大黄联合早期空肠营养治疗重症急性胰腺炎的临床研究

Rhubarb combined with early enteral nutrition in the treatment of severe acute pancreatitis

目的:观察大黄联合早期肠内营养对重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效及探讨可能的作用机制。方法:74例SAP患者随机分成3组:全肠外营养组(total parenteral nutrition,TPN)、早期肠内营养组(early enteral nutrition,EEN)及大黄联合早期肠内营养组(rhubarb with EEN,Rhubarb)。入院后第1、3、7、14天检测血白细胞介素-18(interleukin-18,IL-18),C反应蛋白(C-reactive protein,CRP)和淀粉酶(amylase,AMY)并记录APACHEⅡ评分;记录腹痛缓解时间、肠鸣音恢复时间、体温恢复时间、ICU住院日及平均住院日。结果:3组相比,Rhubarb组腹痛缓解时间最短、肠鸣音恢复最快、体温恢复时间最快、ICU住院日和平均住院日更短,有统计学差异(P<0.05)。第3天,Rhubarb组CRP表达下降,与TPN组比较有统计学差异(P<0.05),第7天,Rhubarb组数值最低,3组表达有统计学差异(P<0.05)。3组IL-18在第7、14天时,Rhubarb组下降均最明显,3组比较均有统计学差异(P<0.05),第14天时,Rhubarb组与EEN组比较也有意义(P<0.05)。结论:大黄结合肠内营养能改善急性胰腺炎炎症反应,加速恢复早期肠道功能,降低治疗费用。

Objective：To observe the efficacy of Rhubarb combined with early enteral nutrition in the treatment of severe acute pan- creatitis（SAP）. Methods：Totally 74 patients with SAP were admitted to intensive care unit（ICU） and were randomly divided into 3 groups：Rhubarb with early entneral nutrition group （Rhubarb group）,total parenteral nutrition group （TPN group） and early enteral nutrition group（EEN group）. At the lst,3rd,7th d and the 14th d after admission,serum interleukin-18（IL-18）,C-reactive protein （CRP） and serum amylase（AMY） were detected;APACHEⅡ scores were recorded and length of abdominal pain, recovery time of bowel sounds and body temperature,length of stay in ICU, average length of stay were observed. Resuluts：The length of abdominal pain, recovery time of bowel sounds and body temperature,length of stay in ICU and average length of stay were significantly shorter in Rhubarb group compared with those in the other groups（P〈0.05）. At the 3th d,level of serum CRP was obviously lower in Rhubarb group than in TPN group（P〈0.05） ;at the 7th d,level of serum CRP was the lowest in Rhubarb group,with statistaical differuces among three groups（P〈0.05）. At the 7th d and the 14th d,level of serum IL-18 was obviously lower in Rhubarb grpup than in EEN group and TPN group （P〈0.05）;at the 14th d, there were significant diffeneces in level of serum IL-18 between Rhubarb grpup and EEN group（P〈0.01）. Conclusions：Rhubarb combined with early enteral nutrition can enhance intestinal peristalsis,protect the gastroin- testinal barrier function,reduce bacteria and endotoxin translocation and releasing of inflammation mediators,especially IL-18 and reduce cost of treatment.