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[目的]观察中西医结合防治重症急性胰腺炎(SAP)肾损害的临床疗效。[方法]将86例SAP患者随机分为对照组和治疗组,各43例。均给予常规西医治疗,治疗组在此基础上用生大黄、芒硝和川芎嗪联合治疗,观察两组肾损害的主要临床指标、血浆肿瘤坏死因子α(TNFα)、白细胞介素6(IL6)、内毒素(LPS)和血管紧张素Ⅱ(ATⅡ)水平及全身炎症反应综合征(SIRS)、急性肾功能衰竭(ARF)、多功能器官综合征(MODS)发生率、病死率和平均住院天数的变化。[结果]治疗组肾损害的主要临床指标的发生率明显降低(P<0.05),血浆TNFα、IL6、LPS和ATⅡ水平明显降低(P<0.05),SIRS、ARF、MODS发生率明显减少(P<0.05),缩短了住院日(P<0.01),病死率有所下降,但差异无统计学意义。[结论]生大黄、芒硝和川芎嗪通过抑制和拮抗LPS和细胞因子,降低了ATⅡ水平,改善胰、肾微循环障碍,减轻了胰腺炎症的发展和肾损害,改善了肾功能;有效地防治SAP肾损害的发生,提高SAP的治愈率。
[Objective] To observe the clinical efficacy of integrated traditional Chinese and western medicine in prevention and treatment of severe acute pancreatitis (SAP) renal damage. [Methods] 86 patients with SAP were randomly divided into control group and treatment group, 43 cases in each. All the patients were given routine Western medical treatment. The treatment group was treated with rhubarb, mirabilite and ligustrazine. The main clinical indexes of renal injury, plasma TNF-α, IL6, The levels of endotoxin (LPS) and angiotensin Ⅱ (ATⅡ) and the incidence of systemic inflammatory response syndrome (SIRS), acute renal failure (ARF), multiple organ syndrome (MODS), mortality and average length of stay Variety. [Results] The incidence of renal damage in the treatment group was significantly lower than that in the control group (P <0.05). The levels of plasma TNFα, IL6, LPS and ATⅡ were significantly decreased (P <0.05) <0.05), shortening the length of stay (P <0.01) and decreasing the case fatality rate, but the difference was not statistically significant. [Conclusion] Rhubarb, Glauber ’s salt and Ligustrazine can reduce the level of ATⅡ, inhibit the microcirculation of pancreas and kidney, reduce the development of pancreatic inflammation and renal damage by inhibiting and antagonizing LPS and cytokines, and improve the renal function effectively. SAP kidney damage occurs, improve the cure rate of SAP.