论文部分内容阅读
目的探讨柴芍承气汤灌肠辅助治疗重症急性胰腺炎(SAP)并发腹腔间隔室综合征(ACS)的临床疗效及可能的作用机制。方法 SAP并发ACS患者18例,随机分为对照组8例和治疗组10例。对照组给予常规西医治疗,治疗组在对照组治疗基础上加用柴芍承气汤灌肠,每次30 min,每日2次。两组患者均治疗7天。比较两组患者肠鸣音恢复时间、排便恢复时间、ICU住院天数。治疗前及治疗第1、4、7天检测患者腹内压、心率、心输出量、平均动脉压、血气分析指标(p H值、氧合指数、乳酸、中心静脉血氧饱和度)、气道峰压及血清胆红素、丙氨酸氨基转移酶(ALT)、血清肿瘤坏死因子α(TNF-α)水平。结果治疗组肠鸣音恢复时间(1.88±0.64)天、排便恢复时间(1.50±0.53)天、ICU住院天数(14.63±2.13)天,均显著低于对照组的(2.50±0.53)天、(2.63±0.74)天、(19.50±3.67)天(P<0.05)。治疗组治疗第1、4、7天腹内压均显著低于治疗前,对照组治疗后第4、7天亦低于本组治疗前(P<0.05或P<0.01),且治疗第1、4、7天治疗组均优于对照组(P<0.05)。治疗后两组患者心功能指标均有不同程度改善,治疗组治疗第4、7天心率、心输出量、平均动脉压及治疗第1、4、7天气道峰压改善均显著优于对照组(P<0.05或P<0.01)。治疗第1、4、7天治疗组患者血气分析各项指标均较治疗前显著改善(P<0.05或P<0.01),治疗第1、4、7天治疗组p H值、氧合指数、乳酸以及治疗第4、7天中心静脉血氧饱和度均较对照组改善显著(P<0.05或P<0.01)。治疗组患者治疗第4、7天的血清胆红素、ALT及治疗第1、4、7天的TNF-α均较治疗前显著下降(P<0.05或P<0.01),且均显著低于同时间对照组(P<0.05)。结论柴芍承气汤灌肠辅助治疗SAP合并ACS,能促进胃肠功能恢复,有效降低腹腔内压力,改善心功能,纠正酸中毒及血气状态,其作用机制可能与清除血清炎症细胞因子有关。
Objective To investigate the clinical efficacy and possible mechanism of ChaiShachhengqi Decoction in adjuvant treatment of severe acute pancreatitis (SAP) complicated with abdominal compartment syndrome (ACS). Methods 18 patients with SAP complicated with ACS were randomly divided into control group (n = 8) and treatment group (n = 10). The control group was given routine western medicine treatment. The treatment group was given Chishao Chengqi Decoction enema on the basis of the control group for 30 min twice daily. Two groups of patients were treated for 7 days. The bowel sounds recovery time, defecation recovery time and ICU stay days were compared between the two groups. Abdominal pressure, heart rate, cardiac output, mean arterial pressure, blood gas analysis index (p H value, oxygenation index, lactic acid, central venous oxygen saturation), gas Peak pressure and serum bilirubin, alanine aminotransferase (ALT), serum tumor necrosis factor alpha (TNF-α) levels. Results The bowel sounds recovery time (1.88 ± 0.64) days, defecation recovery time (1.50 ± 0.53) and ICU stay days (14.63 ± 2.13) days in treatment group were significantly lower than those in control group (2.50 ± 0.53 days, 2.63 ± 0.74) days, (19.50 ± 3.67) days (P <0.05). The treatment group on the 1st, 4th, 7th day of intra-abdominal pressure were significantly lower than before treatment, the control group 4,7 days after treatment is also lower than the group before treatment (P <0.05 or P <0.01), and the treatment of 1 , 4 and 7 days treatment group were better than the control group (P <0.05). After treatment, the cardiac function indexes of both groups improved to some extent. The heart rate, cardiac output, mean arterial pressure and the improvement of airway pressure on the 1st, 4th, 7th day after treatment in the treatment group were significantly better than those in the control group (P <0.05 or P <0.01). On the 1st, 4th and 7th day, the indexes of blood gas analysis in the treatment group were significantly improved (P <0.05 or P <0.01), the p H value, oxygenation index, Lactic acid and central venous oxygen saturation on the 4th and 7th days were significantly improved compared with the control group (P <0.05 or P <0.01). Serum bilirubin, ALT and TNF-α on the 1st, 4th, 7th day after treatment in treatment group were significantly lower than those before treatment (P <0.05 or P <0.01), and were significantly lower than At the same time, the control group (P <0.05). Conclusions ChaiShachheng Chengqi Decoction is an effective adjuvant therapy for SAP with ACS. It can promote gastrointestinal function recovery, reduce intraperitoneal pressure, improve cardiac function and correct acidosis and blood gas state. Its mechanism may be related to the removal of serum inflammatory cytokines.