大黄经鼻空肠管给药治疗中度急性胰腺炎的随机对照研究

Treating Moderately Severe Acute Pancreatitis with Raw Rhubarbs by Intranasal Jejuna Injection:a Randomized Clinical Analysis

目的观察大黄经鼻空肠管给药治疗中度急性胰腺炎(moderately severe acute pancreatitis,MSAP)的临床疗效及其对胃肠道及凝血纤溶系统的影响。方法将84例MSAP患者采用随机数字表法分为对照组和治疗组,每组42例。两组均给予常规治疗,并在发病48 h内在内镜引导下放置经鼻空肠管进行肠内营养。治疗组在上述治疗基础上加用生大黄液100 m L鼻空肠管给药,每天2次,治疗持续时间3~7天。观察患者胃肠道功能恢复情况(肛门排气时间、肠鸣音恢复时间、腹胀消失时间及腹痛消失时间)及凝血纤溶系统功能[凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血浆凝血酶时间(TT)、纤维蛋白原(Fib)、血小板(PLT)、D-二聚体及蛋白C水平],评价临床疗效。结果与对照组比较,治疗组肛门排气时间、肠鸣音恢复时间、腹胀消失时间及腹痛消失时间均缩短,PT、APTT、Fib、TT、D-二聚体水平下降,蛋白C水平升高,差异均有统计学意义(P<0.05)。与对照组比较,治疗组并发症发生率降低,治愈率提高(P<0.05),两组治疗总有效率比较,差异无统计学意义(P>0.05)。结论大黄经鼻空肠管给药治疗中度急性胰腺炎疗效较好,可改善患者胃肠道症状及凝血纤溶系统功能。

Objective To observe clinical efficacy of raw rhubarbs （by intranasal jejuna injection） for moderately severe acute pancreatitis （MSAP）, and its effects on gastrointestinal tract and coagulation fibrinolysis. Methods Totally 84 MSAP patients were randomly assigned to the control group and the treatment group by random number table, 42 in each group. All patients received routine medica- tion. Enteral nutrition by intranasal jejuna injection was input under the endoscope within 48 h of onset. Patients in the treatment group additionally used raw rhubarbs （by intranasal jejuna injection）, 100 m L each time, twice per day, with the treatment duration for 3 -7 days. The recovery of gastrointestinal tract function （passage of gas by anus, recovery time of bowel sound, distension disappearance time, abdominal pain disappearance time） was observed, prothrombin time （PT）, activated partial thromboplastin time （APTT）, thrombin time （TT）, fibrinogen （Fib） content, platelet （PLT） count, D-dimer （DD）, protein C were determined. Clinical efficacy was assessed as well. Results Compared with the control group, time for gas passage by anus, recovery time of bowel sound, distension disappearance time, and ab- dominal pain disappearance time were shortened, PT, AP-I-I＇, Fib content, thrombin time, and DD de- creased, and protein C increased in the treatment group （P 〈0.05）. The incidence rate of complications was lower in the treatment group than in the control group （P 〈0.05）. The cure rate was elevated （P 〈 0.05）. There was no statistical difference in the total effective rate between the two groups （P 〉0.05）.Conclusion Intranasal jejuna injection of raw rhubarbs in treating moderately severe acute pancreatitis could improve symptoms of gastrointestinal tract and coagulation fibrinolysis.