大柴胡汤对重症急性胰腺炎腹腔内压的影响

目的：观察大柴胡汤对重症急性胰腺炎(sever acute pancreatitis, SAP)腹腔内压的影响。方法将符合入选标准的北京中日友好医院外科重症医学科SAP患者70例，按随机数字表法分为2组各35例，常规治疗组予以西医常规治疗；大柴胡汤组在常规治疗的同时鼻饲大柴胡汤。观察急性期内2组患者腹腔内压(intra-abdominal pressure, IAP)的变化并统计腹腔高压(intra-abdominal hypertension, IAH)和腹腔间室综合征(abdominal compartment syndrome, ACS)的发生率。结果入院后2组患者IAP均有升高，但第3～7天大柴胡汤治疗组IAP 水平[(13.31±4.42)mmHg(1 mmHg＝0.133 kPa)、(13.02±5.23)mmHg、(12.35±3.34)mmHg、(11.26±4.46)mmHg、(9.89±3.44)mmHg]明显低于常规治疗组[(16.89±5.71)mmHg、(17.52±3.37)mmHg、(16.21±2.15)mmHg、(14.57±5.56)mmHg、(12.11±1.28)mmHg](P＜0.05)。急性期内大柴胡汤治疗组IAH及ACS发生率分别为40.0%(14/35)、8.6%(3/35)，均明显低于常规治疗组的80.0%(28/35)、28.6%(10/35)，2组比较差异均有统计学差异(χ2值分别为11.667、4.629，P值均＜0.05)。结论大柴胡汤可有效降低SAP患者IAP、IAH及ACS发生率。

Effects of the Dachaihu decoction on intra-abdominal pressure in severe acute pancreatitis

Objective To observe the effects of the Dachaihu decoction on intra-abdominal pressure in severe acute pancreatitis. Methods 70 patients with SAP from China-Japan Friendship Hospital were randomly divided into two groups. 35 patients in a conventional treatment group were treated with conventional treatment of severe acute pancreatitis, and 35 patients in a Dachaihu decoction treatment group were treated with the decoction through nasogastric tube based on conventional treatment. The changes of intra-abdominal pressure and the morbidity of IAH and ACS in both groups were observed in acute stage. Results The intra-abdominal pressure in both groups increased. But the pressure in the Dachaihu decoction treatment group (13.31 ± 4.42 mmHg, 13.02 ± 5.23 mmHg, 12.35 ± 3.34 mmHg, 11.26 ± 4.46 mmHg, 9.89 ± 3.44 mmHg) was lower than the conventional treatment group (16.89 ± 5.71 mmHg, 17.52 ± 3.37 mmHg, 16.21 ± 2.15 mmHg, 14.57 ± 5.56 mmHg, 12.11 ± 1.28 mmHg) from the third day on (P<0.05). And the morbidity of intra-abdominal hypertension and abdominal compartment syndrome in the Dachaihu decoction treatment group were lower than the conventional treatment group in the whole acut stage (40%vs. 8.75%).The differences between two groups were statistically significant (P<0.05). Conclusion The Dachaihu decoction may significantly reduce the intra-abdominal pressure and the morbidity of intra-abdominal hypertension and abdominal compartment syndrome among patients with severe acute pancreatitis.