大承气汤联合乌司他丁治疗中-重度急性胰腺炎的临床疗效观察

Clinical effect of Dachengqi decoction combined with ulinastatin on the treatment of moderate-to-severe acute pancreatitis

目的:探讨大承气汤联合乌司他丁对中-重度急性胰腺炎的治疗效果。方法:采用随机数字表法将2015年1月至2016年12月我院肝胆胰外科收治的68例中-重度急性胰腺炎患者分为治疗组和对照组,治疗组在常规治疗基础上给予乌司他丁加用大承气汤,对照组未使用大承气汤治疗。比较两组的腹痛和腹胀改善时间、胃肠功能恢复时间、住院时间、并发症发生率及死亡率、入院时及入院后3、7、14 d急性生理与慢性健康评分(acute ohysialogy and chronic health evaluation, APACHE-Ⅱ)的变化情况。结果:治疗组患者的腹痛和腹胀缓解时间,胃肠功能恢复时间以及住院时间较对照组明显缩短,差异有统计学意义(P <0.05)。治疗组的呼吸功能衰竭、肾功能衰竭、脓毒血症发生率及死亡率与对照组比较,差异无统计学意义(P> 0.05)。而在腹腔室膈综合征、胰腺周围脓肿、胰腺假性囊肿的发生率均低于对照组(P <0.05)。两组患者在入院后7 d和14 d APACHE-Ⅱ评分与入院时比较下降明显,差异有统计学意义(P <0.05)。在入院后3 d治疗组的APACHE-Ⅱ评分与对照组比较,差异无统计学意义(P> 0.05)。入院后7 d和14 d治疗组的APACHE-Ⅱ评分低于对照组,其差异有统计学意义(P <0.05)。结论:大承气汤与乌司他丁联合应用治疗中-重度急性胰腺炎疗效确切,能缩短临床恢复时间,减少平均住院日,减少并发症发生率,值得临床推广。

Objective To investigate the clinical effect of Dachengqi decoction combined with ulinastatin on thetreatment of moderate-to-severe acute pancreatitis. Methods： A total of 68 patients with moderate-to-severe acutepancreatitis who were admitted to Department of Hepatopancreatobiliary Surgery in our hospital from January 2015to December 2016 were enrolled and divided into treatment group and control group using a random number table.The patients in the control group were given conventional treatment and ulinastatin, and those in the treatment groupwere given Dachengqi decoction in addition to the treatment in the control group. The two groups were compared interms of time to improvement in abdominal pain and distension, time to recovery of gastrointestinal function, lengthof hospital stay, incidence rate of complications, mortality rate, and the change in Acute Physiology and ChronicHealth Evaluation II （APACHE II） score on days 3, 7, and 14 after admission. Results： Compared with the controlgroup, the treatment group had significantly shorter time to improvement in abdominal pain and distension, time to recovery of gastrointestinal function, and length of hospital stay （P 〈 0.05）. There were no significant differences be-tween the two groups in the incidence rates of respiratory failure, renal failure, and sepsis and mortality rate （P 〉0.05）, while the treatment group had significantly lower incidence rates of abdominal compartment syndrome, peri-pancreatic abscess, and pancreatic pseudocyst than the control group （P 〈 0.05）. Both groups had a significant reduc-tion in APACHE II score on days 7 and 14 after admission （P 〈 0.05）. There was no significant difference inAPACHE II score between the two groups on day 3 after admission （P 〉 0.05）. On days 7 and 14 after admission, thetreatment group had a significantly lower APACHE II score than the control group （P 〈 0.05）. Conclusion：Dachengqi decoction combined with ulinastatin has a good clinical effect in the treatment of moderate-to-severeacute pancreatitis and can shorten the time to clinical recovery and the length of hospital stay and reduce the inci-dence rate of complications. Therefore, it holds promise for clinical application.