连续性血液净化联合大承气汤治疗重症急性胰腺炎对患者炎性因子、免疫功能和生化指标的影响

目的 研究连续性血液净化联合大承气汤治疗重症急性胰腺炎对患者炎性因子、免疫功能、生化指标的影响.方法 重症急性胰腺炎患者140例,随机分为试验组和对照组,每组70例.对照组在常规治疗基础上采用连续性血液净化,试验组在对照组基础上将大承气汤由胃管注入,150 ml/次,2次/d.观察2组治疗后腹痛、腹胀消失时间,肠鸣音、排气排便恢复时间和住院时间.观察2组治疗前后炎性因子肿瘤坏死因子-α(TNF-α)、白介素(IL)-1β、IL-6、IL-8]、免疫功能(IgG、IgA、IgM、CD+3、CD+4、CD+8)和血清生化指标(肌酐、淀粉酶、降钙素原),并评价2组治疗效果.结果 试验组治疗后腹痛、腹胀消失时间,肠鸣音、排气排便恢复时间和住院时间均少于对照,差异有统计学意义(P<0.05).2组治疗后血清TNF-α、IL-1β、IL-6、IL-8、肌酐、淀粉酶、降钙素原水平均低于治疗前,且试验组低于对照组,差异均有统计学意义(P<0.05).对照组治疗后IgG、IgA、IgM、CD+3、CD+4、CD+8水平明显低于治疗前,差异有统计学意义(P<0.05).试验组IgG、IgA、IgM、CD+4水平明显高于治疗前,差异有统计学意义(P<0.05),CD+3、CD+8水平高于治疗前,但差异无统计学意义(P>0.05).试验组IgG、IgA、IgM、CD+3、CD+4、CD+8水平均高于对照组,差异有统计学意义(P<0.05).试验组痊愈率、显效率、总有效率高于对照组,差异有统计学意义(P<0.05).结论 连续性血液净化联合大承气汤治疗重症急性胰腺炎可以缩短临床症状消失时间,减少炎性反应,提高机体免疫功能,有利于患者恢复.

Effects of continuous blood purification combined with Dachengqi decoction on inflammatory factors,immunologic function and biochemical parameters in patients with severe acute pancreatitis

Objective To investigate the effects of continuous blood purification combined with Dachengqi decoction on clinical symptoms,inflammatory factors,immunologic function and biochemical parameters in patients with severe acute pancreatitis.Methods One hundred and forty patients with severe acute pancreatitis were randomly divided into trial group and control group,with 70 patients in each group.The patients in control group were treated by continuous blood purification and conventional therapy,however,the patients in trial group,on the basis of control group,were given Dachengqi decoction (150 ml once,twice a day) by gavage.The disappearing time of abdominal pain and abdominal distension,the recovery time of borborygmus,evacuating and defecation,the length of staying in hospital were observed for both groups.Moreover the inflammatory factors including TNF-α,IL-1β,IL-6,IL-8,immunologic function and biochemical parameters including creatinine,diastase and procalcitonin before and after treatment were detected and compared between two groups.Besides the therapeutic effects were observed and compared between two groups.Results After treatment the disappearing time of abdominal pain and abdominal distension,the recovery time of borborygmus,evacuating and defecation,the length of staying in hospitalin in trial group were significantly shorter than those in control group (P<0.05).After 2-week treatment,the levels of TNF-α,IL-1β,IL-6,IL-8,creatinine,diastase and procalcitonin were obviously lower than those before treatment in both groups,moreover,which in trial group were significantly lower than those in control group (P<0.05).After treatment the levels of IgG,IgA,IgM,CD+3,CD+4,CD+8 in control group were significantly lower than those before treatment (P<0.05).However,the levels of IgG,IgA,IgM,CD+4 in trial group after treatment were significantly higher than those before treatment (P<0.05),moreover,the levels of CD+3,CD+8 were higher than those before treatment,but there were no significant differences (P>0.05).The levels of IgG,IgA,IgM,CD+3,CD+4,CD+8 in trial group were significantly higher than those in control group (P<0.05).Besides the cure rate,excellence rate and total effective rate in trial group were significantly higher than those in control group (P<0.05).Conclusion The continuous blood purification combined with Dachengqi decoction in treatment of severe acute pancreatitis can improve clinical symptoms,reduce inflammatory factors,enhance immunologic function,thus,which is helpful to patient's recovery.