甲磺酸萘莫司他持续静脉输注与持续区域性动脉输注治疗重症急性胰腺炎的疗效比较。

Comparison of the efficacy of continuous i.v. infusion versus continuous regional arterial infusion of nafamostat mesylate for severe acute pancreatitis.

作者信息

Yamamoto Tomonori, Yamamura Hitoshi, Yamamoto Hiromasa, Mizobata Yasumitsu

机构信息

Department of Trauma and Critical Care Medicine Osaka City University Osaka Japan.

Department of Disaster and Critical Care Medicine Hirosaki University Osaka Japan.

出版信息

Acute Med Surg. 2016 Jan 14;3(3):237-243. doi: 10.1002/ams2.173. eCollection 2016 Jul.

DOI:10.1002/ams2.173

PMID:29123791

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5667240/

Abstract

AIM

Continuous regional arterial infusion (CRAI) of protease inhibitors may be effective in the treatment of severe acute pancreatitis (SAP), but it is more invasive than i.v. infusion. The purpose of this study was to examine the effectiveness of continuous i.v. infusion (CIVI) for SAP compared with CRAI by unifying the dose and the administration period of nafamostat mesylate.

METHODS

This study comprised 32 patients with SAP who were divided into two groups: the CRAI group and the CIVI group. The protease inhibitor, nafamostat mesylate, was continuously infused at a rate of 200 mg/day for 5 days in both groups. Clinical outcomes including in-hospital mortality were examined.

RESULTS

There were no significant between-group differences in in-hospital mortality and 90-day mortality. The duration from admission to treatment was significantly shorter in the CIVI group (median, 7 h vs. 2 h, = 0.0001; CRAI group vs. CIVI group). The rate of mechanical ventilation was significantly less in the CIVI group than in the CRAI group (93% vs. 47%, = 0.007). The CIVI group showed a tendency toward decreased length of intensive care unit stay (median, 13 days vs. 4 days, = 0.085) and hospital stay (median, 19 days vs. 11 days, = 0.072). Total costs during hospitalization were significantly lower in the CIVI group (median, $18,320 vs. $11,641, = 0.049).

CONCLUSION

The effectiveness of CIVI with early nafamostat mesylate treatment after the development of SAP could be equivalent to, or better than, that of CRAI.

摘要

目的

蛋白酶抑制剂持续区域动脉灌注（CRAI）可能对重症急性胰腺炎（SAP）的治疗有效，但它比静脉输注更具侵入性。本研究的目的是通过统一甲磺酸萘莫司他的剂量和给药期，比较持续静脉输注（CIVI）与CRAI治疗SAP的有效性。

方法

本研究纳入32例SAP患者，分为两组：CRAI组和CIVI组。两组均以200mg/天的速率持续输注蛋白酶抑制剂甲磺酸萘莫司他，共5天。检查包括住院死亡率在内的临床结局。

结果

两组在住院死亡率和90天死亡率方面无显著组间差异。CIVI组从入院到治疗的时间显著更短（中位数，7小时对2小时，=0.0001；CRAI组对CIVI组）。CIVI组的机械通气率显著低于CRAI组（93%对47%，=0.007）。CIVI组在重症监护病房住院时间（中位数，13天对4天，=0.085）和住院时间（中位数，19天对11天，=0.072）有缩短趋势。CIVI组住院期间的总费用显著更低（中位数，18320美元对11641美元，=0.049）。