清胰汤胃管注入联合血必净注射液治疗重症急性胰腺炎80例
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摘要
目的:观察清胰汤胃管注入联合血必净注射液治疗重症急性胰腺炎临床疗效。方法:将160例患者按就诊顺序随机分为对照组80例和观察组80例,2组均给予西医综合治疗,观察组加用清胰汤胃管注入合血必净注射液治疗,比较2组患者病情改善时间,治疗前后中医证候积分、白细胞(WBC)计数、血尿淀粉酶、炎症因子、肠道黏膜屏障指标水平及死亡率。结果:腹痛缓解时间、腹胀缓解时间、胃肠功能恢复时间、机械通气撤机时间2组比较,差异有统计学意义(P<0.05)。腹痛胀满、恶心呕吐、日晡潮热、口干尿赤、舌质红苔黄腻、脉洪大等中医证候积分治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05)。WBC计数和血尿淀粉酶水平治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05)。IL-6、hs-CRP、TNF-α等炎症相关因子水平治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05)。内毒素、DAO、D-乳酸等肠道黏膜功能指标水平治疗前后2组组内比较,差异有统计学意义(P<0.05);治疗后组间比较差异也有统计学意义(P<0.05)。住院期间死亡率对照组、观察组分别为7.50%(6/80)、0.00%(0/80),2组比较差异有统计学意义(P<0.05)。结论:血必净注射液合清胰汤胃管注入治疗重症急性胰腺炎可有效促进临床症状缓解,抑制白细胞和血尿淀粉酶释放,拮抗局部炎症反应水平,保护肠道黏膜功能,并有助于降低死亡风险。
Objective: To observe clinical effects of gastric tube injection of Qingyi decoction and Xuebijing injection in the treatment for severe acute pancreatitis(SAP). Methods: All 160 patients were randomized into the control group and the observation group according to the visiting order, 80 cases each group, both groups accepted comprehensive treatment of Western medicine, and the observation group were treated by Qingyi decoction and Xuebijing injection, to compare the improvement time of disease conditions, TCM syndrome scores before and after treating, WBC counting, hematuria amylase, inflammatory factor, the levels of intestinal barrier indexes and mortality rate between both groups. Results: The difference could be found in the remission time of abdominal pain,the remission time of abdominal distension, the recovery time of gastrointestinal function and the withdrawal time of mechanical ventilation(P <0.05). The difference was statistically significant in TCM syndrome scores including abdominal pain and distension, nausea and vomiting, afternoon tidal fever, dry mouth and hematuresis, red tongue,yellow and greasy fur, large and bounding pulse and others within two groups before and after treating(P<0.05); the difference showed statistical meaning between both groups after treating(P<0.05). The difference had statistical meaning in WBC counting and the levels of blood and urine amylase within two groups before and after treating(P <0.05); there was a significant difference between both groups after treating(P <0.05). The difference was statistically significant in the levels of IL-6, hs-CRP, TNF-α and others within two groups before and after treating(P<0.05); the difference had statistical meaning between both groups after treating(P<0.05). The difference had statistical meaning in the levels of the indexes related to intestinal mucosal function including endotoxin, DAO and D-lactate and others within two groups before and after treating(P<0.05); the difference had statistical meaning between both groups after treating(P<0.05). Mortality rates of the control group and the observation group during the hospitalization period were 7.50%(6/80) and 0.00%(0/80) respectively, and the difference had statistical meaning(P<0.05). Conclusion: Xuebijing injection combined with gastric tube injection of Qingyi decoction in the treatment for SAP could relieve clinical symptoms rapidly and effectively, inhibit the release of leukocyte, blood and urine amylase, fight against local inflammatory reaction, protect intestinal mocusal function, and it could help reduce the risk of death.
Objective: To observe clinical effects of gastric tube injection of Qingyi decoction and Xuebijing injection in the treatment for severe acute pancreatitis(SAP). Methods: All 160 patients were randomized into the control group and the observation group according to the visiting order, 80 cases each group, both groups accepted comprehensive treatment of Western medicine, and the observation group were treated by Qingyi decoction and Xuebijing injection, to compare the improvement time of disease conditions, TCM syndrome scores before and after treating, WBC counting, hematuria amylase, inflammatory factor, the levels of intestinal barrier indexes and mortality rate between both groups. Results: The difference could be found in the remission time of abdominal pain,the remission time of abdominal distension, the recovery time of gastrointestinal function and the withdrawal time of mechanical ventilation(P <0.05). The difference was statistically significant in TCM syndrome scores including abdominal pain and distension, nausea and vomiting, afternoon tidal fever, dry mouth and hematuresis, red tongue,yellow and greasy fur, large and bounding pulse and others within two groups before and after treating(P<0.05); the difference showed statistical meaning between both groups after treating(P<0.05). The difference had statistical meaning in WBC counting and the levels of blood and urine amylase within two groups before and after treating(P <0.05); there was a significant difference between both groups after treating(P <0.05). The difference was statistically significant in the levels of IL-6, hs-CRP, TNF-α and others within two groups before and after treating(P<0.05); the difference had statistical meaning between both groups after treating(P<0.05). The difference had statistical meaning in the levels of the indexes related to intestinal mucosal function including endotoxin, DAO and D-lactate and others within two groups before and after treating(P<0.05); the difference had statistical meaning between both groups after treating(P<0.05). Mortality rates of the control group and the observation group during the hospitalization period were 7.50%(6/80) and 0.00%(0/80) respectively, and the difference had statistical meaning(P<0.05). Conclusion: Xuebijing injection combined with gastric tube injection of Qingyi decoction in the treatment for SAP could relieve clinical symptoms rapidly and effectively, inhibit the release of leukocyte, blood and urine amylase, fight against local inflammatory reaction, protect intestinal mocusal function, and it could help reduce the risk of death.
引文
[1]吕昊泽,吕宁宁,刘仲祥.生长抑素联合乌司他丁应用于重症急性胰腺炎患者治疗对其血清炎性因子的影响[J].中国实验诊断学,2016,20(8):1315-1317.
[2]陈小燕.乌司他丁联合奥曲肽用于重症急性胰腺炎治疗的评价[J].海峡药学,2016,28(5):139-140.
[3]刘玉珍,吕志武.重症急性胰腺炎临床治疗的研究进展[J].胃肠病学和肝病学杂志,2017,26(5):589-593.
[4]韦刚,李海强,李勇.早期肠内营养结合化瘀通腑方治疗重症急性胰腺炎的临床观察[J].中国中医急症,2016,25(4):704-707.
[5]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:144.
[7]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,1995:233-236.
[8]芦波,钱家鸣.重症急性胰腺炎病因及发病机制研究进展[J].中国实用外科杂志,2012,32(7):590-592.
[9]Sathyanarayan G,Garg PK,Prasad HK,et al.Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis[J].Chin J Gastroenterol Hepatol,2007,22(4):550-553.
[10]Gulcubuk A,Altunatmaz K,Sonmez K,et al.Effects of curcumin on tumour necrosis factor-αand interleukin-6 in the late phase of experimental acute pancreatitis[J].Vet Med A,2006,53(1):49-55.
[11]Lankisch PG,Apte M,Banks PA.Acute pancreatitis[J].Lancet,2015,386(98):85-96.
[12]曹锋,李非.重症急性胰腺炎诊治现状[J].中国实用外科杂志,2012,32(7):593-595.
[13]何雷,任毅,何江,等.通腑解毒汤联合血液滤过对重症急性胰腺炎患者炎症介质及疗效的影响[J].中国现代医学杂志,2016,26(7):120-125.
[14]王勇,耿燕.大承气汤联合西药治疗重症急性胰腺炎的临床观察[J].中国中医急症,2016,25(3):507-509.
[15]倪弘,李继坤.大黄对急性胰腺炎大鼠早期的治疗作用[J].中国中西医结合外科杂志,1997,21(5):314-316.
[16]金佳佳,陈建华,杨伟刚.经皮芒硝超声导入对急性胰腺炎大鼠模型的实验研究[J].中国中医急症,2016,25(8):1471-1473.
[17]肖潮勇,张宇,王宇亮.蒲公英总多糖的提取、纯化及其体外抗炎活性分析[J].中国实验方剂学杂志,2016,31(11):25-28.
[18]邵建伟,周伟君,盛慧球,等.血必净注射液对重症急性胰腺炎治疗中炎症因子的影响[J].中国新药与临床杂志,2013,20(5):379-382.
[19]张玮,朱艳娜,刘守信.血必净治疗腹腔感染的实验研究[J].中国现代医学杂志,2017,27(12):21-24.
[2]陈小燕.乌司他丁联合奥曲肽用于重症急性胰腺炎治疗的评价[J].海峡药学,2016,28(5):139-140.
[3]刘玉珍,吕志武.重症急性胰腺炎临床治疗的研究进展[J].胃肠病学和肝病学杂志,2017,26(5):589-593.
[4]韦刚,李海强,李勇.早期肠内营养结合化瘀通腑方治疗重症急性胰腺炎的临床观察[J].中国中医急症,2016,25(4):704-707.
[5]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[6]国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994:144.
[7]中华人民共和国卫生部.中药新药临床研究指导原则[M].北京:中国医药科技出版社,1995:233-236.
[8]芦波,钱家鸣.重症急性胰腺炎病因及发病机制研究进展[J].中国实用外科杂志,2012,32(7):590-592.
[9]Sathyanarayan G,Garg PK,Prasad HK,et al.Elevated level of interleukin-6 predicts organ failure and severe disease in patients with acute pancreatitis[J].Chin J Gastroenterol Hepatol,2007,22(4):550-553.
[10]Gulcubuk A,Altunatmaz K,Sonmez K,et al.Effects of curcumin on tumour necrosis factor-αand interleukin-6 in the late phase of experimental acute pancreatitis[J].Vet Med A,2006,53(1):49-55.
[11]Lankisch PG,Apte M,Banks PA.Acute pancreatitis[J].Lancet,2015,386(98):85-96.
[12]曹锋,李非.重症急性胰腺炎诊治现状[J].中国实用外科杂志,2012,32(7):593-595.
[13]何雷,任毅,何江,等.通腑解毒汤联合血液滤过对重症急性胰腺炎患者炎症介质及疗效的影响[J].中国现代医学杂志,2016,26(7):120-125.
[14]王勇,耿燕.大承气汤联合西药治疗重症急性胰腺炎的临床观察[J].中国中医急症,2016,25(3):507-509.
[15]倪弘,李继坤.大黄对急性胰腺炎大鼠早期的治疗作用[J].中国中西医结合外科杂志,1997,21(5):314-316.
[16]金佳佳,陈建华,杨伟刚.经皮芒硝超声导入对急性胰腺炎大鼠模型的实验研究[J].中国中医急症,2016,25(8):1471-1473.
[17]肖潮勇,张宇,王宇亮.蒲公英总多糖的提取、纯化及其体外抗炎活性分析[J].中国实验方剂学杂志,2016,31(11):25-28.
[18]邵建伟,周伟君,盛慧球,等.血必净注射液对重症急性胰腺炎治疗中炎症因子的影响[J].中国新药与临床杂志,2013,20(5):379-382.
[19]张玮,朱艳娜,刘守信.血必净治疗腹腔感染的实验研究[J].中国现代医学杂志,2017,27(12):21-24.