【摘要】：目的:探討早期使用大黃清解湯輔助治療重癥胰腺炎的臨床療效。方法:將35例重癥胰腺炎患者隨機分成兩組:對照組予重癥監(jiān)護、氧療、禁食、胃腸減壓、液體復(fù)蘇、營養(yǎng)支持、抑酸護胃、抑制胰酶分泌以及抗感染等西醫(yī)內(nèi)科保守治療;治療組在西醫(yī)內(nèi)科保守治療的基礎(chǔ)上,入院12 h內(nèi)加用大黃清解湯灌胃,觀察兩組患者入院后的腹痛腹脹緩解時間、肛門排便排氣時間、SIRS或MODS發(fā)生率以及死亡率,血淀粉酶、白細胞及CRP水平,評估APACHE II以及Balthazar CT評分。結(jié)果:治療組患者的臨床癥狀緩解時間、肛門排便排氣時間顯著低于對照組;治療組有效率顯著高于對照組,兩組的死亡率比較無明顯差異,但對照組的SIRS/MODS發(fā)生率顯著高于治療組。治療7 d,治療組患者的白細胞計數(shù)和血淀粉酶水平與對照組比較,顯著下降。治療14 d,治療組患者的APACHE II顯著低于對照組。結(jié)論:大黃清解湯能有效緩解重癥胰腺炎患者的胃腸道癥狀,改善APACHE II評分,降低白細胞和淀粉酶,降低SIRS/MODS發(fā)生率,改善預(yù)后。
[Abstract]:Objective: to investigate the clinical effect of early use of Dahuang Qingjie decoction in the treatment of severe pancreatitis. Methods: 35 patients with severe pancreatitis were randomly divided into two groups: the control group was treated with intensive care, oxygen therapy, fasting, gastrointestinal decompression, fluid resuscitation, nutritional support, acid and stomach protection, inhibition of trypsin secretion and anti-infection. The treatment group was treated with rhubarb Qingjie decoction for 12 hours on the basis of conservative treatment in western medicine. The time of abdominal distension relief, anal defecation and exhaust time and mortality rate, serum amylase were observed in both groups. WBC and CRP levels, APACHE II and Balthazar CT scores were evaluated. Results: the clinical symptom relief time and anal defecation exhaust time in the treatment group were significantly lower than those in the control group, the effective rate in the treatment group was significantly higher than that in the control group, and there was no significant difference in the mortality between the two groups. But the incidence of SIRS/MODS in the control group was significantly higher than that in the treatment group. The white blood cell count and serum amylase level in the treatment group were significantly lower than those in the control group 7 days after treatment. The APACHE II of the patients in the treatment group was significantly lower than that in the control group at 14 days. Conclusion: rhubarb Qingjie decoction can effectively relieve gastrointestinal symptoms, improve APACHE II score, reduce white blood cell and amylase, reduce incidence of SIRS/MODS and improve prognosis in patients with severe pancreatitis.
【作者單位】： 杭州市紅十字會醫(yī)院;
【基金】：浙江省自然科學(xué)基金項目(LY13H290008)
【分類號】：R576

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