大承气汤对重症胰腺炎患者腹腔压力影响的临床观察

Clinical observation of the effect of Dachengqi Decoction on abdominal pressure in patients with acute pancreatitis

目的:观察大承气汤对重症胰腺炎患者腹腔压力的影响。方法:选取我院重症医学科自2015年01月—2017年12月所收治的重症胰腺炎合并腹腔间隔室综合征患者60例作为本次研究的对象,随机分为对照组和观察组。对照组采用常规的治疗方式(包括抗感染、抑制胰酶分泌、胃肠减压以及营养支持等措施,要时进行血液净化以及机械通气等),观察组在常规治疗的基础上加用大承气汤经鼻-空肠管灌注。分别观察两组治疗前后的膀胱压力变化,APACHE II评分及每日大便次数等,差异有统计学意义(P <0.05)。结果:观察组患者的腹腔压力较治疗组的明显降低,APACHE II评分及每日大便次数均有好转。结论:大承气汤通过攻下实热,涤荡燥结,使邪有出路,恢复中焦枢纽之功能,使气机恢复升降,改善患者的肠道功能,促肠道蠕动,恢复肠道的正常功能,以此来降低腹腔的压力。减少患者因腹腔高压而产生的一系列并发症,进一步防止多脏器功能衰竭的发生,达到降低患者病死率的目的。通过此实验的观察说明大承气汤在重症胰腺炎患者中能够有效地降低腹腔压力。

Objective To observe the efect of Dachengqi Decoction（大承气汤）on abdominal pressure in patients with severe acute pancreatitis. Methods： 60 patients with acute severe pancreatitis treated in our hospital from January 2015 to December 2017 were selected as the subjects of this study and randomly divided into the control group and the observation group. The control group was treated with conventional treatment （ anti-infective inhibition of pancreatic enzyme secretion of gastrointestinal decompression and nutritional support, and blood purifcation and mechanical ventilation ）, on the basis of conventional treatment, the observation group was combined with Dachengqi Decoction （ 大承气汤） and nasal-jejunal tube perfusion. The changes of abdominal pressure, APACHE II score and daily stool count before and after treatment in 2 groups were observed respectively, the diference between the two groups was of statistical signifcance （P 〈0.05）. Results： The abdominal pressure of the observation group was signifcantly lower than that of the treatment group, and the APACHE II score and the number of bowel movements per day improved. Conclusion： Dachengqi Decoction （大承气汤 ） could capture real heat, clean dry knot and the evil way, restore the function of the upper hinge, restore qi movement, improve patients’ intestinal function, promote the intestinal peristalsis, restore the normal function of intestinal tract, and reduce abdominal pressure. It could also reduce the incidence of multiple organ failure and reduce the mortality of patients due to a series of complications caused by abdominal hypertension. The experimental observation showed that Dachengqi Decoction （ 大承气汤 ） could efectively reduce abdominal pressure in patients with severe acute pancreatitis.