柴芩承气汤改良保留灌肠联合西药穴位注射治疗急性胰腺炎合并麻痹性肠梗阻疗效及对血清胃肠激素的影响

Effect of modified retention enema with Chaiqin Chengqi decoction combined with western medicine acupoint injection on acute pancreatitis with paralytic ileus and its effect on serum gastrointestinal hormones

目的观察柴芩承气汤改良保留灌肠联合西药穴位注射治疗急性胰腺炎(AP)合并麻痹性肠梗阻(PI)的疗效及对血清胃肠激素的影响。方法将82例AP合并PI患者随机分为观察组41例和对照组41例,对照组给予西医常规治疗,观察组在对照组治疗基础上给予柴芩承气汤改良保留灌肠联合西药穴位注射治疗,疗程均为7 d。观察2组治疗后临床症状、实验室检查指标、血清胃肠激素改善情况以及临床结局;记录2组口盲传递时间(OTCC)、腹内压水平及血清胃肠激素变化情况。结果观察组临床症状体征改善情况优于对照组(P均<0.05);观察组治疗第3,7天的血淀粉酶、C反应蛋白(CRP)水平、OTCC、腹内压水平均明显低于对照组(P均<0.05),血清血管活性肠肽(VIP)、5-羟色胺(5-HT)、胃泌素(GAS)、胃动素(MTL)水平均显著高于观察组(P均<0.05);观察组住院期间APACHEⅡ评分、并发症发生率、住院时间、住院费用均低于对照组(P均<0.05)。结论柴芩承气汤改良保留灌肠联合西药穴位注射治疗能够显著缓解急性胰腺炎合并麻痹性肠梗阻患者的临床症状,促进肠道功能恢复并降低腹内压,改善预后,其机制可能与调节血清VIP、5-HT、GAS、MTL水平有关。

Objective It is to observe the curative effect of Chaiqin Chengqi Decoction on improving gastrointestinal hormone in patients with acute pancreatitis complicated with paralytic ileus by modified retention enema and western medicine point injection.Methods 82 cases of AP with PI were randomly divided into observation group of 41 cases and control group of 41 cases,the control group given Western conventional treatment,the observation group on the basis of the control group given Chaiqin Chengqi Decoction improved retention enema combined with western medicine point injection,Treatment 7d.The clinical symptoms,laboratory indexes,the improvement of serum gastrointestinal hormones and clinical outcomes of the two groups were observed.The OTCC,the level of intra-abdominal pressure and the changes of serum gastrointestinal hormones were recorded.Results The improvement of clinical symptoms and signs in the observation group was better than that in the control group(P<0.05).The levels of serum amylase,CRP,OTCC and intra-abdominal pressure in the observation group were lower than those in the control group on the 3rd and 7th day(P<0.05).The levels of VIP,5-HT,GAS and MTL in serum of the observation group were significantly higher than those of the observation group(all P<0.05).APACHEⅡscore,complication rate,hospitalization time and hospitalization cost in the observation group were lower than those in the control group P<0.05).Conclusion Chaiqin Chengqi Decoction improved retention enema combined with western medicine acupoint injection can significantly alleviate the clinical symptoms of patients with acute pancreatitis complicated with paralytic ileus,promote intestinal function recovery and reduce intra-abdominal pressure and improve prognosis,the mechanism may be related to the regulation of serum VIP,5-HT,GAS,MTL levels.