大黄保留灌肠结合西医常规疗法治疗急性胰腺炎临床研究

目的：评价大黄保留灌肠结合西医常规疗法治疗急性胰腺炎(acute pancreatitis, AP)的临床疗效。方法将符合入选标准的84例AP患者采用随机数字表法分为2组各42例。对照组给予禁食、持续胃肠减压、纠正水电解质和酸碱失衡等，并配合口服奥曲肽、加贝酯抑制胰液分泌及胰酶活性等常规治疗；观察组在对照组基础上加用大黄保留灌肠。2组均治疗7 d。采用ELISA法检测2组患者治疗前后血清 IL-17、IL-10、IL-6水平，评价临床疗效。结果观察组总有效率为85.7%(36/42)、对照组为71.4%(30/42)，2组比较差异有统计学意义(χ2＝2.366；P＝0.043)。治疗后，观察组 IL-17(13.53±3.16)ng/ml比(20.63±4.83)ng/ml，t＝2.416]、IL-6(22.82±4.56)ng/ml比(31.59±6.63)ng/ml，t＝2.421]表达低于对照组(P＜0.05)，IL-10(16.32±4.15)ng/ml 比(12.17±3.22)ng/ml，t＝2.326]表达高于对照组(P＜0.05)；观察组血淀粉酶(125.69±32.47)U/L比(259.26±51.44)U/L，t＝7.451]、尿淀粉酶(204.73±43.83)U/L比(334.25±60.18)U/L，t＝7.323]均低于对照组(P＜0.01)。对照组腹痛、腹胀缓解时间(4.24±1.06)d比(3.02±0.62)d，t＝2.521]，排气、通便时间(5.42±1.25)d比(3.26±0.73)d，t＝5.124]，体温恢复正常时间(5.63±1.46)d 比(4.58±0.92)d，t＝2.418]及住院时间(18.65±4.16)d 比(13.78±3.15)d，t＝2.386]均明显长于观察组(P＜0.05或 P＜0.01)。结论大黄保留灌肠结合西医常规疗法可调节 AP 患者IL-17/IL-10促炎和抑炎因子失衡状态，抑制炎症反应，疗效优于西医常规疗法。

Clinical effect of Rhubarb retention enema combined with routine western medicine on acute pancreatitis

Objective To detect the effect of Rhubarb retention enema on patients with acute pancreatitis(AP).MethodsA total of 84 AP patients were enrolled in this study. Patients were divided into the control group(n=42) and Rhubarb enema observation group(n=42). Control group was treated with fasting, continuous gastrointestinal decompression, correcting water electrolyte and acid-base imbalance, with the oral administration of octreotide and gabexatemesilate to inhibit pancreatic secretion and enzyme activity. On the basis of the control group, the observation group was treated with rhubarb retention enema. IL-17, IL-10, and IL-6 expression was detected by ELISA analysis. The clinical effect was compared.Results The clinical effect rate (85.7%vs.71.4%,χ2=2.366,P=0.043) in observation group was significantly higher than that in control group. After treatment of 7 days, IL-17 (13.53 ± 3.16 ng/mlvs. 20.63 ± 4.83 ng/ml,t=2.416) and IL-6 (22.82 ± 4.56 ng/mlvs. 31.59 ± 6.63 ng/ml,t=2.421) expression was significantly lower and IL-10 (16.32 ± 4.15 ng/mlvs. 12.17 ± 3.22 ng/ml,t=2.326) expression was significantly higher in observation group than those in control group(P<0.05). The reduction of blood amylase (125.69 ± 32.47 U/Lvs. 259.26 ± 51.44 U/L,t=7.451) and urine amylase (204.73 ± 43.83 U/Lvs. 334.25 ± 60.18 U/L,t=7.323) in the observation group was significantly higher than those in the control group(P<0.01). Abdominal pain and abdominal distension recovery time (4.24 ±1.06 dvs. 3.02 ± 0.62 d,t=2.521), exhaust gas and defecation recovery time (5.42 ± 1.25 dvs. 3.26 ± 0.73 d,t=5.124), temperature recovery time (5.63 ± 1.46 dvs. 4.58 ± 0.92 d,t=2.418), and hospitalization time (18.65 ± 4.16 dvs. 13.78 ± 3.15 d,t=2.386) were higher in control group than those in observation group (P<0.05 orP<0.01). Conclusion Rhubarb enema can regulate the IL-17/ IL-10, and inhibit the inflammatory reaction.