经鼻空肠管给予中药清胰汤治疗重症急性胰腺炎临床研究

Effect of Qingyi Decoction Administrated by Nasal-jejunal Tube for Treatment of Severe Acute Pancreatitis

目的:对比研究经胃管和鼻空肠管给予中药清胰汤治疗重症急性胰腺炎(SAP)的治疗效果。方法:将47例SAP患者随机分为Ⅰ组(22例)和Ⅱ组(25例),在综合治疗基础上Ⅰ组经胃管注入清胰汤煎剂,Ⅱ组经鼻空肠管注入清胰汤煎剂,观察2组患者腹痛缓解、肠道功能恢复时间,呕吐发生率,C反应蛋白(CPR)、血淀粉酶恢复时间,3天、7天、14天时A-PACHE-Ⅱ评分,平均住院时间等。结果:Ⅱ组腹痛缓解时间、肠道功能恢复时间,CPR、血淀粉酶恢复时间明显快于Ⅰ组(P<0.001,P<0.01);Ⅱ组呕吐发生率为28.00%(7/25),明显低于Ⅰ组54.55%(12/22)(P<0.01);Ⅱ组平均住院时间明显少于Ⅰ组(P<0.001)。治疗3天、7天时Ⅱ组APACHE-Ⅱ评分较Ⅰ组有明显降低(P<0.01),治疗14天时Ⅰ组与Ⅱ组APACHE-Ⅱ评分比较,差异无显著性意义(P>0.05)。结论:经鼻空肠管注入中药清胰汤能更有效地控制SAP患者的全身炎症反应,促进胃肠道功能恢复,缩短病程,减少胃肠道反应发生率。

Objective. To compare the effect of Qingyi Decoction administrated by gastric tube and nasal-jejunal tube for the treatment of severe acute pancreatitis （SAP）. Methods： Forty-seven SAP patients were randomly divided into group I （n=22） and group II （n=25）.On the basis of combined treatment, group I received Qingyi Decoction administrated by gastric tube, and group II administrated by nasal-jejunal tube additionally. Time for abdominal pain relief and bowel function recovery, incidence of vomiting, and time for the recovery of C-reactive protein（CRP） and blood amylase level were examined. Meanwhile, APACHE- II score at day 3, 7 and 14 was evaluated, and the average hospitalization time was calculated. Results. The time for abdominal pain relief, the recovery time for bowel function, CPR and blood amylase, and the average hospitalization time in group II were shorter than those in group I （P 〈 0.001, P 〈 0.01）. The incidence of vomiting was 28.00% （7/25）in group II , and was 54.55% （12/22） in group I , the difference being significant（P 〈 0.01）. APACHE- II score at day 3 and 7 in group II was lower than that in group I （P 〈 0.01）. However, no statistical significant difference was found in APACHE- II scores at day 14 between two groups （P 〉 0.05）. Conclusion, Qingyi Decoction administrated by nasal＇jejunal tube is more effective than by gastric tube in controlling the systemic inflammatory response, promoting the recovery of gastrointestinal function, shortening the course of disease,and reducing the incidence of gastrointestinal reaction in SAP patients.