Clinical value of alprostadil in the treatment of severe acute pancreatitis caused by hyperlipemia

Abstract

Objective To explore the clinical value of alprostadil in the treatment of hyperlipidemic severe acute pancreatitis (HSAP). Methods A prospective randomized controlled study method was used. 56 HSAP cases admitted in emergency intensive care unit (ICU)from May 2015 to November 2016 were enrolled and divided randomly into routine group and alprostadil group using random number method. All the patients in routine group received the routine conservative treatments. Alprostadil group was given both routine treatments and the intravenous injection of 20 μg alprostadil once a day for 7 days. Serum amylase, triglyceride, thromboxane A2(TXA2) and IL-6 level were detected before, 3 d and 8 d after the treatment. MCTSI score and modified Marshall score were calculated. The duration of SIRS, abdominal pain relief time, the start time of enteral nutrition, the average hospitalization days and mortality were recorded. Results There was no significant difference between the two groups on gender, age and body mass. There were no significant statistical differences between the two groups on serum amylase, triglyceride, TXA2,IL-6, MCTSI score and modified Marshall score before treatment, which were all obviously decreased after treatment, and the differences were statistically significant. Serum amylase and triglyceride levels were not statistically different between two groups on 8 days after the treatment, but TXA2 [(85.3±26.8)ng/L vs (138.3±34.3)ng/L], IL-6 [(6.99±1.85)ng/L vs (10.58±2.46)ng/L)], MCTSI score[(2.36±1.10) vs (3.21±1.37 )], and modified Marshall score [(1.99±0.57 ) vs (2.64±0.73)] were all obviously lower than those in routine group, and the differences were statistically significant (P value <0.05). The duration of SIRS [(5.02±1.81)d vs (6.79±1.17)d], abdominal pain relief time [(4.89±1.47)d vs (6.14±1.58)d], the starting time of enteral nutrition [(4.68±0.86)d vs (6.39±1.11)d], and the average hospitalization ay [(29.30±8.61)d vs (34.31±9.33)d] in alprostadil group were obviously shorter than those in routine group, and the differences were statistically significant (P value <0.05). But there was no significant difference on hospital mortality. Conclusions Alprostadil can relieve pancreatic injury, reduce organ injury and alleviate abdominal pain early, and promote the recovery of gastrointestinal function by improving pancreatic microcirculation in HSAP. Key words: Pancreatitis, acute necrotizing; Alprostadil; Hyperlipidemias; Microcirculation