生大黄联合白蛋白治疗重症急性胰腺炎

Combination of rhubarb with albumin in the treatment of severe acute pancreatitis

目的探讨早期联合使用生大黄液和白蛋白对重症急性胰腺炎(SAP)患者的临床疗效。方法对2008—2011年广东药学院附属第一医院消化内科收治的SAP患者50例进行前瞻性研究,随机分为对照组(A组)和生大黄联合白蛋白治疗组(B组)。A组患者(n=25例)给予常规综合治疗,B组(n=25例)在常规治疗的基础上,加用生大黄粉100 g的浸泡液200 ml,其中100 ml高位保留灌肠,100 ml经鼻空肠管注入空肠上段,1次/d,患者恢复自主排便后停药;同时静脉联合使用白蛋白5 d。观察2组肠鸣音恢复时间、首次自主排便时间、腹部压痛消失时间、胸/腹水情况、平均住院时间、全身炎症反应消退时间及治疗后第5天的APACHEⅡ评分情况。结果 B组患者肠鸣音恢复时间、首次自主排便时间、腹部压痛消失时间、平均住院时间、全身炎症反应消退时间均较A组缩短,差异具有统计学意义(P<0.01),第5天的APACHEⅡ评分明显改善(P<0.01)。结论早期联合使用生大黄和白蛋白可减轻重症急性胰腺炎病情,减少并发症,缩短住院时间。

Abstract： Objective To study the therapeutic effect of combining Rhubarb and albumin in the treatment of severe acute pancreatitis （SAP）. Methods Total 50 hospitalized patients with SAP in the First Affiliated Hospital of Guangdong Phar- maceutical University from 2008 to 2012 were randomly divided into treatment group and control group. Patients in control group（n =25） received routine treatment,including fasting,gastrointestinal decompression,antibiotics,inhibition of pan- creatic secretion,inhibition of SIRS and organ support. Patients in treatment group （ n = 25 ） early received additional Rhu- barb （200 ml soak solution by 100 g rhubarb） by nasogastrie feeding for 100 mL/d and retention enema for 100 ml/d until the recovery of independent defecation,and albumin intravenous injection for 1 g/（ kg· d） five days in a row. The recov- ery time of bowel sounds, independent defecation, and relief time of abdominal pain, pleural effusiorr/ascites, hospital stay, SIRS improvement and APACHE Ⅱ score were observed. Results The recovery time of bowel sounds,independent defecation and relief time of abdominal pain, hospital stay, SIRS improvement time were shorten in treatment group, showing significant difference（ P 〈 0.01 ）, APACHE Ⅱ score were also improved（ P 〈 0.01 ） in the treatment group. Conclusion The rhubarb combined with albumin were effective in improving the condition of SAP, reducing the occurrence of compli- cations and shorting the hospital stay.