大黄浸泡液不同导泻方法应用于重症急性胰腺炎患者的效果研究

The Effect Investigate of the Patients with Severe Acute Pancreatitis which Used Different Way of Chinese Rhubarb's Soaking Solution to Catharsis

目的探讨大黄浸泡液在治疗重症急性胰腺炎中不同导泻方式的临床效果。方法将2015年3月至2016年7月收治的70例符合重症急性胰腺炎诊断标准的患者按照入院时间顺序分为实验组(奇数号)和对照组(偶数号),每组35例;实验组行干大黄15克150ml 100℃水浸泡,至水温38℃~40℃,去渣,取大黄液经鼻空肠管鼻饲,3次/天,每8小时一次;对照组给予干大黄15克150ml 100℃水浸泡,至水温38℃~40℃,去渣,取大黄液灌肠,3次/天,每8小时一次;对比两组患者采取这两种不同导泻方式后腹胀缓解时间、肠鸣音恢复时间的变化,治疗前、治疗后5d与10d血淀粉酶水平、血白细胞计数、C反应蛋白(CRP)水平,治疗前、治疗后5d与10d APACHEⅡ评分,治疗前、治疗后5d与10d腹腔压力水平(膀胱内压)的变化。结果实验组患者腹胀缓解时间、肠鸣音恢复时间与对照组相比,具有统计学意义(P均<0.05)。患者血淀粉酶水平、WBC计数、CRP水平治疗前无差异(P>0.05);治疗后5d、10d三项指标,实验组比对照组下降明显,具有统计学意义(P均<0.05)。两组患者治疗前APACHEⅡ评分水平无差异(P>0.05),治疗后5d也无统计学差异(P>0.05),治疗后10d实验组的值明显评分低于对照组(P<0.05)。两组患者腹腔压力水平的变化,治疗前两组患者腹腔压力水平无差异(P>0.05),治疗后5d、10d时实验组患者的腹腔压力水平明显低于对照组(P<0.05)。结论大黄浸泡液治疗重症急性胰腺炎时经鼻空肠管鼻饲导泻效果比灌肠效果更好。

Objective To investigate the clinical effect of rhubarb＇s soaking solution which use different cathar- sis＇s way in the treatment of severe acute pancreatitis.Methods From March 2015 to July 2016 ,A total of 70 patients who met the diagnostic requirements of severe acute pancreatitis were divided into test group （odd number） and control group （even number） according to the time of admission, 35 cases in each group; the test group received 15 milligram close of dry rhubarb which soak in 150ml 100℃ water, until a temperature of 38 to 40℃ , abandon slag, feed the rhubarb＇s soaking solution by nasal jejunum tube 3 times a day, every 8 hours; In the matched group 15 milligranl dose of dry rhubarb were given 150ml 100 ℃ water soaking, to a tempera- ture of 38 to 40℃, abandon slag, make rhubarb＇s soaking solution enema 3 times a day, every 8 hours. Control the changes of patients which took these two different ways of catharsis： The release time of abdominal disten- tion after catharsis, recovery time of bowel sound; 5 days and 10 days of blood amylase, white blood cell count and C reaction protein （CRP） levels after the treatment and before; 5 days and 10 days APACHE Ⅱ scores after treatment and before; the changes of abdominal pressure （bladder pressure） after 5 days and 10 days after the treatment and before. Results The experimental group patients with remission time of abdominal distention, bowel sound recovery time compared with the control group, with statistical significance （P〈0.05）. The serum amylase level, WBC count and CRP level were not different before treatment （P〉0.05）. After treatment, the three indexes of 5 days and 10 days decreased significantly compared with the control group, and the difference was statistically significant （P〈0.05）. There was no difference in the level of APACHE II between the two groups before treatment （P〉0.05）, and there was no statistical difference in the treatment of 5 days （P〉0.05）. The value of the 10 days treatment group was significantly lower than that of the control group （P〈0.05）. The ab- dominal pressure levels of the two groups had no difference between the two groups （P〉0.05）. After treatment at 5 days and 10 days, the abdominal pressure levels of the experimental group were significantly lower than that of the control group （P〈0.05）. Conclusion Rhubarb extract in treatment of severe acute pancreatitis by nasal jeju- num tube feeding is better than the effect of enema catharsis.