血必净注射液对重症急性胰腺炎患者血清il-6 tnf-α及bun cr影响的研究-effect of xuebijing injection on serum il - 6 tnf - α and bun cr in patients with severe acute pancreatitis.docx

目录中文摘要···········································································································1英文摘要···········································································································4英文缩写···········································································································7研究论文血必净注射液对重症急性胰腺炎患者血清IL-6、TNF-α及BUN、Cr影响的研究前言8材料与方法······························································································10结果··········································································································13附表··········································································································14讨论··········································································································16结论··········································································································20参考文献·································································································21综述炎症介质及细胞因子在重症急性胰腺炎中的作用机制及对血BUN、Cr影响24致谢··················································································································33个人简历········································································································34血必净注射液对重症急性胰腺炎患者血清IL-6、TNF-α及BUN、Cr影响的研究摘要目的：重症急性胰腺炎(Severeacutepancreatitis,SAP)发病急骤，病情变化迅速，进展快，死亡率高，患者常因多脏器功能衰竭（MultipleOrganDysfunctionSyndrome，MODS）以及严重感染而死亡。SAP在急性反应初期，即发生全身炎性反应综合症（SIRS），并且在发病机制和疾病发展过程中发挥重要作用，而全身炎性反应综合症其启动因子为炎症因子，如白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)。同时常于初期伴发血清尿素氮（BUN）、肌酐(Cr)水平升高。其发病机制常与患者的肾细胞缺血缺氧、炎症因子释放、细菌毒素移位及细胞因子被激活后对肾脏皮髓质细胞内膜及肾小管的损伤有关，同时还与肾素-血管紧张素系统激活和微循环系统血流动力学变化障碍有关。如未及时采取有效治疗措施常常导致全身炎性反应综合症加重及包括急性肾损伤在内的多脏器功能障碍，是SAP患者预后不良的重要因素之一。但是炎症因子是如何互相作用并推动胰腺炎病程的循序演进及远隔脏器并发症产生的详细机制尚不十分清楚。临床治疗针对脏器损伤采用功能保护和功能支持，细胞因子免疫调节及血液滤过等也在探索研究中，针对微循环障碍、炎性介质释放和细胞因子作用等发病机制进行深入研究，力求及早阻断MODS的发生，促进机体机能快速康复。因此，临床医生应加强对重症急性胰腺炎血清中白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和血清尿素氮（BUN）、肌酐（Cr）水平的早期监测，加强认识，提高警惕，早期诊断，早期治疗，避免可能加