两种途径注入大黄辅助治疗重型急性胰腺炎的对比研究

Effect comparison of nasogastric and nasojejunal administration of rhubarb on severe acute pancreatitis

目的：对比研究经鼻胃管和经鼻空肠管两种途径注入大黄辅助治疗重型急性胰腺炎的疗效。方法：将77例重型急性胰腺炎患者按随机数字表法分为两组,G组38例,J组39例,全部病例在综合治疗的基础上,G组经鼻胃管注入大黄,J组经鼻空肠管注入大黄,观察患者治疗前及治疗37、d时急性生理学和慢性健康评分（APACHEⅡ评分）及Balthazar CT评分,血淀粉酶、C-反应蛋白（CRP）恢复正常时间,腹痛、腹胀缓解时间,重症监护病房（ICU）停留时间,并发症发生率和死亡率的变化。结果：治疗前及治疗7 d时G组与J组的APACHEⅡ评分及Balthazar CT评分均无明显差别（P〉0.05）;治疗3 d时G组的APACHEⅡ评分及Balthazar CT评分均比J组高（8.33±2.13vs7.06±2.07,5.03±0.98 vs4.52±0.73,P〈0.050.01）;J组患者血淀粉酶、CRP恢复正常时间和ICU停留时间均少于G组患者（7.6±1.2vs8.5±1.8,7.9±1.3vs8.9±2.1,2.6±1.7vs3.6±2.0,P〈0.05）,腹痛、腹胀缓解时间明显少于G组（2.7±1.4vs3.8±2.2,3.0±1.7vs4.1±1.9,P〈0.01）;两组并发症发生率和死亡率无明显差别（P〉0.05）。结论：经鼻空肠管注入大黄能更有效缓解重型急性胰腺炎患者的病情。

Objective： To compare the efficacy of nasogastric and nasojejunal administration of rhubarb on severe acute pancreatitis（SAP）.Methods： Seventy-seven SAP patients were randomly divided into group G（n=38） and J（n=39）.Based on comprehensive treatment,the patients in group G were given rhubarb by nasogastric feeding,while those in group J were given rhubarb by endoscopic nasojejunal feeding.The acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score and Balthazar CT score before treatment and 3、7 days after treatment were observed and compared.Besides,serum amylase and C-reactive protein（CRP） levels,the remission time of abdominal pain and distension,length of stay in ICU,complication incidence as well as mortality were also observed.Results： Before and 7 days after treatment,the APACHE Ⅱand Balthazar CT scores in group G and group J were not significant different（P〉0.05）.Three days after treatment,the APACHEⅡand Balthazar CT score in group J were significantly lower than group G（8.33±2.13 vs 7.06±2.07,5.03±0.98 vs 4.52±0.73,P both 〈0.01）.The restore of normal serum amylase and CRP levels,length of stay in ICU,remission time of abdominal pain and distension in group J were significant shorter than that in group G（7.6±1.2 vs 8.5±1.8,7.9±1.3 vs 8.9±2.1,2.6±1.7 vs 3.6±2.0,P〈0.05;2.7±1.4 vs 3.8±2.2,3.0±1.7 vs 4.1±1.9,P〈0.01）.The complication incidence and mortality in the two groups had no significant difference（P〉0.05）.Conclusion： Administration of rhubarb by nasojejunal feeding is more effectively on SAP as auxiliary treatment.