胰瘅方内服和灌肠对重症胰腺炎肠黏膜屏障功能的影响

Yidan Decoction Influence on Severe Acute Pancreatitis Intestinal Mucosal Barrier Function by Oral and Enema

目的:探讨胰瘅方内服加灌肠对重症胰腺炎(SAP)肠黏膜屏障功能及炎性因子的影响。方法:将83例SAP随机按入院顺序分为对照组42例和中药组41例。两组均参照"重症急性胰腺炎诊治指南"给予西医常规治疗,醋酸奥曲肽注射液,0.6 mg溶于50 mL生理盐水中,接静脉输液泵,24 h持续泵入;注射用奥美拉唑钠,40 mg·d-1,静脉滴注;注射用亚胺培南西司他丁钠,1.0 g/次,2次/d,静脉滴注。中药组在对照组治疗的基础上加用胰瘅方内服和灌肠。两组疗程均为14 d。记录急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)发生情况和手术中转情况;记录腹痛和腹胀缓解时间、肠鸣音恢复时间及首次通气排便时间;于第0,3,7,14天进行急性生理学和慢性健康状况评分(APACHEⅡ)评分;监测第0,3,7天血浆D-乳酸、二胺氧化酶(DAO)、内皮素(ET)、一氧化氮(NO)、丙二醛(MDA)水平;监测第0,3,7天肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)和白介素-10(IL-10)水平。结果:治疗第3,7天,中药组血浆D-乳酸、DAO,ET,NO和MDA水平均低于同期对照组(P<0.01);治疗第3,7天,中药组血清TNF-α,IL-1β和IL-6水平低于对照组,IL-10水平高于对照组(P<0.01);中药组腹痛、腹胀缓解、肠鸣音恢复及首次通气排便时间均短于对照组(P<0.01);治疗后第7,14天中药组APACHEⅡ评分低于对照组(P<0.01);中药组ARDS发生率为14.63%,MODS发生率为12.19%,均低于对照组的38.09%和30.95%(P<0.05);中药组手术中转率为9.75%,低于对照组的19.05%,但差异无统计学意义。结论:胰瘅方内服、灌肠辅助治疗SAP,能减少ARDS,MODS的发生率,促进SAP患者的康复,其作用机制可能与调节炎性炎子,减轻炎性反应,改善肠微循环障碍,保护肠黏膜屏障的完整性有关。

Objective：To discuss the influence of severe acute pancreatitis （SAP） intestinal mucosal barrier function and inflammatory factor by taking Yidan decoction oral and enema.Method：Eighty-three patients were randomly divided into control group （42 cases） and Chinese medicine group （41 cases） according to digital method.Patients of the two groups received conventional western medicine treatment,which referred to diagnosis and treatment of severe acute pancreatitis＇ guidance,octreotide acetate injection,0.6 mg dissolved in 50 mL saline,picked up intravenous infusion pump,pumping continuous 24 hours.Omeprazole sodium for injection,40 mg/day,intravenous drip.Imipenem and cilastatin sodium for injection,1.0 g/time,2 does/day,intravenous drip.Based on the treatment of control group,patients in Chinese medicine group added Yidandecoction taken orally combined with enema.Course of treatment in two groups were both 14 days.Occurrence and conversive rates of acute respiratory distress syndrome （ARDS） and multiple organ dysfunction syndrome （MODS） were recorded.And time of stomachache,remission of abdominal distension,restoration of gurgling sound and the first time of ventilation defecation were also recorded.At the zeroth,third and seventh day after treatment,acute physiology scores and acute physiology and chronic health scores （APACHE Ⅱ） were made.Levels of D-lactic acid in plasma,diamine oxidase （DAO）,endothelin （ET）,nitric oxide （NO） and malonaldehyde （MAD） were monitored.Levels of tumor necrosis factor-α （TNF-α）,interleukin-1β （（IL-1β）,interleukin-6 （IL-6） and interleukin-10 （IL-10） were monitored.Result：At the third and seventh day after treatment,levels of serous D-lactate,DAO,ET,NO and MDA in Chinese medicine group were lower than those in control group of corresponding period （P ＜ 0.01）.And levels of TNF-α,IL-1β and IL-6 were lower than those in control group,but level of IL-10 was higher than in control group （P ＜ 0.01）.Time of stomachache,remission of abdominal distension,restoration of gurgling sound and the first time of ventilation defecation were all less than those in control group （P ＜0.01）.At the seventh and fourteenth day after treatment,score of APACHE in Chinese medicine group was lower than in Chinese medicine group （P ＜0.01）.For chinese medicine group,occurrence rate of ARDS was 14.63％ lower than 38.09％ in control group.Besides occurrence rate of MODS was 12.19％ lower than 30.95％ in control group （P ＜0.05）.Conversion rate of operation in Chinese medicine group was 9.75％ lower than 19.05％ in control group,but there was no statistical significance from the differences between two groups.Conclusion：Yidan decoction taken orally combined with adjuvant therapy of enema in treating SAP,can reduce occurrence rate of ARDS and MODS,promote recovery of patients with SAP,and its mechanism of action may be related to regulation of inflammatory factors,reducing inflammatory response,ameliorating microcirculation disorder of intestine and protecting integrity of intestinal mucosal barrier.