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目的研究高渗盐水用于急性胰腺炎(AP)患者的治疗作用机制,为临床应用高渗盐水治疗AP提供理论依据。方法48例AP患者随机分为A组(24例)和B组(24例),A组在术前及术后24h输7.5%高渗盐水4ml/kg,B组则在同时点输复方氯化钠溶液,余治疗同,分别于术后1、3、5、7、10、15d测血、尿淀粉酶及白细胞计数的变化;并分别于入手术室时(T0)、术后4h(T1)、24h(T2)、36h(T3)、48h(T4)分别测定IL-6和IL-8,同时在这5个时点测平均动脉压(MAP)、心率(HR)、CVR。结果T1时A组MAP、CVP明显高于B组(P<0.05),HR组间差异无统计学意义(P>0.05);HR在T2时A组较B组低(P<0.05),MAP、CVP组间差异无统计学意义(P>0.05);T3时MAP、CVPA组明显高于B组(P<0.05),HR组间差异无统计学意义(P>0.05);T2、T3、T4时IL-6、IL-8A组明显低于B组(P<0.05),并且均低于T0时。血淀粉酶在术后15d内组间差异无统计学意义(P>0.05);尿淀粉酶在术后1周内组间差异无统计学意义(P>0.05),10d、15d时A组明显低于B组(P<0.05);而WBC自3d起A组明显低于B组(P<0.05)。结论高渗盐水可降低AP围手术期的血浆IL-6、IL-8水平,抑制全身性炎症反应,对AP伴随的全身炎症反应有肯定治疗作用。
Objective To study the therapeutic mechanism of hypertonic saline on patients with acute pancreatitis (AP) and provide a theoretical basis for the clinical application of hypertonic saline to treat AP. Methods Forty-eight AP patients were randomly divided into group A (24 cases) and group B (24 cases). A group received 7.5% hypertonic saline 4ml / kg preoperatively and 24 hours after operation, and group B Sodium solution, the remaining treatment with the same, respectively, after 1, 3, 5, 7, 10 and 15 days after the test of blood, urine amylase and leukocyte count changes; and were entered the operating room (T0), 4h IL-6 and IL-8 were measured at T1, 24h, 36h and 48h, mean arterial pressure (MAP), heart rate (HR) and CVR were measured at these five time points. Results At T1, MAP and CVP in group A were significantly higher than those in group B (P <0.05), and there was no significant difference between HR groups (P> 0.05). HR at T2 was lower in group A than in group B (P <0.05) (P> 0.05). There was no significant difference between HR group and CV group (P> 0.05) in CV and CVPA group at T3 (P> 0.05) The levels of IL-6 and IL-8A in T4 group were significantly lower than those in B group (P <0.05), and both were lower than those at T0. Blood amylase within 15 days after surgery there was no significant difference between groups (P> 0.05); urinary amylase within 1 week after surgery was no significant difference between groups (P> 0.05), 10d, 15d group A was significantly (P <0.05). However, WBC in group A was significantly lower than that in group B from 3d (P <0.05). CONCLUSION: Hypertonic saline can decrease plasma perioperative IL-6 and IL-8 levels, inhibit systemic inflammatory response and have definite therapeutic effect on systemic inflammatory response associated with AP.