通里攻下中药联合早期肠内营养治疗急性重症胰腺炎临床研究
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摘要
目的探讨通里攻下中药联合早期肠内营养治疗急性重症胰腺炎的临床疗效与作用机制。方法选择新乐市医院消化内科2015年1月至2018年1月诊断的急性重症胰腺炎患者120例,按信封法随机分为中药组和对照组,各60例。对照组患者予常规治疗,中药组患者在对照组治疗基础上给予通里攻下中药鼻饲,疗程均为2周。结果中药组总有效率为83. 33%,明显高于对照组的53. 33%(P <0. 05);治疗后,两组患者血清内毒素、D-乳酸、二胺氧化酶活性、降钙素原(PCT)、血淀粉酶、血清超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均显著下降(P <0. 05),且中药组下降幅度高于对照组(P <0. 05);中药组血浆白蛋白、前白蛋白水平升高,急性生理学与慢性健康状况评分、葡萄糖氢呼气试验总产氢量均下降,重度胃肠功能不良发生率与腹内压水平均降低,且与对照组比较差异显著(P <0. 05)。结论通里攻下中药联合肠内营养治疗急性重症胰腺炎可显著改善患者的肠道功能,可能与保护胃肠道黏膜屏障、抑制肠道内细菌过度生长和降低血清炎性反应机制有关。
Objective To investigate the clinical effect of Tongli Gongxia( TLGX) herbs combined with early enteral nutrition in the treatment of acute severe pancreatitis and its mechanism. Methods Totally 120 patients with severe acute pancreatitis diagnosed in Department of Gastroenterology of Xinle Hospital from January 2015 to January 2018 were selected and randomly divided into the traditional Chinese medicine( TCM) group and the control group according to the envelope method, 60 cases in each group. The patients in the control group were given routine treatment,on this basis,the patients in the TCM group were given TCM nasal feeding with TLGX herbs. The course of treatment was 2 weeks. Results The total effective rate of the TCM group was 83. 33%,which was significantly higher than 53. 33% of the control group( P < 0. 05). After treatment, the levels of serum endotoxin, D-lactate, diamine oxidase activity, procalcitonin( PCT), blood amylase, serum hs-CRP, interleukin-6( IL-6) and tumor necrosis factor-α( TNF-α) in the two groups were significantly decreased than those before treatment( P < 0. 05),and the decrease of the TCM group was higher than that of the control group( P < 0. 05). In the TCM group, the levels of plasma albumin and prealbumin were increased, the APACHE Ⅱ score and the total hydrogen production in glucose hydrogen breath test were decreased, and the incidence of severe gastrointestinal dysfunction and intra-abdominal pressure level were decreased,and the difference between the two groups was significant( P < 0. 05). Conclusion TLGX herbs combined with enteral nutrition can significantly improve the intestinal function of patients with acute severe pancreatitis,which may be related to the mechanism of protecting gastrointestinal mucosal barrier,inhibiting intestinal bacterial overgrowth and reducing serum inflammatory reaction.
Objective To investigate the clinical effect of Tongli Gongxia( TLGX) herbs combined with early enteral nutrition in the treatment of acute severe pancreatitis and its mechanism. Methods Totally 120 patients with severe acute pancreatitis diagnosed in Department of Gastroenterology of Xinle Hospital from January 2015 to January 2018 were selected and randomly divided into the traditional Chinese medicine( TCM) group and the control group according to the envelope method, 60 cases in each group. The patients in the control group were given routine treatment,on this basis,the patients in the TCM group were given TCM nasal feeding with TLGX herbs. The course of treatment was 2 weeks. Results The total effective rate of the TCM group was 83. 33%,which was significantly higher than 53. 33% of the control group( P < 0. 05). After treatment, the levels of serum endotoxin, D-lactate, diamine oxidase activity, procalcitonin( PCT), blood amylase, serum hs-CRP, interleukin-6( IL-6) and tumor necrosis factor-α( TNF-α) in the two groups were significantly decreased than those before treatment( P < 0. 05),and the decrease of the TCM group was higher than that of the control group( P < 0. 05). In the TCM group, the levels of plasma albumin and prealbumin were increased, the APACHE Ⅱ score and the total hydrogen production in glucose hydrogen breath test were decreased, and the incidence of severe gastrointestinal dysfunction and intra-abdominal pressure level were decreased,and the difference between the two groups was significant( P < 0. 05). Conclusion TLGX herbs combined with enteral nutrition can significantly improve the intestinal function of patients with acute severe pancreatitis,which may be related to the mechanism of protecting gastrointestinal mucosal barrier,inhibiting intestinal bacterial overgrowth and reducing serum inflammatory reaction.
引文
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[11]刘晓颖,陈尔真.重症急性胰腺炎的严重度与风险评估[J].国际外科学杂志,2011,38(3):166-169.
[2]杨明,王春友.急性胰腺炎诊治的历史变迁与发展趋势[J].临床外科杂志,2015,23(3):165-167.
[3]焦旭,卢云.中医药治疗急性胰腺炎的临床进展[J].中国中医急症,2016,25(10):1922-1924.
[4]石慧荣,唐国都,梁志海.重症急性胰腺炎肠内营养治疗的时机[J].国际消化病杂志,2014,34(2):96-98.
[5]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].临床外科杂志,2015,23(1):1-3.
[6]王勇峰,熊光苏,高琴琰.肠内营养对重症急性胰腺炎患者小肠细菌过度生长抑制作用的临床评估[J].胃肠病学,2010,15(4):222-224.
[7]陈波.中西医结合治疗重症急性胰腺炎[J].中国药业,2007,16(15):62-64.
[8]黄家财,卢文生.急性胰腺炎患者血浆降钙素原的变化及其意义[J].内科,2012,7(5):463-464.
[9]彭春燕,韩真. C反应蛋白、血钙和胸腔积液对急性胰腺炎早期预后的评估[J].皖南医学院学报,2013,32(3):213-215.
[10]苗利辉,宋青,刘辉,等.白细胞介素-6对重症急性胰腺炎早期判别预后的作用研究[J].中华危重病急救医学,2013,25(4):238-240.
[11]刘晓颖,陈尔真.重症急性胰腺炎的严重度与风险评估[J].国际外科学杂志,2011,38(3):166-169.