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目的探讨生大黄联合丹参酮ⅡA磺酸钠和奥曲肽治疗急性胰腺炎(acute pancreatitis,AP)的临床效果。方法选择2013年6月—2015年6月收治的112例AP患者作为研究对象,随机分为对照组和观察组各56例。对照组予静脉滴注奥曲肽和丹参酮ⅡA磺酸钠治疗,1次/d;观察组在对照组治疗基础上行常规胃肠减压,从胃管注入生大黄10 g,1次/d,同时给予抗感染治疗。两组均以10 d为一个疗程。比较两组临床疗效、主要症状改善时间、血尿淀粉酶恢复正常时间、住院时间、住院费用、炎性因子及不良反应发生情况。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ2检验,P<0.05为差异有统计学意义。结果治疗后,观察组总有效率为94.64%,明显优于对照组的80.36%,差异有统计学意义(P<0.05)。观察组腹痛腹胀消失时间、体温恢复正常时间、首次排便时间、呕吐消失时间分别为(2.32±0.53)、(2.69±0.58)、(1.06±0.30)、(2.15±0.43)d,均优于对照组的(2.91±0.48)、(3.22±0.48)、(1.23±0.22)、(2.36±0.51)d,差异均有统计学意义(均P<0.05)。治疗后,观察组与对照组炎性因子CRP、IL-6和TNF-α水平分别为(19.38±4.51)mg/L、(0.18±0.09)、(3.73±0.48)g/L、(26.54±4.98)mg/L、(0.32±0.12)、(4.06±0.41)g/L,均优于治疗前的(132.62±6.78)mg/L、(0.57±0.23)、(12.25±0.58)g/L、(133.83±7.23)mg/L、(0.62±0.21)、(12.31±0.56)g/L,差异均有统计学意义(均P<0.05)。两组治疗后各炎症因子水平比较差异均有统计学意义(均P<0.05)。观察组不良反应发生率为17.86%,低于对照组的46.43%,差异有统计学意义(P<0.05)。结论生大黄联合丹参酮ⅡA磺酸钠和奥曲肽治疗AP安全有效,能明显改善患者胃肠功能状态、临床症状及生化指标,降低炎症反应,不良反应及并发症较少,值得临床推广使用。
Objective To investigate the clinical effects of rhubarb combined with tanshinone Ⅱ A sulfonate and octreotide in the treatment of acute pancreatitis (AP). Methods One hundred and twelve patients with AP who were admitted to our hospital from June 2013 to June 2015 were randomly divided into control group and observation group of 56 patients. The control group was given intravenous infusion of octreotide and sodium tanshinone Ⅱ A sulfonate once a day. In the control group, conventional gastrointestinal decompression was performed on the basis of the control group. The rhubarb was injected into the gastric tube 10 g once a day, Anti-infective treatment. Both groups were 10 days for a course of treatment. The clinical curative effect, main symptom improvement time, hematuria amylase recovery time, hospitalization time, hospitalization expenses, inflammatory factors and adverse reactions were compared between the two groups. Measurement data were compared between groups using t test, the group was compared using paired t test, count data using χ2 test, P <0.05 for the difference was statistically significant. Results After treatment, the total effective rate of the observation group was 94.64%, which was significantly better than that of the control group (80.36%), the difference was statistically significant (P <0.05). The disappearance time of abdominal distension, the normal time of body temperature recovery, the time of first defecation and the disappearance of vomit in observation group were (2.32 ± 0.53), (2.69 ± 0.58), (1.06 ± 0.30) and (2.15 ± 0.43) d respectively, (2.91 ± 0.48), (3.22 ± 0.48), (1.23 ± 0.22) and (2.36 ± 0.51) d respectively. There were significant differences between the two groups (all P <0.05). After treatment, the levels of CRP, IL-6 and TNF-αin the observation group and the control group were (19.38 ± 4.51) mg / L, (0.18 ± 0.09), (3.73 ± 0.48) g / L, 4.12), (4.98) mg / L, (0.32 ± 0.12) and (4.06 ± 0.41) g / L respectively, which were all better than those before treatment (132.62 ± 6.78 mg / , (133.83 ± 7.23) mg / L, (0.62 ± 0.21) and (12.31 ± 0.56) g / L respectively, all with statistical significance (all P <0.05). The levels of inflammatory cytokines in both groups after treatment were significantly different (all P <0.05). The incidence of adverse reactions in the observation group was 17.86%, lower than 46.43% in the control group, the difference was statistically significant (P <0.05). Conclusion Rhubarb combined with tanshinone Ⅱ A sulfonate and octreotide in the treatment of AP is safe and effective. It can significantly improve gastrointestinal function, clinical symptoms and biochemical indexes, reduce inflammatory reaction, fewer adverse reactions and fewer complications. It is worthy of clinical promotion.