaneous injection of LMWH every 12 h in addition to the routine treatment. Group D received IIT + LMWH and the routine treatment. The white blood cell count, hemodiastase, serum albumin, arterial partial pressure of oxygen and prothrombin time were recorded prior to treatment and 1, 3, 5, 7 and 14 days after the initiation of treatment. The intestinal function recovery time, incidence rate of multiple organ failure (MOF), length of hospitalization and fatality rates were observed. IIT + LMWH noticeably increased the white blood cell count, hemodiastase level, serum albumin level and the arterial partial pressure of oxygen in the patients with SAP (P<0.05). It markedly shortened the intestinal recovery time and the length of stay and reduced the incidence rate of MOF, the surgery rate and the fatality rate (P<0.05). It did not aggravate the hemorrhagic tendency of SAP (P>0.05). IIT + LMWH had a noticeably improved clinical curative effect on SAP compared with that of the other treatments.

摘要

本研究探讨了强化胰岛素治疗(IIT)联合低分子量肝素(LMWH)抗凝治疗对重症急性胰腺炎(SAP)的影响。选取2008年6月至2012年6月期间接受治疗的134例SAP患者,随机分为A组(对照组;n = 33)、B组(IIT组;n = 33)、C组(LMWH组;n = 34)和D组(IIT + LMWH组;n = 34)。A组采用常规治疗。B组在常规治疗基础上接受持续静脉泵入胰岛素,以维持血糖水平在4.4至6.1 mmol/l之间。C组在常规治疗基础上每12小时皮下注射一次LMWH。D组接受IIT + LMWH及常规治疗。记录治疗前及治疗开始后1、3、5、7和14天的白细胞计数、血淀粉酶、血清白蛋白、动脉血氧分压和凝血酶原时间。观察肠功能恢复时间、多器官功能衰竭(MOF)发生率、住院时间和病死率。IIT + LMWH显著提高了SAP患者的白细胞计数、血淀粉酶水平、血清白蛋白水平和动脉血氧分压(P < 0.05)。它明显缩短了肠功能恢复时间和住院时间,降低了MOF发生率、手术率和病死率(P < 0.05)。它并未加重SAP的出血倾向(P > 0.05)。与其他治疗方法相比,IIT + LMWH对SAP的临床疗效有明显改善。

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