精制芒硝与柴芍承气汤辅助治疗重度急性胰腺炎并腹腔间隔室综合征

Clinical study of refined mirabilite vs. Chaishao Chengqi Decoction in treating sever acute pancreatitis complicated with abdominal compartment syndrome

目的比较精制芒硝与柴芍承气汤在治疗重度急性胰腺炎(SAP)并腹腔间隔室综合征(ACS)的临床疗效差异。方法 SAP合并ACS患者60例,随机分为治疗组32例,对照组28例。治疗组在常规西医治疗基础上,予以精制芒硝鼻饲+灌肠;对照组在常规西医治疗基础上,予以柴芍承气汤鼻饲+灌肠。比较两组患者治疗前与治疗第1、3、7天的APACHEⅡ评分、腹内压、内毒素、降钙素原(PCT)、肿瘤坏死因子α(TNF-α)变化;比较两组患者肠鸣音恢复时间、自主排便恢复时间、住院时间及住院费用。结果两组患者治疗7 d后,肠道通透性指标(内毒素)及感染相关指标(PCT、TNF-α)均较治疗前显著下降,差异有统计学意义(P<0.05)。两组在治疗第1、3、7天腹内压均显著低于治疗前(P<0.05),且同时间两组间比较差异无统计学意义(P>0.05)。治疗第3、7天APACHEⅡ评分均较治疗前显著改善(P<0.05),且同时间两组比较差异无统计学意义(P>0.05)。在肠鸣音恢复时间、自主排便恢复时间、住院时间、住院费用方面,两组比较差异无统计学意义(P>0.05)。结论精制芒硝辅助治疗SAP合并ACS,能有效降低腹内压,促进肠道功能恢复,保护肠道黏膜屏障功能,减少肠道细菌及内毒素移位,减少感染并发症的发生,有利病情恢复,与柴芍承气汤具有相似的临床疗效。

Objective To compare the clinical efficacy of refined mirabilite vs. Chaishao Chengqi Decoc-tion in treating sever acute pancreatitis（SAP） complicated with abdominal compartment syndrome（ACS）.Methods 60 cases of SAP complicated with ACS were divided into treatment group（n = 32）and control group（n = 28） with random number table. The treatment group was given the nasal feeding and enema with refined mira-bilite base on routine western medicine treatment. The control group was given the nasal feeding and enema withChaishao Chengqi Decoction. The 2 groups were compared with respect to the changes of the APACHEⅡ scores,intra-abdominal pressure,endotoxin,calcitonin（PCT）,tumor necrosis factor alpha（TNF-α）,recovery time ofbowel sound,self-defecation recovery time,length of stay and hospitalization expenses. Results After 7 days oftreatment,the intestinal permeability index（endotoxin）and the related indicators（PCT,TNF-α）were significantlylower than before treatment in both groups（P〈0.05）. The abdominal pressure of both groups at days 1,3 and 7 days after treatment was significantly lower than before treatment（P〈0.05）but the difference between the twogroups had no statistical significance（P〈0.05）. In the 3 rd and 7 th days of the treatment,APACHEⅡ scoreswere significantly lower than before treatment（P〈0.05）,but the difference between the two groups was not statis-tically significant in the score（P〈0.05）. The two groups showed no significant difference in the recovery time ofbowel sound,self-defecation recovery time,length of stay and hospitalization expenses（P〈0.05）. Conclusions Refined mirabilite as adjuvant therapy in SAP with ACS,can effectively reduce the internal pressure,promote theintestinal function recovery,protect the intestinal mucosal barrier function,reduce intestinal bacteria and endotox-in translocation and the complications of infection. It has a similar clinical effect as Chaishao Chengqi Decoction tothe recovery of the disease.