重症胰腺炎合并肠梗阻的治疗体会

Experience of the Treatment of Severe Acute Pancreatitis with Intestinal Obstruction

【目的】探讨临床诊治重症胰腺炎（SAP）合并肠梗阻的体会。【方法】本院收治的48例SAP合并肠梗阻患者，其中45侧麻痹性肠梗阻，3例为机械性肠梗阻，将麻痹性肠梗阻患者随机分为两组，对照组20例采用禁食，胃肠减压、肠内营养，纠正水电解质紊乱、维持酸碱平衡，抗生素防感染等常规内科治疗。治疗组25例在常规内科治疗基础上，给予生大黄，芒硝及硫酸镁治疗，比较两组的临床疗效。【结果】治疗组25例患者治疗后禁食时间，腹痛、腹胀缓解时间，肠鸣音恢复时间，首次排便恢复时间，血淀粉酶恢复时间，住院时间及病死率等指标均显著优于对照组（P〈O．05）。3例机械性肠梗阻患者采用保守治疗疗效不明显时实施了手术治疗。【结论】选择有效的治疗方法可降低SAP患者腹压，促进胃肠遭蠕动，达到良好的预后效果。

[Objective] To explore the experience of clinical diagnosis and treatment of severe acute pancre- atitis（SAP） with intestinal obstruction. [Methods] A total of 48 cases of SAP with intestinal obstruction ad- mitted in our hospital included 45 cases of paralytic ileus and 3 cases of mechanical ileus. The patients with paralytic ileus were randomly divided into two groups. The control group received absolute diet and routine medical therapy including gastrointestinal decompression, enteral nutrition, the rectification of fluid and elec- trolyte imbalance, the maintenance of acid-base balance and antibiotic therapy for infection. The treatment group was given radix et rhizoma rhei, mirabilite and magnesium sulfate on the basis of routine medical thera- py. Clinical efficacy was compared between two groups. [Results]After treatment, the fasting time, abdomi- nal pain, the remission time of abdominal distention, the recovery time of bowel sound, first defecation time, the recovery time of hemodiastase, hospitalization day and mortality in 25 patients of treatment group were better than the control group（ P 〈0.05）. Three patients with mechanical ileus underwent surgical treatment due to poor efficacy of expectant treatment. [Conclusion] The choice of effective method can reduce the ab- dominal pressure of SAP patients, promote gastrointestinal peristalsis and obtain good prognosis.