严格液体把控结合针刺疗法治疗急性胰腺炎合并胃肠功能障碍的疗效观察

Effect of Fluid Volume Control combined with Acupuncture on Intestinal Function, Bacterial Flora and Inflammatory Factors in Patients with Acute Pancreatitis Complicated With Gastrointestinal Dysfunction

目的:研究严格液体量把控联合针刺对急性胰腺炎合并胃肠功能障碍患者肠道功能、菌群、血乳酸水平及血清炎性因子的影响。方法:63例急性胰腺炎患者中采取开放液体量复苏的21例患者为开放组,以液体量把控复苏的21例患者作为限量组,以液体量把控复苏结合针刺疗法的21例患者作为针刺组;治疗72 h后评估统计3组的胃肠功能、血乳酸水平、肠道细菌计数及血清炎性因子并进行对比分析。结果:自复苏后24 h起,针刺组24 h、48 h及72 h血乳酸水平均低于开放组及限量组(P<0.05);3组复苏后肠道细菌计数比较,差异均有统计学意义(P<0.05);开放组肠道菌群紊乱发生率为71.4%,限量组为42.9%,针刺组为28.6%,差异有统计学意义(P<0.05);针刺组胃肠功能障碍评分及肠鸣恢复时间、排气时间、排便时间、腹痛缓解时间均明显优于开放组及限量组(P<0.05);治疗后针刺组CRP及IL-6、IL-8、TNF-α均明显低于开放组与限量组,针刺组IL-10明显高于开放组与限量组,差异均有统计学意义(P<0.05);炎性因子IL-6、IL-8、TNF-α、CRP与胃肠功能障碍评分具有正相关性。结论:严格液体量把控联合针刺治疗重度胰腺炎可有效改善患者胃肠功能,维持肠道菌群平衡,并可明显抑制炎性因子IL-6、IL-8、TNF-α的过高表达,提升IL-10的表达水平。

Objective： To study the effect of strict liquid volume control combined with acupuncture on intestinal function, bacterial flora, blood lactic acid level and serum inflammatory factors in patients with acute pancreatitis complicated with gastrointestinal dysfunction. Methods： 63 cases of patients with acute pancreatitis in our hospital from July 2014 to July 2016 as the research object, in which the open liquid volume resuscitation in 21 patients in the open group, in which 21 cases take the quantity of liquid resuscitation patients as the control group limited, to take them to control the amount of liquid resuscitation in 21 cases combining with acupuncture therapy the patients as the acupuncture group; 72 h treatment ＇after statistical evaluation of three groups of patients with gastrointestinal function and blood lactate level and bacterial count and serum inflamma- tory factors and comparative analysis. Results： 24 h from patients in the acupuncture group after resuscitation, 24 h, 48 h and 72 h determination of blood lactate levels were lower than that of the open group and Group Limited （P〈0.05）; intestinal bacterial count was statistically difference after resuscitation （P〈0.05）, the data in Table 2; the open group, the intestinal flora disorder incidence 71.43%, a limited group of intestinal flora disorder and the incidence rate was 42.86%, the acupuncture group the intestinal flora disorder incidence rate was 28.57%, three groups of intestinal flora disorder rate was statistically significant （P〈0.05）; and a limited group of gastrointestinal dysfunction score and bowel recovery time, exhaust time, defecation time, abdominal pain relief time were significantly better than the open group after treatment （P〈0.05）; acupuncture group CRP and IL-6, IL-8 and TNF-α were significantly lower than those of the open group and a limited group, acupuncture group was significantly higher than that of the open group and IL-10 Limited group （P〈0.05）; Inflammatory factors IL-6, IL-8, TNF-alpha and CRP were positively correlated with gastrointestinal dysfunction score. Conclusion： Strict liquid volume control combined with acupuncture in the treatment of severe acute pancreatitis treatment can improve gastrointestinal function, maintain the balance of intestinal flora, and can inhibit the inflammatory factor IL-6, IL-8, TNF-α high expression, enhance the expression level of IL-10.