大承气汤加味联合西药治疗急性胰腺炎28例临床观察

目的 观察大承气汤加味联合西药治疗急性胰腺炎的临床疗效. 方法 将56例急性胰腺炎患者随机分为常规治疗组和中药治疗组,常规治疗组给予禁食、禁水、胃肠减压、补液、肠外营养支持、防治感染、抑制胃酸及胰腺分泌等常规治疗.中药治疗组在常规治疗基础上,经空肠营养管注入大承气汤加味.比较患者治疗前后血淀粉酶(AMY)、白细胞(WBC)、C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白介素1(IL-1)及体重、白蛋白、前白蛋白、转铁蛋白、血红蛋白的水平,同时记录AMY恢复时间、腹胀缓解时间、住院费用及时间、并发症情况. 结果 两组患者AMY、WBC、CRP、TNF-α、IL-1水平治疗后均低于治疗前(P＜0.05),其中中药治疗组AMY、WBC、CRP、TNF-α、IL-1治疗后明显低于常规治疗组(P＜0.05).中药治疗组患者AMY恢复时间、腹胀缓解时间、住院费用、住院天数明显低于常规治疗组(P＜0.05或P＜0.01).中药治疗组腹腔感染率、胰腺假性囊肿形成率、严重腹胀发生率均低于常规治疗组(P＜0.05).两组患者白蛋白、前白蛋白、转铁蛋白治疗后均高于治疗前(P＜0.05).中药治疗组体重、白蛋白、前白蛋白、转铁蛋白、血红蛋白治疗后明显高于常规治疗组(P＜0.05).结论 早期应用大承气汤加味联合西药治疗急性胰腺炎安全有效,并能保护肠黏膜屏障,提高机体免疫,改善营养状况,缩短病程,改善预后.

Clinical Observation on Modified Dachengqi Decoction Combined with Western Medicine for 28 Cases of Acute Pancreatitis

Objective To analyze the therapeutic effect of Modified Dachengqi Decoction (Major Qi Coordinating Decoction) combined with western medicine on acute pancreatitis (AP) .Methods Fifty-six cases of AP were randomized into treatment group and control group.The control group was given conventional therapy including food and water fasting , gastrointestinal decompression , parenteral nutrition , infection prevention and intervention , inhibition of gastric acid and pancreatic secretion. The treatment group was added with injection of supplemented Dachengqi Decoction by the jejunal feeding tube.All the indices were recorded and analyzed before and after treatment including serum amylase (AMY), white blood cell (WBC), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), body weight , albumin , prealbumin , ferritin , hemo- globin , and AMY recovery time , bloating relief time , complication rate , hospital stay and inpatient spending were recorded. Results AMY , WBC , CRP , TNF-αand IL-1decreased significantly in both groups after treatment (P<0.05), especially in the treatment group (P<0.05) .The AMY recovery time , bloating relief time , hospital stay were shorter and inpatient spend- ing was lower in the treatment group than in the control group (P<0.05or P<0.01) .The intraperitoneal infection rate , pan- creatic pseudocyst formation rate and the incidence of severe bloating in the treatment group were significantly lower than those in the control group (P<0.05) .Albumin , prealbumin and ferritin increased significantly in both groups after treatment.After treatment , the body weight , albumin , prealbumin , feritin and hemoglobin in the treatment group were significantly higher than those in the control group (P<0.05) .Conclusion The early application of Modified Dachengqi Decoction combined with western medicine is safe and effective for AP , which could protect the intestinal mucosal barrier , improve the immune function and nutritional status , and shorten the course.