生大黄水浸液灌胃与芒硝外敷结合西医常规疗法治疗重症急性胰腺炎

Clinical study of Rhubarb water extract gavage combined with external appucauon of mirabilite and western medicine in the treatment of severe acute pancreatitis

目的探讨生大黄水浸液灌胃与芒硝外敷结合西医常规疗法对重症急性胰腺炎（severe acute pancreatitis，SAP）炎性细胞因子及肠黏膜屏障相关因子的影响。方法将符合入选标准的62例SAP患者采用随机数字表法分为2组，每组31例。对照组采用西医常规疗法治疗，研究组在对照组基础上结合生大黄水浸液灌胃与芒硝外敷。2组均治疗28d。观察2组持续血液净化时间、腹痛消失时间、血淀粉酶恢复时间、肠蠕动恢复时间、住院时间及28d病死率。结果研究组持续血液净化时间、腹痛消失时间、血淀粉酶恢复时间、肠蠕动恢复时间、住院时间均低于对照组（t值分别为2．434、2．507、2．804、2-318、2．614，P〈0．05）。观察组28d病死率为6．5％（2／31）、对照组为16．1％（5／31），2组比较差异无统计学意义（χ^2=1．449，P=0．229）。与对照组同期比较，治疗后1、3、7d研究组D．乳酸（t值分别为38．752、36．975、36．018）、二胺氧化酶it值分别为4．119、4．632、3．907）、内毒素（t值分别为25．699、23．805、24．472）水平均降低（P〈0．01）；血清hs．CRP（t值分别为4．791、5．025、5．288）、降钙素原（t值分别为4．350、4．742、6．012）水平及APACHEII评分0值分别为3．988、4．350、5．722）均降低∽〈0．01）。结论生大黄水浸液灌胃联合芒硝外敷可保护SAP患者肠黏膜屏障，减轻炎症反应，缩短症状缓解时间，提高疗效。

Objective To investigate the effects of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis （SAP）. Methods A total of 62 patients with SAP meeting the inclusion criteria were randomly divided into 2 groups, with 31 cases in each group. The control group was treated with western medicine routine treatment. The study group was given the combination of raw and rhubarb water infusion and mirabilite external application on the basis of the control group. After treated with 28 d, the duration of blood purification, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time and 28 d mortality were observed in the 2 groups. Results The duration of blood purification time, abdominal pain disappeared time, blood amylase recovery time, bowel peristalsis recovery time, hospitalization time of the study group were significantly lower than those of the control group （t=2.434, 2.507, 2.804, 2.318, 2.614, P〈0.05）. After treatment 1, 3, 7 d, the level of D-lactic acid in the study group was respectively which were significantly lower than those of the control group （t=38.752, 36.975, 36.018, P〈0.05）. The level of DAO in the study group was respectively which were significantly lower than those of the control group （t=4.119, 4.632, 3.907, P〈0.05）. The level of ET in the study group was respectively which were significantly lower than those of the control group （t=25.699, 23.805, 24.472, P〈0.05）. The level of hs-CRP in the study group was respectively which were significantly lower than those of the control group （t=4.791, 5.025, 5.288, P〈0.05）. The level of PCT in the study group was respectively which were significantly lower than those of the control group （t=4.350, 4.742, 6.012, P〈0.05）. The APACHE II scores in the study group were respectively which were significantly lower than those of the control group （t=3.988, 4.350, 5.722, P〈0.01）. Conclusions The application of Rhubarb water extract gavage combined with external application of mirabilite and western medicine in the treatment of severe acute pancreatitis can protect the intestinal mucosal barrier of SAP patients, reduce the level of inflammatory reaction, shorten the time of symptom relief and improve the curative effect.