乌药和大黄合用保护重症胰腺炎肠屏障的治疗体会

Wu-Yao,Da-Huang combination protect the intestinal barrier in the treatment of severe acute pancreatitis experience

目的 观察乌药和大黄合用对重症胰腺炎肠屏障的保护作用,评价乌药、大黄合用对重症胰腺炎的临床治疗效果.方法 将南京军区福州总医院普通外科近10个月收治的45例重症胰腺炎患者随机分为3组：A组在抑制胰酶分泌和抗感染等传统治疗的基础上给予50%硫酸镁50 mL胃管注入,每日2次（2次/d）;B组在传统治疗的基础上给予大黄水煎液100 mL高位保留灌肠,2次/d;C组在传统治疗的基础上给予乌药水煎液50 mL胃管注入,大黄水煎液100 mL保留灌肠,2次/d.观察3组患者腹胀改善情况（腹围）、腹压（膀胱测压）、APACHE-Ⅱ评分、中性粒细胞（N）、C-反应蛋白（CRP）及第1,3,5,7,9……天血中D-乳酸的含量.结果 3组治疗后在腹围、腹压、APACHE-Ⅱ评分、N等指标有显著性差异（P〈0.05）,以C组递减最明显,而CRP无显著性差异.内毒素含量在3组之间有显著性差异（P〈0.05）,并且每组随着时间的延长而递减也有显著性差异（P〈0.05）.结论 乌药和大黄合用对重症胰腺炎肠屏障功能障碍有协同保护作用.

Objective To observe the effects of Wu-Yao,Da-Huang combination on severe acute pancreatitis gut barrier protection,and on the clinical treatment of severe acute pancreatitis.Methods In the past 10 months,45 casea of severe pancreatitis those treated in our department were randomly divided into 3 groups.group A：on the basis of conventional treatment of inhibiting trypsin secretion and anti-infection,50%magnesium sulfate 50 mL were insected via stomach tube,twice a day;group B：on the basis of conventional treatment,Da-Huang decoction 100 mL high retention enema,twice a day;group C：on the basis of conventional treatment were given by Wu-Yao decoction 50 mL.as well as 100 mL Da-Huang decoction enema,twice a day.Three groups were observed the release of abdominal distension,abdominal（bladder pressure measurement）,ACAPHE-Ⅱ score,indicators of neutrophils（N）,C-reactive protein（CRP）,and the blood levels of D-lactic acid in 1,3,5,7,9 days etc.Results The abdomenal circumference,abdominal pressure,APACHE-Ⅱ score,N and other indicators of the three groups after treatment had the significantly different（P〈0.05）,with group C the most significant decrease,while no significant difference in CRP.Endotoxin content in three groups was significantly different（P〈0.05）,and each diminished with time（P〈0.05）.Conclusion Wu-Yao,Da-Huang combination on gut barrier dysfunction in severe acute pancreatitis showed synergistic protective effect.