清胰方联合肠内营养和腹腔微创引流治疗重症胰腺炎的疗效
|
摘要
目的探讨中药清胰方联合肠内营养和腹腔微创引流治疗重症胰腺炎的临床疗效。方法选择2015年1月至2017年12月就诊的急性重症胰腺炎患者120例,随机分为对照组和研究组,每组60例。对照组早期给予肠内营养和腹腔微创引流治疗,研究组在对照组基础上联合中药清胰方治疗。比较2组患者临床疗效、血浆蛋白相关指标、肠功能指标及继发脏器损伤指标变化。结果治疗组总有效率为93.33%显著高于对照组的70.00%(P<0.05);2组患者治疗前血浆蛋白相关指标(总蛋白、白蛋白、前蛋白和转铁蛋白)差异无统计学意义(P>0.05),治疗后四指标均优于治疗前,且研究组优于对照组(P<0.05);研究组患者腹痛缓解、腹胀缓解、肠鸣音缓解及肛门排便肠功能指标恢复正常时间明显短于对照组(P<0.05);研究组患者血、尿淀粉酶水平恢复正常时间明显短于对照组(P<0.05);研究组治疗中出现急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)、急性肾功能衰竭(ARF)、上消化道出血、腹腔脓肿等继发脏器损伤人数显著低于对照组(P<0.05)。结论中药清胰方联合肠内营养和腹腔微创引流治疗重症胰腺炎取得不错的临床效果,有助于改善患者的整体营养状况,促进患者肠道功能恢复,阻止内毒素、炎性因子吸收,减少继发性脏器组织损伤。
Objective To investigate the therapeutic effects of Qingyi decoction combined with enteral nutrition and minimally invasive peritoneal drainage on acute severe pancreatitis.Methods A total of 120 patients with acute severe pancreatitis who were treated in our hospital from January 2015 to December 2017 were randomly divided into control group(n=60) and research group(n=60).The patients in control group were treated by early enteral nutrition and minimally invasive abdominal drainage,however,the patients in research group,on the basis of control group, were treated by Qingyi decoction.The clinical curative effects,plasma protein related indexes,intestinal function indexes and secondary organ injury indexes were observed and compared between the two groups.Results The total effective rate in research group was 93.33%,which was significantly higher than that(70.00%) in control group(P<0.05).Before treatment there were no significant differences in plasma protein related indexes between the two groups(P<0.05).After reatment,the four indexes in both groups were superior to those before treatment,moreover,which in research group were superior to those in control group(P<0.05).In addition the recovery time of abdominal pain relief,abdominal distention relief,bowel sounds relief and anal defecation in research group was significantly shorter than that in control group(P<0.05),and the recovery time of serum and urinary amylase levels in research group was(6.1±1.4) days,(7.6±1.1) days,respectively,which in in research group was significantly shorter than that in control group(P<0.05). The numbers of patients with secondary organ injuries including acute respiratory distress syndrome(ARDS), multiple organ dysfunction syndrome(MODS),acute renal failure(ARF),upper gastrointestinal hemorrhage and abdominal abscess in research group were significantly lower than those in control group(P<0.05).Conclusion Qingyi prescription combined with enteral nutrition and minimally invasive abdominal drainage can obtain satisfactory therapeutic effects on acute severe pancreatitis,which is helpful to improve the overall nutritional status of patients,promote the recovery of intestinal function,prevent the absorption of endotoxin and inflammatory factors,and reduce secondary organ and tissue injury.
Objective To investigate the therapeutic effects of Qingyi decoction combined with enteral nutrition and minimally invasive peritoneal drainage on acute severe pancreatitis.Methods A total of 120 patients with acute severe pancreatitis who were treated in our hospital from January 2015 to December 2017 were randomly divided into control group(n=60) and research group(n=60).The patients in control group were treated by early enteral nutrition and minimally invasive abdominal drainage,however,the patients in research group,on the basis of control group, were treated by Qingyi decoction.The clinical curative effects,plasma protein related indexes,intestinal function indexes and secondary organ injury indexes were observed and compared between the two groups.Results The total effective rate in research group was 93.33%,which was significantly higher than that(70.00%) in control group(P<0.05).Before treatment there were no significant differences in plasma protein related indexes between the two groups(P<0.05).After reatment,the four indexes in both groups were superior to those before treatment,moreover,which in research group were superior to those in control group(P<0.05).In addition the recovery time of abdominal pain relief,abdominal distention relief,bowel sounds relief and anal defecation in research group was significantly shorter than that in control group(P<0.05),and the recovery time of serum and urinary amylase levels in research group was(6.1±1.4) days,(7.6±1.1) days,respectively,which in in research group was significantly shorter than that in control group(P<0.05). The numbers of patients with secondary organ injuries including acute respiratory distress syndrome(ARDS), multiple organ dysfunction syndrome(MODS),acute renal failure(ARF),upper gastrointestinal hemorrhage and abdominal abscess in research group were significantly lower than those in control group(P<0.05).Conclusion Qingyi prescription combined with enteral nutrition and minimally invasive abdominal drainage can obtain satisfactory therapeutic effects on acute severe pancreatitis,which is helpful to improve the overall nutritional status of patients,promote the recovery of intestinal function,prevent the absorption of endotoxin and inflammatory factors,and reduce secondary organ and tissue injury.
引文
1 杨尚柱,杨海清.肠内营养时机的选择对重症急性胰腺炎预后的影响.肝胆胰外科杂志,2013,25:330-333.
2 吴丹,戴洪银,汪小燕.不同早期营养支持疗法治疗重症急性胰腺炎的疗效比较.重庆医学,2011,40:1834-1836.
3 陈磊,王璐,朱振,等.早期不同肠内营养对重症急性胰腺炎肠道屏障功能及肝损害的影响.中华临床医师杂志:电子版,2013,7:1986-1990.
4 苗祥,昝建宝,宋康颉,等.早期肠内营养对重症急性胰腺炎患者血清CRP及T淋巴细胞亚群的影响.肝胆胰外科杂志,2013,25:116-118.
5 刘华桥,罗志纯,王小立.清热解毒通腑活血中药联合丹参注射液及奥曲肽对重症急性胰腺炎患者的疗效观察.临床消化病杂志,2015,27:364-367.
6 苏赛赛,鲍丽莎.大黄通便颗粒联合早期肠内营养治疗重症急性胰腺炎的临床疗效及对肠道黏膜屏障功能的影响.世界华人消化杂志,2016,24:2720-2725.
7 中国中西医结合普通外科专业委员会.重症急性胰腺炎中西医结合诊治常规(草案).中国中西医结合外科杂志,2007,14:232-237.
8 阿力木江·阿布力米提,阿不都外力·赛买提,亚力坤·赛来,等.早期肠内营养治疗对重症急性胰腺炎的疗效分析.北京医学,2015,37:238-241.
9 黄洁,秦帅,毛恩强,等.重症急性胰腺炎早期肠内营养的影响因素分析.国际外科学杂志,2010,37:158-161.
10 金忠海.不同时机肠内营养在重症急性胰腺炎治疗中的效果分析.浙江医学,2013,35:1062-1064.
11 富丽.ICU重症急性胰腺炎患者实施连续性静脉-静脉血液滤过的分析.中国医药指南,2016,14:128.
12 崔立红,王少鑫,王晓辉,等.早期应用微生态制剂对急性重症胰腺炎患者血清炎性介质水平的影响.中国新药杂志,2009,18:1854-1857.
13 陈素梅,熊光苏,吴叔明.不同时间开始的肠外营养与肠内营养对急性胰腺炎影响的对比.中华临床营养杂志,2012,20:363-368.
14 文静,陈义华,王农荣.中心静脉导管腹腔引流在重症急性胰腺炎中的应用.江西医药,2015,50:138-140.
15 胡军涛,潘熠平,汤展宏,等.早期经鼻肠内营养在重症急性胰腺炎治疗中的临床价值.重庆医学,2013,42:1806-1808.
16 李秀云,邓先明,冯敏.早期肠内营养对22例重症急性胰腺炎预后的影响.中国现代普通外科进展,2009,12:1090-1091.
17 许春芳,黄晓曦,沈云志,等.肠内营养与肠外营养对重症急性胰腺炎患者肠屏障功能影响的比较.中华内科杂志,2011,50:370-373.
18 骆一舟,陈尚武,赏仲兔.早期肠内外营养支持对急性重症胰腺炎的临床价值探讨.中国全科医学,2010,13:1980-1982.
19 Majdoub A,Bahloul M,Ouaz M,et al.Severe acute biliary pancreatitis requiring intensive careunit admission:evaluation of severity score for the prediction of morbidity and moatality.Int Crit Illn Inj Sci,2016,6:155-156.
20 汪翊,张宇,黄子星,等.重症急性胰腺炎高压的临床诊疗与影像学研究现状.放射学实践,2017,32:292-297.
21 曹秀梅,安舞凤.大黄临床新用途及其作用机理.承德医学院学报,2003,20:253-255.
22 Ni Q,Zhang W,Sun K,et al.In vitro effects of emodin on peritoneal macrophage intercellular adhesion molecule3 in a rat model of severe acute pancreatitis systemic inflammatory response syndrome.Biomedical Reports,2014,2:63-68.
23 朱雅碧,栾双梅.肠内营养联合大黄对重症急性胰腺炎的临床疗效分析.浙江实用医学,2011,16:34-35.
24 卢杰夫,黎波,彭卓嵛,等.早期空肠内营养联合中药肠内滴注对重症急性胰腺炎患者肠麻痹的改善作用.世界华人消化杂志,2011,19:1257-1262.
25 梅礼强,周世冀,唐先斌,等.大柴胡汤加减方治疗急性重症胰腺炎 25 例.世界华人消化杂志,2011,19:407-409.
26 高建波,唐卫东.通腑清胰方辅助治疗重症急性胰腺炎的临床疗效及对肠道黏膜屏障功能和免疫功能的影响.中药材,2015,38:1546-1549.
2 吴丹,戴洪银,汪小燕.不同早期营养支持疗法治疗重症急性胰腺炎的疗效比较.重庆医学,2011,40:1834-1836.
3 陈磊,王璐,朱振,等.早期不同肠内营养对重症急性胰腺炎肠道屏障功能及肝损害的影响.中华临床医师杂志:电子版,2013,7:1986-1990.
4 苗祥,昝建宝,宋康颉,等.早期肠内营养对重症急性胰腺炎患者血清CRP及T淋巴细胞亚群的影响.肝胆胰外科杂志,2013,25:116-118.
5 刘华桥,罗志纯,王小立.清热解毒通腑活血中药联合丹参注射液及奥曲肽对重症急性胰腺炎患者的疗效观察.临床消化病杂志,2015,27:364-367.
6 苏赛赛,鲍丽莎.大黄通便颗粒联合早期肠内营养治疗重症急性胰腺炎的临床疗效及对肠道黏膜屏障功能的影响.世界华人消化杂志,2016,24:2720-2725.
7 中国中西医结合普通外科专业委员会.重症急性胰腺炎中西医结合诊治常规(草案).中国中西医结合外科杂志,2007,14:232-237.
8 阿力木江·阿布力米提,阿不都外力·赛买提,亚力坤·赛来,等.早期肠内营养治疗对重症急性胰腺炎的疗效分析.北京医学,2015,37:238-241.
9 黄洁,秦帅,毛恩强,等.重症急性胰腺炎早期肠内营养的影响因素分析.国际外科学杂志,2010,37:158-161.
10 金忠海.不同时机肠内营养在重症急性胰腺炎治疗中的效果分析.浙江医学,2013,35:1062-1064.
11 富丽.ICU重症急性胰腺炎患者实施连续性静脉-静脉血液滤过的分析.中国医药指南,2016,14:128.
12 崔立红,王少鑫,王晓辉,等.早期应用微生态制剂对急性重症胰腺炎患者血清炎性介质水平的影响.中国新药杂志,2009,18:1854-1857.
13 陈素梅,熊光苏,吴叔明.不同时间开始的肠外营养与肠内营养对急性胰腺炎影响的对比.中华临床营养杂志,2012,20:363-368.
14 文静,陈义华,王农荣.中心静脉导管腹腔引流在重症急性胰腺炎中的应用.江西医药,2015,50:138-140.
15 胡军涛,潘熠平,汤展宏,等.早期经鼻肠内营养在重症急性胰腺炎治疗中的临床价值.重庆医学,2013,42:1806-1808.
16 李秀云,邓先明,冯敏.早期肠内营养对22例重症急性胰腺炎预后的影响.中国现代普通外科进展,2009,12:1090-1091.
17 许春芳,黄晓曦,沈云志,等.肠内营养与肠外营养对重症急性胰腺炎患者肠屏障功能影响的比较.中华内科杂志,2011,50:370-373.
18 骆一舟,陈尚武,赏仲兔.早期肠内外营养支持对急性重症胰腺炎的临床价值探讨.中国全科医学,2010,13:1980-1982.
19 Majdoub A,Bahloul M,Ouaz M,et al.Severe acute biliary pancreatitis requiring intensive careunit admission:evaluation of severity score for the prediction of morbidity and moatality.Int Crit Illn Inj Sci,2016,6:155-156.
20 汪翊,张宇,黄子星,等.重症急性胰腺炎高压的临床诊疗与影像学研究现状.放射学实践,2017,32:292-297.
21 曹秀梅,安舞凤.大黄临床新用途及其作用机理.承德医学院学报,2003,20:253-255.
22 Ni Q,Zhang W,Sun K,et al.In vitro effects of emodin on peritoneal macrophage intercellular adhesion molecule3 in a rat model of severe acute pancreatitis systemic inflammatory response syndrome.Biomedical Reports,2014,2:63-68.
23 朱雅碧,栾双梅.肠内营养联合大黄对重症急性胰腺炎的临床疗效分析.浙江实用医学,2011,16:34-35.
24 卢杰夫,黎波,彭卓嵛,等.早期空肠内营养联合中药肠内滴注对重症急性胰腺炎患者肠麻痹的改善作用.世界华人消化杂志,2011,19:1257-1262.
25 梅礼强,周世冀,唐先斌,等.大柴胡汤加减方治疗急性重症胰腺炎 25 例.世界华人消化杂志,2011,19:407-409.
26 高建波,唐卫东.通腑清胰方辅助治疗重症急性胰腺炎的临床疗效及对肠道黏膜屏障功能和免疫功能的影响.中药材,2015,38:1546-1549.