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目的:观察清热解毒、通里攻下法联合西医治疗对重症急性胰腺炎(SAP)肠道功能及肠道微生态的影响。方法:将2014年6月~2015年6月于我院住院的94例SAP患者采用随机数字表法分为两组。对照组(47例)采用西医常规治疗,观察组(47例)在对照组的基础上加用清热解毒、通里攻下法药物煎服。通过比较两组患者的排气时间、腹胀缓解时间、肠鸣音恢复时间、住院时间等临床症状缓解情况及血清淀粉酶(AMS)、血清二胺氧化酶(DAO)及D-乳酸水平来评估患者的肠道功能;采用培养皿活菌计数法检测排泄物中肠杆菌、肠球菌、双歧杆菌及乳酸杆菌的总数,评价患者的肠道微生态情况;比较两组临床疗效。结果:观察组排气时间、腹胀缓解时间、肠鸣音恢复时间、住院时间均较对照组显著较低(P<0.05);治疗1周观察组AMS(3675.74±574.22)U/L、血浆DAO水平(4.45±0.95)U/ml较对照组(4561.78±581.37)U/L、(5.71±1.13)U/ml显著较低(P<0.05);治疗1周观察组肠杆菌总数(7.37±1.64)In/g、肠球菌(4.24±1.03)In/g总数较对照组(8.93±1.71)In/g、(5.62±1.24)In/g显著较低(P<0.05),双歧杆菌总数(6.48±1.44)In/g、乳酸杆菌总数(7.64±2.13)In/g较对照组(4.76±1.52)In/g、(5.21±1.75)In/g显著较高,差异有统计学意义(P<0.05)。结论:采用清热解毒、通里攻下法联合西医治疗SAP患者可显著改善患者的肠道功能,维持肠道微生态的稳定,提高其临床疗效。可在临床上广泛推广。
Objective: To observe the effects of clearing heat and detoxification, Tongli attacking method and western medicine on intestinal function and gut microecology in patients with severe acute pancreatitis (SAP). Methods: 94 SAP patients hospitalized in our hospital from June 2014 to June 2015 were divided into two groups according to random number table. The control group (n = 47) was treated with conventional Western medicine. The observation group (n = 47) was treated with detoxification on the basis of the control group. The clinical symptoms, such as exhaust time, abdominal distension time, bowel recovery time, length of hospital stay, and serum amylase (AMS), serum diamine oxidase (DAO) and D-lactate levels were compared The intestinal function of the patients was evaluated. The total number of Enterobacteriaceae, Enterococcus, Bifidobacteria and Lactobacilli in the feces were detected by the culture plate count of live bacteria to evaluate the intestinal microflora. The clinical curative effect was compared between the two groups. Results: The evacuation time, abdominal distension time, bowel sound recovery time and hospital stay in the observation group were significantly lower than those in the control group (P <0.05). The AMS (3675.74 ± 574.22) U / L, plasma DAO (4.45 ± 0.95) U / ml was significantly lower than that of control group (4561.78 ± 581.37) U / L, (5.71 ± 1.13) U / ml (P <0.05) ) Were significantly lower (P <0.05) than those in the control group (8.93 ± 1.71) In / g, (5.62 ± 1.24) In / g and Enterococcus (4.24 ± 1.03) 6.48 ± 1.44) In / g, the total number of Lactobacillus (7.64 ± 2.13) In / g was significantly higher than that of the control group (4.76 ± 1.52) In / g and <0.05). Conclusion: Qingrejiedu, Tongli attack combined with Western medicine treatment of SAP patients can significantly improve the patient ’s intestinal function, maintain intestinal microecological stability and improve their clinical efficacy. Can be widely promoted in the clinic.