中药泻下法替代胃肠减压在治疗重症急性胰腺炎中的疗效观察

Traditional Chinese medicine diarrhea method in stead of gastrointestinal decompression in treatment of severe acute pancreatitis

目的观察胃肠减压在中西医结合泻下法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)中的作用。方法68例重症急性胰腺炎患者随机分为A和B两组。A组采用中西医结合泻下法治疗,同时安置胃肠减压;B组取消胃肠减压,余与A组同。结果A和B各组内治疗5d后APACHEⅡ评分均显著低于入院时APACHEⅡ评分(P<0.05),两组无1例发生胰腺感染;两组间的开始排便时间、局部症状缓解时间、肠鸣恢复时间、与治疗有关的主要并发症发生率、中转手术率、病死率、平均住院天数以及治疗前后的APACHEⅡ评分均差异无统计学意义(P>0.05);A组和B组低钾血症发生率较高,分别达64.7%和50%,但差异无统计学意义(P>0.05)。结论中西医结合是治疗SAP的有效方法;中西医结合下泻治疗SAP无须安胃肠减压;但需要及时发现和纠正低钾血症。

Objective To observe the effect of the tradition Chinese medicine（TCM）which induce diarrhea method in stead of gastrointestinal decompression in treatment of severe acute pancreatitis（SAP） .Methods Sixty-eight patients of SAP were divided by random into tow groups. A group was treated by combination of western medicine and tradition Chinese medicine（TCM） which induce di- arrhea method, at the same time treated with gastrointestinal decumpression;and B group was treated by the same way of A group but gastrointestinal decompressic, n. Results either A or B group, the APACHE Ⅱ score of post-treatment five days was significant lower than they were In hospital begin（ P 〉 0.05）.Two groups had no infection of pancreas.There were no significant difference between the two groups about the time of beginning defecation, the time of rugitus recovery, the time of local symptom relief of bellyache and abdominal distention, the average stay and the incidence rates of acute respiratory distress syndrome（ARDS）, acute renal failure and mortality（ P 〉 0.05）. The incidence rates of kaliopenia of A group（64.7 % ）and B group（50% ） were all higher, but they were not significant different （ P 〉 0.05 ） Conclusion The way of combination of western medicine and TCM of diarrhea method on treatment of SAP was effective. There was no necessity to place gastrointestinal decompression when we adopted this way. But you shoud pay attention to the kaliopenia.