大承气汤联合早期肠内营养治疗重症急性胰腺炎临床研究

The Clinical Research into Severe Acute Pancreatitis Treated with Major Purgative Decoction in Combination with Early Enteral Nutrition

目的:观察大承气汤联合早期肠内营养治疗重症急性胰腺炎的临床疗效。方法:将2012年5月—2015年3月本院收治的重症急性胰腺炎患者128例随机分为对照组和观察组各64例。两组患者均给予西医抗炎、胃肠减压等常规治疗,对照组患者在此基础上给予早期肠内营养治疗,观察组在对照组治疗的基础上加用大承气汤鼻饲治疗,连续治疗2周。检测治疗前后患者炎症细胞因子水平变化,观察免疫功能的改善及不良反应发生情况。结果:观察组患者的炎性因子TNF-α、CRP、IL-6、IL-8水平与对照组相比明显降低,差异有统计学意义(P<0.05);观察组患者与机体免疫力相关的T细胞亚群CD4+、CD4+/CD8+水平明显高于对照组患者,而CD8+水平则明显低于对照组患者,其血清免疫球蛋白Ig G、Ig A、Ig M水平则明显高于对照组患者,差异有统计学意义(P<0.05);对照组不良反应率为17.2%,观察组不良反应率为3.1%,两组不良反应率比较差异具有统计学意义(P<0.05)。结论:大承气汤联合早期肠内营养治疗重症急性胰腺炎疗效确切,安全性高,其机制与降低机体炎症反应、提高机体免疫力密切相关。

Objective： To observe the clinical curative effect of Major Purgative Decoction in combination with early enteral nutrition on severe acute pancreatitis（ SAP）. Methods： One hundred and twenty eight patients with SAP who were treated in our hospital between May of 2012 and March of 2015 were randomly divided into the control group and the observation group,with 64 cases in each group. All the ones in the two groups were given routine treatment such as Western medicine for resisting inflammation,gastrointestinal decompression,etc. Based on this,the ones in the control group were added early enteral nutrition treatment,while the ones in the observation group were added Major Purgative Decoction for nasal feeding based on the treatment of the control group.The two groups were treated for 2 weeks continuously. Then the changes of inflammatory cell factor level before and after the treatment in the two groups were detected; Their immune function improvementand adverse reactions were observed. Results： The inflammatory factor TNF-α,CRP,IL-6 and IL-8 level of the observation group were obviously reduced compared with those of the control group; And the differences were statistically significant（ P〈0. 05）. CD4＋and CD4＋/ CD8＋level of T-cell subsets which are related to body immunity of the observation group were much higher than those of the control group,but its CD8＋was much lower than that of the control group; Its Ig G,Ig A and Ig M level of serum immune globulin were much higher than those of the control group; And the differences between them were statistically significant（ P〈0. 05）. The rate of adverse reactions of the control group was 17. 2%,while that of the observation group was 3. 1%; And the difference between them was statistically significant（ P〈0. 05）. Conclusion： Major Purgative Decoction in combination with early enteral nutrition has remarkable clinical curative effect with high safety on SAP. The working mechanism has close relationship with reducing body inflammatory reactions and increasing body immunity.