经鼻空肠营养管给予中药大黄联合生大黄外敷治疗重症急性胰腺炎的临床研究

Clinical studies on Chinese medicine rhubarb gived by nasal jejunal nutrition tube combined with raw rhubarb in the topical application for the treatment of severe acute pancreatitis

目的:对比研究经鼻空肠营养管给予中药大黄联合生大黄外敷治疗重症急性胰腺炎(SAP)的治疗效果。方法:将60例SAP患者随机分为治疗组(30例)和对照组(30例),两组均予急性胰腺炎规范化治疗,包括监测生命体征、禁食水、胃肠减压、补充液体、维持水电解质和酸碱平衡、抗感染、镇痛、抑酸治疗、抑制胰酶活性等。治疗组经空肠营养管注入中药大黄,同时联合给予生大黄外敷。比较两组患者治疗效果,观察两组患者腹痛腹胀缓解时间、首次排便时间、血尿淀粉酶恢复正常时间及第3、7天时APACHE-Ⅱ评分等。结果:治疗组疗效优于对照组,差异有统计学意义(P<0.05)。治疗组腹痛腹胀缓解时间、首次排便时间、血尿淀粉酶恢复正常时间均短于对照组,差异均有统计学意义(P<0.05)。两组治疗3、7 d时APACHE-Ⅱ评分均下降,以治疗组下降更明显,差异有统计学意义(P<0.01)。结论:经鼻空肠营养管给予中药大黄联合生大黄外敷治疗SAP能够提高临床疗效、促进胃肠道功能恢复、缩短病程,值得推广应用。

Objective： To compare the effect of Chinese medicine rhubarb gived by nasal jejunal nutrition tube combined with raw rhubarb in the topical application for the treatment of severe acute pancreatitis （SAP）. Methods： Sixty patients with SAP were randomly divided into treatment group and control group, each group had 30 cases. All patients were treated with conventional treatment, monitoring vital signs, fasting water, gastrointestinal decompression, venous transfusion, balance of water, electrolyte and acid-base, antiinfection, analgesia, acid suppression therapy, suppression of trypsin activity were included. In treatment group 30 cases received the treatment of Chinese medicine rhubarb gived by nasal jejunal nutrition tube combined with raw rhubarb in the topical application. The therapeutic effects of patients in the two groups were compared. Time for abdominal pain and abdominal distention relief, the first defecation time, and the time of blood and urine amylase returning to normal time were examined. The acute physiology and chronic health evaluation II score （APACHE I1 ） were calculated before and after 3 days,7 days the treatment respectively. Results： Treatment group curative effect was superior to control group （P 〈 0. 05 ）. Compared with control group, remission time of abdominal pain and abdominal distention, first defecation time, blood and urine amylase returning to normal time of patients in treatment group shortened （ P 〈 0. 05 ）. Two groups after treatment the APACHE- 11 score at day 3 and 7 decreased, in treatment group decreased more obviously, the differences were statistically significant（ P 〈 0.01 ）. Conclusion： The treatment of SAP by Chinese medicine rhubarb gived by method of nasal jejunal nutrition tube combined with raw rhubarb in the topical can improve the clinical efficacy and promote the recovery of gastrointestinal function. It is worthy of widely application.