复方丹参滴注并早期清胰汤灌肠与施他宁治疗重症急性胰腺炎的疗效及成本效益比较

Comparison of curative effect and cost-benefit of instillation of compound danshen injections com- bined with early retention enema of qingyi decoction and injection of stilamin in treating severe a-cute pancreatitis

目的比较复方丹参静脉滴注和清胰汤早期保留灌肠联合应用与施他宁治疗重症急性胰腺炎（SAP）的疗效及成本效益，探讨非手术治疗SAP有效且价廉的方法。方法将64例SAP患者随机分为治疗组（复方丹参静脉滴注和清胰汤早期保留灌肠）与对照组（施他宁），对SAP患者的临床症状改善时间、血清淀粉酶和血常规复常时间、住院天数和住院直接费用、最终病死率以及治疗后患者腹腔内高压（IAH）缓解时间进行比较。结果治疗组腹痛初步缓解时间、首次排大便时间、恢复进食时间较对照组明显缩短，住院费用、住院天数大幅度减少，差异有统计学意义（P〈0．05）。腹部压痛体征消除时间、血清淀粉酶和血常规复常时间两组比较差异无统计学意义。SAP患者经治疗后IAH缓解时间，治疗组较对照组明显提前（P〈0．05）。两组最终病死率比较差异无统计学意义。结论复方丹参滴注和清胰汤早期保留灌肠联合应用，可明显改善SAP病情，减少住院天数，住院费用比施他宁更低。能比施他宁更快地缓解IAH，病死率则差异无统计学意义。

Objective To compare the curative effect and cost-benefit of instillation of com- pound danshen injections combined with early retention enema of qingyi decoction and injection of stil- amin in treating severe acute pancreatitis （SAP）, and investigate the effective and cheap non-operative treatment for SAP. Methods Sixty-four patients with SAP were randomly divided into two groups. In treatment group, patients were treated with compound danshen injections combined with early retention enema of qingyi decoction. In control group, patients were treated with injection of stilamin. The time of clinical symptom remised, serum amylase and blood routine recovery, hospital stay time, hospitalization expenses, the eventual fatality rate and the remission time of intra abdominal hypertension （IAH） were compared between the two groups. Results The time of preliminary abdominal pain relief, first defeca- tion and eating recovery were significantly shorter and hospital stay time and hospitalization expenses de- creased more in treatment group than those in control group （ P 〈 0.05）. There was no significant differ- ence in the time of abdominal tenderness remised, serum amylase or blood routine recovery between the two groups. There was significant difference in the remission time of IAH, the treatment group was supe- rior to the control group （ P 〈 0. 05 ）. There was no significant difference in the eventual fatality rate be- tween the two groups. Conclusions Compared with injection of stilamin, instillation of compound dan- shen injections combined with early retention enema of qingyi decoction can improve the condition of pa- tients with SAP, decrease hospital stay time and relieve IAH rapidly and it has obvious medical econom- ics advantages in treatin~ SAP. But its effect on the fatality rate of SAP need further study.