生大黄保留灌肠辅助治疗重症急性胰腺炎肠麻痹的临床研究

Retention enema with rhubarb for the treatment of severe acute pancreatitis with intestine paralysis

目的探讨生大黄液灌肠对重症急性胰腺炎（SAP）患者肠道功能恢复的影响。方法选择近5年收治的60例SAP患者，按完全随机法分为对照组和生大黄灌肠治疗组。对照组患者给予常规综合治疗，包括胃肠减压、禁食、抗感染、抑制胰腺分泌、抑制全身炎症反应及器官功能支持等；生大黄组在常规治疗的基础上，加用生大黄粉100g的浸泡液200ml高位保留灌肠，1次／d，直至肠道功能恢复后停药。于入院第1、2、5、6天测膀胱压力，行APACHE11评分。观察两组肠道功能恢复（出现肠鸣音及肛门排气、排便）时间、全身炎症反应综合征（SIRS）消退时间、住院天数及病死率。结果入院第5、6天，生大黄组患者的膀胱压力及APACHE1I评分均显著低于对照组患者[（21．9±9．0）cmH：0比（25．3±9．5）cmH2O，（16．5±7．5）cmH20比（20．6±7．7）cmH2O，1cmH，0=0．098kPa；（9．8±3．8）分比（12．5±3．6）分，（9．2±2．4）分比（11．2±2．5）分；P值均〈0．05）]。生大黄组患者肠道功能恢复时间、SIRS消退时间、住院天数及病死率分别为（126．8±28．2）h、（131．2±29．6）h、（25．6±6．2）d及16．7％，其肠道功能恢复及SIRS消退时间、住院天数均较对照组患者的（169．9±53．4）h、（160．4±30．4）h、（33．2±6．4）d明显缩短（P值均〈0．05），病死率较对照组的26．7％降低，但差异无统计学意义（P〉0．05）。结论生大黄液保留灌肠可明显缩短SAP患者的肠道功能恢复时问及住院天数。

Objective To investigate the efficacy of retention enema with rhubarb for severe acute pancreatitis （SAP） with intestine paralysis. Methods Totally 60 patients with SAP since last five years were included, and then they were randomly divided into control group and treatment group with 30 patients in each group. Patients in control group received routine treatment of SAP, including fasting, gastrointestinal decompression, antibiotics, inhibition of pancreatic secretion, inhibition of SIRS and organ support. Patients in treatment group received additional retention-enema with rhubarb （200mL soak solution by 100g rhubarb） , once daily until the recovery of bowel function. The bladder pressure （the 1,2, 5 and 6 days after admission） was evaluated, and APACHE Ⅱ score was determined. The recovery of bowel function （the bowel sounds, the flatus and defecation of intestinal tract）, SIRS recovery time, hospital stay, and the mortality were observed. Results At the 5 and 6 days after admission, the bladder pressure and APACHE Ⅱ score in treatment group were significantly lower than those in control group [ （21.9 ± 9.0）cmH2O vs （25.3 ± 9.5 ）cmH2O, （16.5 ±7.5）cmH2O vs （20.6 ±7.7）cmH2O, 1 cmH2O=0.098 kPa; （9.8 ±3.8） vs （12.5±3.6）, （9.2 ±2.4） vs （ 11.2 ±2.5 ）, P 〈 0.05 ） ]. The recovery time of bowel function and SIRS recovery time, hospital stay, and the mortality in treatment group were （126.8 ± 28.2）h, （131.2 ± 29.6）h, （25.6 ±6.2）d and 16.7 %,and the recovery time of bowel function and SIRS recovery time, hospital stay were significantly lower than those in control group [ （ 169.9± 53.4） h, （ 160.4 ± 30.4） h, （33.2± 6.4） d, P 〈 0.05）. The mortality was reduced, but the difference between the two groups was not statistically significant （26.7%, P 〉 0.05）. Conclusions The retention-enema with rhubarb can accelerate the recovery time of bowel function of SAP patients and reduce the hospital stay.