预防性护理对乌司他丁治疗重症急性胰腺炎患者肝功能及血清炎症因子水平的影响

doi:10.3760/cma.j.cn441417-20240707-01025

摘要/Abstract

摘要：

目的　分析预防性护理对乌司他丁治疗重症急性胰腺炎患者肝功能及血清炎症因子水平的影响。方法　选取2020年4月至2022年4月商丘市第一人民医院收治的72例重症急性胰腺炎患者作为研究对象。采用随机数字表法，将患者分为对照组（36例）与试验组（36例）。对照组男20例，女16例；年龄21～55（38.18±1.74）岁；病程1～47（24.26±2.05）h。试验组男22例，女14例；年龄20～56（38.21±1.53）岁；病程1～48（24.19±2.12）h。对照组采用常规护理干预，试验组在对照组基础上采用预防性护理干预。两组均持续干预7 d。比较两组干预前后肝功能［丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、总胆红素（TBIL）］、血清炎症因子水平［C反应蛋白（CRP）、白细胞介素（IL）-6、IL-10、肿瘤坏死因子α（TNF-α）］、免疫功能［免疫球蛋白（Ig）G、IgA、IgM］，干预期间临床症状改善时间（腹痛、腹胀、肠鸣音、发热）、并发症发生情况（胰性脑病综合征、急性肾功能衰竭、上消化道出血等）。采用独立样本t检验和χ²检验进行统计学分析。结果　干预后，试验组血清ALT、AST、ALP和TBIL水平均低于对照组［（51.05±3.52）U/L比（80.49±5.03）U/L、（53.05±4.32）U/L比（84.01±6.92）U/L、（60.72±4.23）U/L比（75.80±6.81）U/L、（11.72±1.23）μmol/L比（18.80±1.81）μmol/L］（均P<0.05）；试验组血清CRP、IL-6和TNF-α水平均低于对照组［（39.05±3.52）mg/L比（48.49±4.03）mg/L、（42.05±3.32）μg/L比（47.01±3.92）μg/L、（30.76±4.61）ng/L比（47.01±5.26）ng/L］，IL-10高于对照组［（92.72±7.23）ng/L比（81.80±6.81）ng/L］（均P<0.05）；试验组血清IgG、IgA和IgM水平均高于对照组［（15.05±2.52）g/L比（11.49±2.03）g/L、（3.65±0.22）g/L比（3.31±0.32）g/L、（1.25±0.13）g/L比（1.20±0.11）g/L］（均P<0.05）。干预期间，试验组腹痛、腹胀、肠鸣音、发热改善时间均短于对照组［（2.58±1.22）d比（3.88±1.12）d、（3.05±1.32）d比（3.81±1.22）d、（2.45±1.06）d比（4.53±1.62）d、（3.72±1.23）d比（4.80±1.81）d］（均P<0.05）；试验组并发症总发生率低于对照组［8.33%（3/36）比36.11%（13/36）］（P<0.05）。结论　预防性护理可改善重症急性胰腺炎患者肝功能，减轻炎症反应，提高免疫功能，缩短临床症状缓解时间，减少并发症发生。

关键词:

重症急性胰腺炎, 乌司他丁, 预防性护理, 肝功能, 并发症

Abstract:

Objective　To analyze the effects of preventive nursing on liver function and serum inflammatory factors in patients with severe acute pancreatitis treated by ulinastatin. Methods　A total of 72 patients with severe acute pancreatitis admitted to Shangqiu First People's Hospital from April 2020 to April 2022 were studied, all of whom were given ulinastatin treatment. The patients were divided into a reference group and an experimental group with 36 cases in each group according to the random number table method. In the control group, there were 20 males and 16 females, aged 21-55 (38.18±1.74) years, and the course of disease was 1-47 (24.26±2.05) h. In the experimental group, there were 22 males and 14 females, aged 20-56 (38.21±1.53) years, and the course of disease was 1-48 (24.19±2.12) h. The reference group received routine nursing, and the experimental group was given preventive nursing measures on this basis for 7 d. The liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and total bilirubin (TBIL)], serum levels of inflammatory factors [C-reactive protein (CRP), interleukin-6 (IL-6), IL-10, and tumor necrosis factor α (TNF-α)], and immune function [immunoglobulin (Ig) G, IgA, and IgM] before and after intervention and improvement time of clinical symptoms (abdominal pain, abdominal distension, bowel sound, and fever) and occurrence of complications (pancreatic encephalopathy syndrome, acute renal failure, upper gastrointestinal bleeding, etc.) during intervention were compared between the two groups. Independent sample t test and χ² test were used for statistical analysis. Results　After intervention, serum ALT, AST, ALP, and TBIL levels in the experimental group were lower than those in the control group [(51.05±3.52) U/L vs. (80.49±5.03) U/L, (53.05±4.32) U/L vs. (84.01±6.92) U/L, (60.72±4.23) U/L vs. (75.80±6.81) U/L, (11.72±1.23) μmol/L vs. (18.80±1.81) μmol/L] (all P<0.05). Serum levels of CRP, IL-6, and TNF-α in the experimental group were lower than those in the control group [(39.05±3.52) mg/L vs. (48.49±4.03) mg/L, (42.05±3.32) μg/L vs. (47.01±3.92) μg/L, (30.76±4.61) ng/L vs. (47.01± 5.26) ng/L], the IL-10 level was higher than that in the control group [(92.72±7.23) ng/L vs. (81.80±6.81) ng/L] (all P<0.05). Serum IgG, IgA, and IgM levels in the experimental group were higher than those in in the control group [(15.05±2.52) g/L vs. (11.49±2.03) g/L, (3.65±0.22) g/L vs. (3.31±0.32) g/L, (1.25±0.13) g/L vs. (1.20±0.11) g/L] (all P<0.05). During the intervention, the improvement time of abdominal pain, abdominal distension, bowel sound, and fever in the experimental group were shorter than those in the control group [(2.58±1.22) d vs. (3.88±1.12) d, (3.05±1.32) d vs. (3.81±1.22) d, (2.45±1.06) d vs. (4.53±1.62) d, (3.72±1.23) d vs. (4.80±1.81) d] (all P<0.05). The total complication rate of the experimental group was lower than that of the control group [8.33% (3/36) vs. 36.11% (13/36)] (P<0.05). Conclusion　After admission of severe acute pancreatitis patients, preventive nursing can not only improve their liver function, reduce the inflammatory response of the body, but also improve their immune function, effectively shorten the time of clinical symptom remission, and reduce the incidence of complications.

Key words:

Severe acute pancreatitis, Ulinastatin, Preventive nursing, Liver function, Complications

李轶晓庞海燕赵景芹曹飞.

预防性护理对乌司他丁治疗重症急性胰腺炎患者肝功能及血清炎症因子水平的影响 [J]. 国际医药卫生导报, 2025, 31(1): 117-121.

Li Yixiao, Pang Haiyan, Zhao Jingqin, Cao Fei.

Effects of preventive nursing on liver function and serum inflammatory factors in patients with severe acute pancreatitis treated by ulinastatin [J]. International Medicine and Health Guidance News, 2025, 31(1): 117-121.

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