清热解毒通里攻下法联合西医治疗对重症急性胰腺炎肠道功能及肠道微生态的影响

Effects of Heat-clearing and Detoxifying,Removing Stasis by Purgation Method Combined with Western Medicine on Intestinal Function and Intestinal Microecology in Severe Acute Pancreatitis

目的:观察清热解毒、通里攻下法联合西医治疗对重症急性胰腺炎(SAP)肠道功能及肠道微生态的影响。方法:将2014年6月~2015年6月于我院住院的94例SAP患者采用随机数字表法分为两组。对照组(47例)采用西医常规治疗,观察组(47例)在对照组的基础上加用清热解毒、通里攻下法药物煎服。通过比较两组患者的排气时间、腹胀缓解时间、肠鸣音恢复时间、住院时间等临床症状缓解情况及血清淀粉酶(AMS)、血清二胺氧化酶(DAO)及D-乳酸水平来评估患者的肠道功能;采用培养皿活菌计数法检测排泄物中肠杆菌、肠球菌、双歧杆菌及乳酸杆菌的总数,评价患者的肠道微生态情况;比较两组临床疗效。结果:观察组排气时间、腹胀缓解时间、肠鸣音恢复时间、住院时间均较对照组显著较低(P<0.05);治疗1周观察组AMS(3675.74±574.22)U/L、血浆DAO水平(4.45±0.95)U/ml较对照组(4561.78±581.37)U/L、(5.71±1.13)U/ml显著较低(P<0.05);治疗1周观察组肠杆菌总数(7.37±1.64)In/g、肠球菌(4.24±1.03)In/g总数较对照组(8.93±1.71)In/g、(5.62±1.24)In/g显著较低(P<0.05),双歧杆菌总数(6.48±1.44)In/g、乳酸杆菌总数(7.64±2.13)In/g较对照组(4.76±1.52)In/g、(5.21±1.75)In/g显著较高,差异有统计学意义(P<0.05)。结论:采用清热解毒、通里攻下法联合西医治疗SAP患者可显著改善患者的肠道功能,维持肠道微生态的稳定,提高其临床疗效。可在临床上广泛推广。

Objective： To explore effects of heat-clearing and detoxifying, removing stasis by purgation combined with west- ern medicine on intestinal function and intestinal microecology in severe acute pancreatitis （SAP）. Methods： 94 SAP patients ad- mitted to our hospital from June 2014 to June 2015 were divided by random number table into two groups. The controlled group （47 cases） was given routine western medicine, the observation group （47 cases） added heat-clearing and detoxifying, removing stasis by purgation drugs on the basis of the controlled group. Exhaust time, relieving time of abdominal distension, recovery time of bowel sound, length of stay and remission of clinical symptoms, serum amylase （AMS）, serum diamine oxidase （DAO）, D- lactic acid level in the two groups were compared to evaluate intestinal function of patients ; live bacteria in glass garden counting method was used to detect totality of enterobacteria, enterococcus, bacillus bifidus and bacillus acid/lactici, evaluated intestinal microecology of patients ; clinical efficacy of the two groups were compared. Results ： Exhaust time, relieving time of abdominal distension, recovery time of bowel sound, length of stay in the observation group were significantly lower than the controlled group （P 〈 0. 05） ; AMS （3675.74±574. 22） U/L, plasma DAO level （4.45±0. 95） U/m1 in the observation group after 1 weeks of treatment were significantly lower than the controlled group [ （4561.78±581.37 ） U/L, （5.71 ± 1.13 ） U/ml ] （ P 〈 0. 05 ） ; to- tality of enterobacteria （7.37±1.64） In/g, totality of enterococcus （4. 24±1.03） In/g in the observation group after 1 weeks of treatment were significantly lower than the controlled group [ （8.93±1.71） In/g, （5.62±1.24） In/g] （P 〈 0. 05）, totality of bacillus bifidus （6. 48±1.44） In/g, totality of bacillus acidi lactici （7.64±2. 13 ） In/g were significantly higher than the con- trolled group [ （4. 76±1.52） In/g, （5.21±1.75） In/g] （P 〈 0.05）. Conclusion： Heat-clearing and detoxifying, removing stasis by purgation combined with western medicine for SAP patients can improve intestinal function of patients significantly, maintain stability of intestinal microecology, improve the clinical efficacy. It can be spread in the clinical application.