论文部分内容阅读
目的:观察通腑清胰方辅助治疗重症急性胰腺炎(SAP)的疗效及对肠黏膜屏障功能的保护作用。方法:64例SAP患者随机按数字法分为对照组和观察组各32例。两组均给予西医常规治疗。观察组在对照组基础上采用通腑清胰方,胃灌注入,1剂/d,疗程10 d。监测血清D-乳酸、二胺氧化酶(DAO)、血浆内毒素水平及尿乳果糖/甘露醇(L/M)值;记录首次排便时间、腹痛缓解时间、腹胀缓解时间及肠鸣音恢复时间;检测治疗前后血清白介素-6(IL-6)、白介素-8(IL-8)及肿瘤坏死因子-α(TNF-α)水平;检测治疗前后血浆血栓素B2(TXB2)和6-酮-前列腺素F1a(6-keto-PGF1a)水平;记录4周内急性呼吸窘迫综合征(ARDS)和多器官功能障碍综合征(MODS)发生率、中转手术率,死亡率。结果:治疗后第5、10天观察组血清D-乳酸、DAO及尿L/M值均明显下降并低于同期对照组(P<0.01);两组血浆内毒素呈升高趋势,观察组在第5、10天均低于对照组(P<0.01);观察组首次排便时间、腹痛和腹胀缓解时间,肠鸣音恢复时间均短于对照组(P<0.01);治疗后观察组血清IL-6、IL-8及TNF-α水平低于对照组(P<0.01);治疗后观察组TXB2水平低于对照组,6-keto-PGF1a水平高于对照组(P<0.01);4周内观察组ARDS、MODS的发生率分别为12.5%、9.38%,均低于对照组的37.5%和31.25%(P<0.05)。结论:通腑清胰方辅助治疗SAP,能减轻肠麻痹,促进胃肠功能恢复,减轻炎性损伤,改善微循环,保护了SAP患者肠道黏膜屏障功能,降低肠道细菌、内毒素移位,从而降低了ARDS、MODS发生率。
Objective: To observe the curative effect of Tongfu Qingyao prescription in the treatment of severe acute pancreatitis (SAP) and the protective effect on intestinal mucosal barrier function. Methods: Sixty-four SAP patients were randomly divided into control group and observation group according to the digital method. Both groups were given routine treatment of Western medicine. The observation group on the basis of the control group Tongfu Qingyao prescription, gastric perfusion, 1 / d, course of treatment 10 d. Serum D-lactate, diamine oxidase (DAO), plasma endotoxin levels and lactulose / mannitol (L / M) values were recorded. The first defecation time, abdominal pain relief time, abdominal distension time and bowel recovery time The levels of serum interleukin-6 (IL-6), interleukin-8 (IL-8) and tumor necrosis factor-α (TNF- The levels of prostaglandin F1a (6-keto-PGF1a) were recorded. The incidences of acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) within 4 weeks were recorded. Results: The levels of D-lactate, DAO and urinary L / M in the observation group decreased significantly and were lower than those in the control group on the 5th and 10th day after treatment (P <0.01). The plasma endotoxin in both groups showed an increasing tendency. The observation group (P <0.01). The first defecation time, abdominal pain, abdominal distension time and bowel sound recovery time in the observation group were shorter than those in the control group (P <0.01) The levels of IL-6, IL-8 and TNF-α in the observation group were lower than those in the control group (P <0.01). The levels of TXB2 in the observation group were lower than those in the control group, and the levels of 6-keto-PGF1a in the observation group were higher than those in the control group The incidences of ARDS and MODS in the observation group were 12.5% and 9.38% respectively in the week, which were all lower than those in the control group (37.5% and 31.25%, P <0.05). Conclusion: Tongfu Qingyao Prescription can reduce intestinal paralysis, promote gastrointestinal function recovery, reduce inflammatory injury, improve microcirculation, protect the intestinal mucosal barrier function of SAP patients and reduce intestinal bacterial endotoxin translocation , Thus reducing the ARDS, MODS incidence.