柴芍承气汤灌肠联合生大黄灌胃治疗急性重症胰腺炎的疗效研究

目的观察柴芍承气汤灌肠、生大黄灌胃治疗急性重症胰腺炎的疗效。方法选取SAP患者114例,随机分为对照组、单纯灌肠组和联合组,对照组采用常规西医治疗;单纯灌肠组在对照组的基础上进行柴芍承气汤灌肠;联合组在对照组的基础上,采用柴芍承气汤灌肠联合生大黄灌胃治疗。7 d后观察3组患者的实验室检查指标肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、血清淀粉酶],胃肠功能恢复时间(排气恢复、腹胀缓解、腹痛缓解、肠鸣音恢复、排便恢复),腹内高压(IAP),以及临床疗效和并发症发生情况。结果实验室检查方面,联合组治疗后TNF-α、hs-CRP、血清淀粉酶指标均优于对照组和单纯灌肠组,差异有统计学意义(P<0.05);在症状方面,联合组除排便恢复时间仅优于对照组外,在排气恢复、腹胀缓解、腹痛缓解、肠鸣音恢复的时间均优于单纯灌肠组和对照组,差异有统计学意义(P<0.05);在腹内高压(IAP)比较上,联合组低于其余两组,差异有统计学意义(P<0.05);而在疗效和并发症方面,联合组均优于其余两组,差异有统计学意义(P<0.05)。结论基于"上下通腑"理论的柴芍承气汤灌肠联合生大黄灌胃治疗,能有效降低血清淀粉酶,抑制炎症介质,同时可以降低腹内压,加快肠道功能的恢复,提高临床疗效,降低相关并发症。

Clinical Observation of Chaishao Chengqi Decoction Enema and Rhubarb Gavage in the Treatment of Severe Acute Pancreatitis

Objective:To observe the curative effect of Chaishao Chengqi Decoction enema and rhubarb gavage on severe acute pancreatitis(SAP).Methods:A total of 114 patients with SAP were selected from the Department of Intensive Medicine of the Affiliated Hospital of Southwest Medical University,and randomly divided into the control group,simple enema group and combined group.The control group was treated with conventional western medicine;the simple enema group performed Chaishao Chengqi Decoction enema on the basis of the control group;the combined group received Chaishao Chengqi Decoction enema and rhubarb gavage based on the"up and down catharsis"theory.After 7 days of treatment,the laboratory tests(TNF-α,hs-CRP,serum amylase),the recovery time of gastrointestinal function(exhaust gas recovery,abdominal distension relief,abdominal pain relief,bowel sound recovery,bowel movement recovery)and abdominal Internal hypertension(IAP),the clinical efficacy and complications of the 3 groups of patients were observed.Results:In terms of laboratory examinations,the 3 indexes of TNF-α,hs-CRP and serum amylase in the combined group were better than those in the control group and the simple enema group after treatment,and the differences were statistically significant(P<0.05);in addition,except for the"defecation recovery"item in the combined group,which was only superior to the control group,the time in"exhaust recovery","abdominal distension relief","abdominal pain relief",and"intestinal sound recovery"were better than the simple enema group and control group,and the differences were statistically significant(P<0.05);in the comparison of intra-abdominal hypertension(IAP),the combined group was lower than the other two groups,and the difference was statistically significant(P<0.05);in terms of complications,the combination group was superior to the other two groups,and the differences were statistically significant(P<0.05).Conclusion:Based on the"up and down catharsis"theory,Chaishao Chengqi Decoction enema and rhubarb gavage can effectively reduce serum amylase and inhibit inflmmatory mediators;at the same time,it can reduce intra-abdominal pressure and accelerate the recovery of intestinal function to improve clinical efficacy and reduce related complications,which is worthy of further study and promotion.