目的 觀察依諾肝素鈉聯(lián)合常規(guī)方案治療重癥急性胰腺炎的臨床療效。方法 選取2015年6月-2018年6月福建省立金山醫(yī)院收治的重癥急性胰腺炎患者118例作為研究對象，采用隨機數(shù)字法將患者分為對照組（58例）、觀察組（60例）。對照組采用微量泵入注射用生長抑素，6~12 mg/d；靜脈滴注注射用泮托拉唑鈉，40 mg/次，2次/d；靜脈滴注左氧氟沙星氯化鈉注射液，0.5 g/次，1次/d，及營養(yǎng)補液治療，療程10~14 d。觀察組在對照組基礎(chǔ)上皮下注射依諾肝素鈉注射液，6 000 IU/次，1次/12 h，療程10~14 d。觀察兩組患者的臨床指標改善情況、急性生理與慢性健康評分（APACHE II）、改良Marshall評分、并發(fā)癥率、治愈率、病死率、中轉(zhuǎn)手術(shù)率及平均住院日，同時比較兩組患者治療前后的實驗室指標、胰腺損害CT評分（Balthazar-CTSI），并觀察患者的不良反應及1年的隨訪情況。結(jié)果 治療14 d后，觀察組臨床癥狀和體征改善率分別為93.33%、83.67%，而對照組分別為79.31%、70.69%，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療后，觀察組的APACHE II評分、改良Marshall評分均低于對照組，差別具有統(tǒng)計學意義（P<0.05）。治療后，觀察組的并發(fā)癥率、治愈率、病死率、中轉(zhuǎn)手術(shù)率均優(yōu)于對照組，差別具有統(tǒng)計學意義（P<0.05）；觀察組的平均住院時間明顯短于對照組，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療14 d后，兩組治療后白細胞（WBC）、血小板（PLT）、凝血酶原時間（PT）、丙氨酸氨基轉(zhuǎn)移酶（ALT）、肌酐（CRE）、血鈣、血糖、血氧分壓（pO₂）、C反應蛋白（CRP）、血淀粉酶、尿淀粉酶均較治療前改善（P<0.05），二氧化碳分壓（pCO₂）治療前后無明顯差別。其中觀察組WBC、PLT、PT、ALT、CRE、血鈣、血糖、pO₂、CRP、血淀粉酶、尿淀粉酶在治療3 d、7 d和14 d均明顯優(yōu)于對照組，差別具有統(tǒng)計學意義（P<0.05）。治療14 d后，兩組Balthazar-CTSI評分均較治療前顯著降低，同組治療前后比較差異具有統(tǒng)計學意義（P<0.05）；其中觀察組Balthazar-CTSI評分較對照組明顯減少，兩組比較差別具有統(tǒng)計學意義（P<0.05）。治療過程中，觀察組的出血、皮下瘀斑和皮下結(jié)節(jié)發(fā)生率分別為6.67%、11.67%和8.33%，均高于對照組。隨訪1年，觀察組患者癥狀反復明顯少于對照組（P<0.05）。結(jié)論 依諾肝素鈉治療重癥急性胰腺炎療效肯定，不良反應少，值得臨床推廣。

Objective To observe the clinical efficacy of enoxaparin sodium combined with conventional regimen in the treatment of severe acute pancreatitis. Methods Patients (118 cases) with acute severe pancreatitis in Fujian Provincial Hospital South Branch from June 2015 to June 2018 were randomly divided into control (58 cases) and observation (60 cases) group. Patients in the control group were microscale pumping with Somatostatin for Injection, 6-12 mg/d, iv administered with Pantoprazole Sodium for Injection, 40 mg/time, twice daily, and iv administered with Levofloxacin and Sodium Chloride Injection, 0.5 g/time, once daily. And nutritional fluid therapy, 10-14 d course of treatment. Patients in the observation group were injected with Enoxaparin Sodium Injection on the basis of the control group, 6 000 IU/time, once every 12 h, and the course of treatment was 10-14 d. Clinical indexes, APACHE II, modified Marshall score, complication rate, cure rate, case fatality rate, transit operation rate, and average such confinement in two groups were observed. At the same time, the laboratory indexes and Balthazar-CTSI before and after treatment were compared, and the adverse reactions of patients and 1 year of follow-up were observed.Results After treatment, the improvement rates of clinical symptoms and signs in the observation group were 93.33% and 83.67%, respectively, while those in the control group were 79.31% and 70.69%, respectively, the difference between two groups was statistically significant (P<0.05). After treatment, APACHE II score and modified Marshall score in the observation group were lower than those in the control group, with statistically significant differences (P<0.05). After treatment, the complication rate, cure rate, case fatality rate, and transfer operation rate in the observation group were better than those in the control group, and the differences were statistically significant (P<0.05). And the average length of stay in the observation group was significantly shorter than that in the control group, and the difference between the two groups was statistically significant (P<0.05). After 14 days of the treatment, the levels of WBC, PLT, PT, ALT, CRE, blood calcium, blood glucose, pO₂, CRP, blood amylase, and urine amylase were improved (P<0.05), there was no significant difference in pCO₂ before and after treatment. After treatment of 3, 7, and 14 d, the levels of WBC, PLT, PT, ALT, CRE, blood calcium, blood glucose, pO₂, CRP, blood amylase, and urinary amylase in the observation group were significantly better than those in the control group, with statistically significant differences (P<0.05). After treatment, Balthazar-CTSI scores in two groups were significantly decreased, and the difference before and after treatment in the same group was statistically significant (P<0.05). And the Balthazar-CTSI score in the observation group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P<0.05). During the treatment, the incidence of hemorrhage, subcutaneous ecchymosis, and subcutaneous nodules in the observation group were 6.67%, 11.67% and 8.33%, respectively, which were all higher than the control group. Followed up for 1 year, the recurrence of symptoms in the observation group was significantly less than that in the control group (P<0.05). Conclusion Enoxaparin Sodium Injection in treatment of severe acute pancreatitis has positive efficacy, less adverse reactions, worthy of clinical promotion.

R975

福建省衛(wèi)生計生青年科研課題（2017/1/29）；福建省衛(wèi)生計生中青年骨干人才培養(yǎng)項目（2017-ZQN-11）