Effect of Ulinastation on intra-abdominal hypertension and intestinal mucosa barrier in older patients with severe acute pancreatitis

Abstract

Abstract: AIM: To study the effect of Ulinastation(UTI) on intra-abdominal hypertension(IAP) and intestinal mucosa barrier in older patients with severe acute pancreatitis.METHODS: To divide 48 older patients with severe acute pancreatitis into treatment group(n=24) and contral group(n=24) randomly, including continuous blood purification(CBP).Both treatment group and control group were given conventional therapy,and ulinastatin was added to the treatment group. The changes of intra-abdominal pressure, IL-6,DAO, IgA were observed and compared in 24 and 48 hours.RESULTS: The level of IAP before treatment was (17.45±1.87)mm Hg, which was positively associated with the level of IL-6(P＜0.01). The intra-abdominal pressure,IL-6, DAO level were decreased and IgA was increased significantly in both groups after treatment(P＜0.01). Compared with the control group, there were no significant difference between these results and those of control group before treatment,but significantly the intra-abdominal pressure,IL-6, DAO level were decreased and IgA was increased significantly at 48 hours and IL-6 was decreased at 24 hours after treatment(P＜0.01). CONCLUSION: The conventional therapy plus ulinastatin for older patients with acute acute pancreatitis can improve intra-abdominal hypertension and shelter the function of intestinal mucosa by anti-inflammatory effect.

Key words: Ulinastation, Older patient, Severe acute pancreatitis, Function of intestinal mucosa , , , ,

CLC Number:

R657.5⁺1

MA Jing, GU Pei-yu,YU Zhui. Effect of Ulinastation on intra-abdominal hypertension and intestinal mucosa barrier in older patients with severe acute pancreatitis[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2011, 16(1): 93-97.

References

[1] 杨振林,郑树森,朱峰,等.两种不同途径应用乌司他丁治疗重症胰腺炎的疗效观察[J].中华肝胆外科杂志,2005, 11(2):101-103.
[2] 张明智,雷敏.乌司他汀联合生长抑素治疗急性胰腺炎疗效观察[J]. 中国医药导报, 2009, 4(10) :194-195.
[3] 曾连山,陈念平,林木生,等.乌司他丁治疗急性胰腺炎的临床疗效评价[J]. 中国临床药理学与治疗学,2004, 9(7):828-830.
[4] Leppaniemi A, Johansson K, De Waele JJ, et al. Secondary abdominal compartment syndrome and acute pancreatitis[J]. Acta Ckin Belg Suppl, 2007, (1): 131-135.
[5] Seiler CA, Brugger L, Forssmann U, et al. Conservative surgical treatment of diffuse peritonitis[J]. Surgery, 2000, 127(2): 178-184.
[6] 中华医学会外科学会胰腺学组. 急性胰腺炎的临床诊断及分级标准[J].中华外科杂志,1997, 35(12): 773.
[7] 黎君友, 吕艺, 付小兵,等. 二胺氧化酶在创伤后肠道损伤中变化及意义[J]. 中国危重病急救医学, 2000, 12(8): 482-484.
[8] Inagaki T, Hoshino M, Hayahawa T, et al. Interleukin -6 is a useful maker for early prediction of the severity of acute pancreatitis[J]. Pancreatitis, 1997, 14:1-8.
[9] Varela JE, Cohn SM, Giannotti GD, et al. Near- infrared spectroscopy reflects changes in mesenteric and systemic perfusion during abdominal compartment syndrome[J]. Surgery, 2001, 129(3): 363.
[10]Diebel LN, Wilson RF, Dulchavsky SA. Effect of increased intraabdominal pressure on heptatic arterial and intestinal mucosal blood flow[J]. J Trauma, 1992, 8, 33(2): 279-283.
[11]程君涛, 李小毅, 冯智,等. 腹内高压对肠黏膜氧化还原状态的影响[J]. 世界华人消化杂志,2009, 9, 17(26): 2673-2678.
[12]程君涛,肖光夏,夏培元,等. 腹内高压对兔肠道通透性及内毒素细菌移位的影响[J]. 中华烧伤杂志,2003, 8, 19(4): 229-232.
[13]Odi J, Ivatury RR, Blocher CR, et al. Amplified Cytokine response and lung injury by sequential hemorrhagic shock and abdominal compartment syndrome in a laboratory model of ischemiq-reperfusion[J]. J Trauma,2002, 52(4): 625-631; discussion 632.
[14]Oda S, Hirasawa H, Shiga H, et al. Management of intra-abdominal hypertension in patients with severe acute pancreatitis with continuous hemodiafiltration using a polymethyl methacrylate membrane hemofilter[J]. Ther Apher Dial,2005, 9(4): 355-361.
[15]上海乌司他丁临床试验协作组. 国产乌司他丁治疗急性胰腺炎的多中心临床研究[J]. 中华消化杂志, 2001, 21(5): 293.
[16]Sato Y,Ishiwaka S.Otaki A,et a1.Induction of acute-phase reactive substances during openheart surgery and eficacy to ulinastating inhibiting cytokines and postoperative organ injury[J]. J Thorac Cardiovasc Surg, 2000, 48 (7): 1005-1009.
[17]于金贵, 周广利, 孟冬梅,等. 乌司他丁对心脏直视手术患者围体外循环期炎性细胞因子和自由基的影响[J]. 中华麻醉学杂志, 2001, 21(12):724-726.