低分子量肝素干预治疗重症急性胰腺炎及对TNF-α影响.doc

低分子量肝素干预治疗重症急性胰腺炎及对TNF-α影响[摘要]目的 探讨低分子量肝素（low molecular weight heparin，LMWH）干预治疗重症急性胰腺炎（ severe acute pancreatitis， SAP）患者的疗效以及对患者外周血TNF-α的影响。方法 将收治的40例SAP患者随即分为对照组和治疗组，对照组采用常规治疗方案，治疗组在常规治疗的基础上加用LMWH 100mg/kg，皮下注射，1次/12h，连续2周。比较两组患者的APACHE-II评分、治愈率、病死率、并发症以及外周血TNF-α水平。结果 与对照组相比，治疗组治愈率明显提高（P＜0.05），病死率明显下降（P＜0.05），并发症明显减少（P＜0.05），APACHE-II评分下降（P＜0.05），TNF-α水平明显下降（P＜0.05）。结论 LMWH通过减少炎症因子TNF-α，改善微循环障碍，缓解临床症状，缩短病程。 [关键词] 低分子量肝素；急性胰腺炎；TNF-α；炎症因子 [中图分类号] R576 [文献标识码] B [文章编号] 1673-9701（2011）26- 49-02 Low Molecular Weight Heparin Protects Severe Acute Pancreatitis Patients Via Lowering Tumor Necrosis Factor-α ZHANG Haiding1 YE Jihui2 1.Department of Internal Medicine，Fenghua Xikou Hospital，Fenghua 315502，China；2.ICU of the First Hospital of Ningbo City，Ningbo 315010， China [Abstract] Objective To explore the therapeutic effects of low molecular weight heparin on severe acute pancreatitis（SAP）. Methods All 40 cases of SAP randomLy divided into 2 groups. Control group（n=20） received conventional treatment. The treatment group（n=20） received low molecular weight（LMWH，100mg/kg，once/12h，2 weeks） except conventional treatment. There was no significant difference between control group and the treatment group in ordinary conditions（P＞0.05）. Results 16（80.0%）out of 20 cases were cured and 4（20.0%） died in treatment group； 13（65.0 %） out of 20 cases were cured and 7（35.0%） died in control group. The therapeutic efficacy of treatment group was superior to control group，there was significant difference between two groups（P＜0.05）. The APACHE-II point in treatment group at the fourteenth day（0.09±.0.05） were significantly lower than the control group（0.19±.0.08）（P＜0.05）. Conclusion Low molecular weight heparin protects severe acute pancreatitis patients via lowering tumor necrosis factor-α levels. [Key words] Low molecular weight；Severe acute pancreatitis；Tumor necrosis factor-α； Inflammatory factor 重症急性胰腺炎 （severe acute pancreatitis，SAP）是危重的急腹症，病死率可高达20%～30%[1]。除