早期肠内营养结合化瘀通腑方治疗重症急性胰腺炎的临床观察

Clinical Observation on Early Enteral Nutrition Combined with Huayu Tongfu Principle on Severe Acute Pancreatitis

目的观察早期肠内营养联合化瘀通腑方治疗重症急性胰腺炎的临床疗效。方法将所选的60例重症急性胰腺炎患者按随机数字表法分为对照组和治疗组,每组30例,对照组予西医常规治疗及完全胃肠外营养支持,治疗组予西医常规治疗并加用早期肠内营养联合化瘀通腑法;比较两组患者的症状和体征恢复的时间,观察两组中医症状积分,APACHEⅡ评分、胃肠功能障碍评分及相关指标的变化。结果治疗组治疗后首次排大便时间、腹痛、腹胀、恶心呕吐明显短于对照组(P<0.05)。两组治疗5 d和10 d后的中医症状积分,APACHEⅡ评分、胃肠功能障碍评分、血淀粉酶、C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)较治疗前明显降低(P<0.05),但治疗组上述指标明显低于对照组同期(P<0.05)。两组白细胞介素-10(IL-10)较治疗前明显升高,治疗组明显高于对照组同期(P<0.05)。结论早期肠内营养联合化瘀通腑法可抑制重症急性胰腺炎患者炎症反应,消除肠道功能障碍,有利于病情的恢复。

Objective：To observe the clinical efficacy of early enteral nutrition combined with Huayu tongfu Principle on patients with severe acute pancreatitis（SAP）.Methods：Sixty patients with SAP were divided into the treatment group and the control group at random,30 cases in each group.The control group were given conventional western medicinal therapy and total parenteral nutrition support,while the treatment group were given enteral nutrition combined with Huayu Tongfu Principle on the basis of conventional trentment.Recovery time of symptoms and signs in the two groups were compared.The changes of TCM symptom score,APACHE Ⅱ score,gastrointestinal dysfunction score and related indexes were observed（P〈0.05）.Results：First defecation time,relief time of abdominal pain and abdominal distention,Nausea and vomiting were significantly shorter in the treament group than in the control group after treatment（P〈0.05）.TCM symptom score,APACHEⅡscore,Gastrointestinal dysfunction score,Serum amylase,CRP,TNF-α,IL-6 of both groups significantly reduced on the 5th and8 th days after treatment,compared with before treatment（P〈0.05）,while their levels in the treament group were significantly lower than those in the controle group on the 5 th and 8 th days after treatment（P〈0.05）.IL-10 of both groups significantly increased compared with their levels on the 5th and 8th days before treatment（P〈0.05）,and the increase was more significant in the treatment group on the 5th and 8th days after treatment（P〈0.05）.Conclusion：Early enteral nutrition combined with Huayu tongfu Principle can relieve inflammatory response of patients with severe acute pancreatitis and eliminate gastrointestinal dysfunction,shorten the course of disease.