The Clinical Research Of Large-dose Glucocorticoid To Acute Pancreatitis Combine Systemic Inflammatory Response Syndrome

Objective: Based on observation of the clinical effectiveness about glucocorticoid in treatment of acute pancreatitis(AP) associated with systemic inflammatory response syndrome(SIRS), the objective of this paper is to analyze the role of glucocorticoid in the treatment of acute pancreatitis complicated with systemic inflammatory response syndrome, and to provide a new theoretical basis for acute pancreatitis treatment. Methods: After gathering 48 cases of patients in acute pancreatitis associated with SIRS from first affiliated hospital of Nanchang University Hospital during July 14, 2014 and February 28, 2015, the result has been found that all patients in AP associated with SIRS are meet the diagnostic standards of the Atlanta classification of acute pancreatitis of 2012, and also meet the diagnostic standards of SIRS that made by American College of Chest Physicians and Society of Critical Care Medicine(ACCP/SCCM). Then we employed a randomized trial of two groups of patients, one is group of high-dose methylprednisolone therapy(23 cases) while the other is group of conventional therapy(25 cases). The group of high-dose methylprednisolone therapy is using 1.5mg/kg/d×3days based on conventional medical treatment, in contrary, the other group of conventional therapy only use conventional medical treatment. According to the standard of MODS(Multiple organ dysfunction score), the patients with Acute Respiratory Distress Syndrome( ARDS)were given care by using a breathing machine immediately, and the patients with renal failure(kidney failure) were given care of continuous renal replacement therapy instantly, also the patients with shock were given care by using vasoactive drug as soon as possible. We observed the lasting time of multiple organ dysfunction syndrome, the variation of indicator with SIRS at different points in time during the clinical trail. Also, wecalculated the APACHE Ⅱ score and SIRS score at meanwhile, compared two groups of infection rates and length of stay in hospital patients. Result: Through the analysis on the baseline, two groups of patients showed no significant differences when they were admitted to hospital at the 1st day. 1, Variation of serum CRP in two groups of patients: Compared with the previous days, the CRP decreased significantly at the 3rd and 5th day in group of high-dose methylprednisolone therapy and group of conventional therapy after they were admitted to hospital, and the difference at the 5th day has statistical significance.(p<0.05) 2, Comparison with SIRS score and APACHEⅡ score in two groups of patients: We have observed that comparing with the previous days, the SIRS score and APACHEⅡ score decreased significantly at the 3rd and 5th day in both groups, but the difference of the two groups has no statistical significance(p>0.05). 3, The incidence of acute organ dysfunction in two groups of patients: The differences about incidence of acute respiratory failure, acute renal failure, shock, abdominal compartment syndrome and MODS between two groups of patients have no statistical significance(p>0.05). 4, The infection rate in the two groups: The infection rates decreased in both groups on the 7th day and 14 th day, but the incidence of infection at different system and different points in time has no statistical significance(p>0.05). 5, Days of stay in hospital of patients in two groups: We have observed that the group of conventional therapy stay less days in hospital than the group of high-dose methylprednisolone therapy, but the difference has no statistical significance(p>0.05).Conclusions: Using high-dose methylprednisolone for three days in the treatment of acute pancreatitis with SIRS in the early period, could decreased C-reactive protein levels in plasma at first period, further more, it does not increase the risk of infection.