重症急性胰腺炎血浆内毒素水平的动态变化及中药治疗的临床意义

目的研究重症急性胰腺炎（SAP）患者血浆内毒素（PE）水平的动态变化及应用中药治疗的临床意义。方法收集25例SAP和40例轻型急性胰腺炎（MAP）,将SAP患者随机分为A组（13例）和B组（12例）,A组在常规治疗外,在入院后2～3d内开始加服中药;SAP患者于入院后1、24h、3d、7d、14d、21d,MAP患者于入院后1、24h、3d、7d分别抽血测定PE浓度;并对各组结果进行对照分析。结果所有AP患者的血清中均检出PE,与MAP组相比,SAP组（A组和B组）PE在各个时期浓度都明显升高,比较差异有统计学意义（P〈0.05）。A组在应用中药治疗后,血清中的PE浓度开始缓慢下降,组内治疗后与治疗前PE浓度相比有明显降低（P〈0.05）。与常规组B组同一时相相比,PE浓度差异亦有统计学意义（P〈0.05）。结论急性胰腺炎合并有细菌移位及内毒素血症的程度和疾病本身严重程度存在正相关关系,应用中药治疗能够减轻SAP患者肠黏膜损害,加快胃肠道细菌及其毒素的排泄,从而减少细菌移位致肠源性感染的作用,疗效较好,值得在各级医院推广使用。

Clinical significance of the dynamic changes of plasma endotoxin in severe acute pancreatitis and traditional Chinese herbal drug treatment

Objective To study the dynamic changes of plasma endotoxin （PE） in patients with severe acute pancreatitis（SAP） and the clinical significance of traditional Chinese herbal drug treat the patient.Methods 25 cases of SAP and 40 patients with mild acute pancreatitis （MAP）,the patients of SAP was randomly divided into A group （13 cases） and B group （12 cases）,Besides conventional medical treatment,in the 2 ～ 3 d after admission to begin plus traditional Chinese herbal drug in A group;The change of PE levels at post-admission 1,24 h,3 d,7 d,14 d,21 d in SAP patients and at post-admission 1,24 h,3 d,7 d in MAP patients were detected respectively;then analysed and contrasted the Group results.Results PE was detected in the serum of all patients with AP,comparing with the MAP group,PE concentration of SAP group （A group and B group） were significantly increased in the various periods,the difference was statistically significant （P0.05）.The PE concentrations of A group began to decline slowly at the application of traditional Chinese herbal drug,the changes of PE in A group between before treatment and after treatment were statistically significant difference （P0.05）.comparing to B Group in the same phase,the difference was statistically significant （P0.05）.Conclusion Acute pancreatitis complicated with bacterial translocation and endotoxemia extent and severity of the disease itself was positive correlation,the application of traditional Chinese herbal drug can reduce mucosal damage in patients with SAP,to accelerate the excretion of gastrointestinal tract bacteria and its toxin,thereby to reduce the intestinal infection caused by the bacterial translocation,efficacy is good,and it has worthy to be popularized.