本文選題：重癥急性胰腺炎 + 大黃　； 參考：《安徽醫(yī)科大學(xué)》2013年碩士論文

【摘要】：目的比較經(jīng)鼻空腸管和經(jīng)胃管途徑注入生大黃對SAP患者炎癥反應(yīng)、生化指標及臨床指標影響的差異，探討經(jīng)鼻空腸途徑注入生大黃治療SAP的療效。 方法選取安徽醫(yī)科大學(xué)附屬安慶醫(yī)院2010年8月至2013年2月期間收治的45例SAP患者為研究對象。將45例患者隨機分為實驗組(N=23例)、對照組（N=22例），所有患者均在入院1h內(nèi)放入胃管或鼻空腸導(dǎo)管，兩組患者均給予SAP的一般基礎(chǔ)治療，包括吸氧、重癥監(jiān)護、禁食禁水、胃腸減壓、抑酸、抑酶、補液擴容、糾正水電解質(zhì)酸堿平衡紊亂、應(yīng)用抗生素預(yù)防感染、芒硝持續(xù)外敷、解痙止痛、營養(yǎng)支持等綜合治療，實驗組經(jīng)鼻空腸管途徑注入生大黃，對照組經(jīng)胃管途徑注入生大黃。觀察比較兩組患者入院1d,7d時急性生理學(xué)與慢性健康狀況評分系統(tǒng)Ⅱ評分（APACHE-Ⅱ評分），Balthazar CT積分，血清IL-1,IL-6,細菌內(nèi)毒素水平，外周血白細胞計數(shù)，血清CRP、血淀粉酶恢復(fù)正常時間，肛門恢復(fù)排氣排便時間，并發(fā)癥發(fā)生率的差異，分析經(jīng)鼻空腸管注入生大黃治療SAP的療效。 結(jié)果（1）實驗組血清CRP、血清淀粉酶恢復(fù)時間為[（6.74±1.42）d、（5.78±1.04）d],對照組為[（8.00±1.63）d、（6.82±1.22）d]，實驗組血清CRP、血淀粉酶恢復(fù)時間明顯早于對照組（P0.05）。（2）實驗組肛門恢復(fù)排氣排便時間為（3.30±0.97）d，對照組為（4.68±0.89）d，實驗組肛門恢復(fù)排氣排便時間明顯早于對照組（P0.05）。（3）治療7d時實驗組APACHE-Ⅱ評分為（4.48±1.44），對照組為（5.32±1.04），實驗組的APACHE-Ⅱ評分明顯低于對照組；實驗組下降幅度為（6.26±2.86），對照組下降幅度為（4.77±1.77），實驗組的下降幅度明顯大于對照組。治療7d時實驗組Balthazar CT積分為（2.57±1.38），對照組為（2.95±1.05），兩組比較無明顯差異（P0.05），，實驗組下降幅度為（3.04±2.10），對照組下降幅度為（2.36±1.50），實驗組下降幅度和對照組相比無明顯差異（P0.05），（4）治療7d時實驗組血清IL-1、IL-6、細菌內(nèi)毒素為[（28.76±7.36）pg/ml、（33.56±8.13）pg/ml、（21.03±13.67）pg/ml],對照組為[（34.80±7.71）pg/ml、（38.33±6.42）pg/ml、（33.25±14.15）pg/ml]（P0.05），實驗組的IL-1、IL-6、細菌內(nèi)毒素水平明顯低于對照組（P0.05）；且兩組和入院時相比均明顯降低（P0.05）。治療組的IL-1、IL-6、細菌內(nèi)毒素下降幅度分別為[（30.00±10.65）pg/ml、（38.30±9.41）pg/ml、（97.96±28.12）pg/ml]，對照組為[（19.13±7.94）pg/ml、（28.58±11.19）pg/ml、（78.37±26.94）pg/ml]（P0.05），實驗組的下降幅度明顯大于對照組（P0.05）。（5）治療7d時實驗組外周血白細胞計數(shù)為（12.28±2.28）×109/L，對照組為（16.53±2.48）×109/L，實驗組白細胞計數(shù)明顯低于對照組（P0.05）。（6）實驗組并發(fā)癥發(fā)生率為21.7%，對照組并發(fā)癥發(fā)生率為50.0%，實驗組的并發(fā)癥發(fā)生率明顯低于對照組（P0.05）。 結(jié)論（1）經(jīng)鼻空腸管途徑注入生大黃治療SAP可使患者血清CRP、血淀粉酶酶較早恢復(fù)正常。（2）經(jīng)鼻空腸管途徑注入生大黃治療SAP可早期消除腸麻痹、恢復(fù)腸道功能。（3）經(jīng)鼻空腸管途徑注入生大黃治療SAP可降低患者APACHE-Ⅱ評分，但對降低Balthazar CT積分無明顯優(yōu)勢。（4）經(jīng)鼻空腸管途徑注入生大黃治療SAP可降低外周血白細胞計數(shù)。（5）經(jīng)鼻空腸管途徑注入生大黃治療SAP可降低患者炎癥反應(yīng)，減少細菌腸道細菌和內(nèi)毒素易位。（6）經(jīng)鼻空腸管途徑注入生大黃治療SAP可減少并發(fā)癥的發(fā)生率。因此，經(jīng)鼻空腸途徑注入生大黃治療SAP是一種更有效的給藥途徑，值得臨床推廣。
[Abstract]:Objective to compare the effects of rhubarb on the inflammatory response, biochemical indexes and clinical indexes of SAP patients via nasal empty intestines and gastric tube into the treatment of SAP by injecting rhubarb via the jejunum via the jejunum.
Methods 45 SAP patients admitted to Anqing Hospital Affiliated to Medical University Of Anhui from August 2010 to February 2013 were selected as the research subjects. 45 patients were randomly divided into experimental group (N=23 cases), control group (N=22 cases), all patients were put into the stomach tube or the nasal jejunum catheter in the admission 1H, and the two groups were given the general basic treatment of SAP, including sucking. Oxygen, intensive care, fasting water prohibition, gastrointestinal decompression, inhibition of acid, enzyme inhibition, dilation of fluid and electrolyte, correcting the disturbance of water and electrolyte acid-base balance, using antibiotics to prevent infection, continuous external application of mirabilite, spasmodic analgesic and nutritional support, the experimental group injected the rhubarb through the nasal hollow tube pathway, and the control group injected the rhubarb through the gastric tube way. The two groups were observed and compared. Patients admitted to 1D, 7d, acute physiological and chronic health status score system II score (APACHE- II score), Balthazar CT score, serum IL-1, IL-6, bacterial endotoxin level, peripheral blood leukocyte count, serum CRP, blood amylase recovery time, anal recovery exhaust defecation time, the difference in the incidence of complications, and analysis of transnasal empty intestines The effect of rhubarb on SAP was injected.
Results (1) the serum CRP in the experimental group was (6.74 + 1.42) d, (5.78 + 1.04) d], the control group was [8 + 1.63) d, (6.82 + 1.22) d], the serum amylase recovery time of the experimental group was significantly earlier than that of the control group (P0.05). (2) the time of anus recovery and exhaust defecation in the experimental group was (3.30 + 0.97) d, the control group was (4.68 + 1.42) d, the experimental group anus The time of portal recovery and defecation was earlier than that of the control group (P0.05). (3) the APACHE- II score of the experimental group was (4.48 + 1.44) and the control group was (5.32 + 1.04), and the APACHE- II score of the experimental group was significantly lower than that of the control group; the decrease of the experimental group was (6.26 + 2.86) and the decrease of the group was (4.77 + 1.77), and the decrease of the experimental group was obviously greater than that of the experimental group. In the control group, the Balthazar CT score of the experimental group was (2.57 + 1.38), the control group was (2.95 + 1.05), the two groups had no significant difference (P0.05), the decrease of the experimental group was (3.04 + 2.10), the decrease of the control group was (2.36 + 1.50), and the decrease of the experimental group was not significantly different (P0.05), and (4) the serum IL-1 and IL-6 in the treatment group of the experimental group (4). The bacterial endotoxin was [(28.76 + 7.36) pg/ml, (33.56 + 8.13) pg/ml and (21.03 + 13.67)) pg/ml], the control group was [34.80 + 7.71) pg/ml, (38.33 + 6.42) pg/ml, (33.25 + 14.15) pg/ml] (P0.05). The level of IL-1, IL-6 and bacterial endotoxin in the experimental group was significantly lower than that of the control group (P0.05), and the two group and the admission period were significantly lower (P0.05). IL-1 of treatment group (P0.05) L-6, the decrease of bacterial endotoxin was [30 + 10.65) pg/ml, (38.30 + 9.41) pg/ml, (97.96 + 28.12) pg/ml], and the control group was [19.13 + 7.94) pg/ml, (28.58 + 11.19) pg/ml, (78.37 + 26.94) pg/ml] (P0.05). The decrease of the experimental group was significantly greater than that of the control group (P0.05). (5) the peripheral blood white blood cell count of the experimental group was (12.28 + +) * * * *. 109/L, the control group was (16.53 + 2.48) x 109/L, the white blood cell count of the experimental group was significantly lower than that of the control group (P0.05). (6) the incidence of complications in the experimental group was 21.7%, the incidence of complications in the control group was 50%, and the incidence of complications in the experimental group was significantly lower than that of the control group (P0.05).
Conclusion (1) the treatment of SAP by injection of rhubarb through nasal empty intestines can make patients' serum CRP and blood amylase back to normal early. (2) SAP can eliminate intestinal paralysis and restore intestinal function by injection of rhubarb through nasal empty intestinal canal in the early stage. (3) SAP can reduce the APACHE- II score of the patients via naso intestinal canal into yellowish yellow to reduce the APACHE- II score, but to reduce Balth Azar CT integral has no obvious advantages. (4) SAP can reduce peripheral blood leucocyte count by injection of rhubarb through nasal empty intestinal canal. (5) injection of rhubarb via nasal hollow tube into rhubarb can reduce the inflammatory response and reduce bacterial translocation of bacterial intestinal bacteria and endotoxin. (6) SAP can reduce complications by injection of rhubarb via the nasal Jejunum Tube Pathway. Therefore, intranasal injection of rhubarb via nasojejunal route is a more effective way to treat SAP, which is worthy of clinical promotion.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R657.51

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