| Objective:To evaluate curative effect of combination treatment with somatostatin and growth hormone in severe acute pancretitis , providing the more effective therapeutic regimen in order to treatment of severe acute pancretitis.Severe acute pancretitis is the chemical properties inflammation of the pancreatic enzyme activated in the pancreatic gland ,leading to pancreatic tissue autodigestion, dropsy, or necrosis,usually following many complication of multiple organ functional disturbance, secondary infection ,or pseudocyst ,and so on..It is the characteristic of complex etiopathogenisis , hazardous pathogenetic condition, progression rapidly, complication and mortality rate being high.In recent years, incidence rate of acute pancreatitis increases gradually in our country ,about 20% patients may develop SAP,even 20%～30% patients died.so,the treatment of severe acute pancreatitis was pay important attention to by exterior and interior scholar, with the investigative of pathogenesy and clinical research of severe acute pancreatitis gradually profound, the concept of therapy gradually occurrence alteration. At present, unanimous common recognition of exterior and interior scholar is that SAP should adopt combined therapy in the early period,the most major is medical treatment . Up to now pathogenesy of severe acute pancreatitis is a yet incompletely elucidation. therefore, therapeutic regimen is still stay in research. Recently investigation discover that there were usually severe immunity suppression in the evolving disease period of SAP, the direct consequence of immunity suppression is that inflammation get out of control and occur to systemic inflammatory response syndrome. if the treatment isn't in time,multiple organ dysfunction syndrome will bring about, even multiple organ failure and death. at present ,Somatostatin and analogue is generally applied medicine in clinic. But, treatment of somatostatin singly in SAP have some limitation.so many scholars proposed combination treatment with somatostatin and growth hormone in SAP in order to decrease adverse reaction,it is already become a hot spot in the treatment of SAP .Methods: The investigation involved 80 patients who received treatment from October of 2003 to February of 2007 in our department and were clinically diagnose severe acute pancreatitis. The treatment group 38 cases received combination treatment with somatostatin and growth hormone,the control group 42 cases received somatostatin singly ,The control group received traditional therapy in combination with sandostatin 0.4mg, 24 hours continuous intravenous drop infusion, continuously 7-10days. individual serious patients received stilamin 6mg,24 hours continuous intravenous drop infusion,continuously 7-10days. The treatment group received traditional therapy in combination with sandostatin 0.4mg, 24 hours continuous intravenous drop infusion, continuously 7-10days. individual serious patients received stilamin 6mg,24 hours continuous intravenous drop infusion, continuously 7-10days.and treated with growth hormone 4 units after using somatostatin 2-4 days. hypodermical injection. twice per day., continuously5-7days. the two groups had no significant difference in sex ,age, pathogenetic condition and medicative proportion of sandostatin and stilamin by statistical analysis(P>0.05),.the two groups were similar in the basic information and pathogenetic condition.Statistics adopt SPSS11.5 statistics software incalculating, comparison of measurement data adopt t test, comparison of numeration data adopt X2 test.Results: we discover the below results by clinical observation①The course of treatment of SAP with combination of somatostatin and growth hormone. the complication,operability,mortality were significantly shorter than those in control group and there were significant differences(p<0.05).The change in the APACHE II on the seventh day,fourteenth day after treatment were obviously improve compare with the control group and there were significant differences(p<0.05).The degree of pathogenetic condition quickly degrade and therapeutic efficacy was excellent.③Hospital day,extinction time of abdominal distension,the days for hemodiastase restoration were significantly different in the two groups (p<0.01), extinction time of abdominal pain was significantly different in the two groups (p<0.05). Hospital day,extinction time of abdominal distension,the days for hemodiastase restoration and extinction time of abdominal pain were significantly shorter than those in control group,it indicated that therapeutic alliance can make clinical symptom of patients to eliminate for a short time and shorten course of disease in SAP. shorten hospital day was related to decline of operability in treatment group ,because growth hormone can protect intestinal tract mucosal barrier from exempt from damaging and prevent intestinal tract microbial population from displacing,so abdominal distension can obtain the better relief.④The seventh day,the fourteenth day after treatment the level of plasma-albumin,white blood cell,blood calcium were obviously higher than those in control group and there were significant differences(p<0.01); In particular ,the change of plasma-albumin indicated that growth hormone have promote the effect ofprotein synthesis and can effectually correct hypoproteinemia, so as to promote turnover and prognosis of Pancreatic necrosis in SAP. white blood cell was obviously lower than that in control group, considering which was related to growth hormone,because growth hormone can increase power of resistance of organism , capability of defense and infextation result from microbial population interchange . Blood calcium is related to the degree of pathogenetic condition in SAP,So blood calcium is higher than that in control group, it indicated that prognosis of the treatment group was better than that in control group.⑤The process of treatment, The seventh day after treatment blood glucose was higher than that in control group and there were significant differences(p<0.05),The foueteenth day after treatment blood glucose recover normal in the treatment group and there weren't significant differences which compared between two groups (p>0.05), growth hormone is insulin rivalry hormone which can degrade carbohydrate tolerance, heighten blood glucose may relate to this. To SAP patients, islet cell is easy to be destroyed which result in blood glucose heighten, therefore, when Making use of growth hormone pay attention to side effect.conclusion: All above,combination treatment with somatostatin and growth hormone in SAP can shorten Hospital day,extinction time of abdominal pain, abdominal distension and the days for hemodiastase restoration;The change in the APACHE II can be efficiently improved; the complication,operability,mortality were significantly shorter than those in control group and improved biochemical indicator.So , the treatment of SAP with combination of somatostatin and growth hormone can obviously elevate therapeutic effect and improve, which is a kind of new effectively means and can protect many organs from harming. Then the change in the APACHE II can carry out dynamicclinical observation in SAP and can monitor prognosis. But,growth hormone have temporal effect of elevating blood glucose, paying attention to the change of the blood glucose, choiceing righe time of taking medication. |
