大黄牡丹汤加味保留灌肠联合低分子肝素钙治疗重症急性胰腺炎的临床疗效及对患者肠黏膜屏障功能和炎症因子的影响

Effect of modified Dahuang Mudan decoction retention enema combined with low molecular weight heparin on intestinal mucosal barrier function and inflammatory factors in patients with severe acute pancreatitis

目的观察大黄牡丹汤加味保留灌肠联合低分子肝素钙治疗重症急性胰腺炎的临床疗效及对患者肠黏膜屏障功能和炎症因子的影响。方法将60例重症急性胰腺炎患者按照随机数字表法分为2组。对照组30例予常规方案+低分子肝素钙治疗;治疗组30例在对照组治疗基础上加用大黄牡丹汤加味保留灌肠治疗。2组均治疗2周后统计临床疗效,并观察2组治疗前后主要症状(腹痛腹胀、恶心呕吐、发热、身目发黄、大便不畅)积分、肠黏膜屏障功能指标[D-乳酸、二胺氧化酶(DAO)、内毒素]、血淀粉酶、尿淀粉酶、炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)及IL-10]的变化情况。结果治疗组总有效率96.7%,对照组总有效率76.7%,治疗组疗效优于对照组(P<0.05)。治疗后2组恶心呕吐、腹胀腹痛、发热、身目发黄、大便不畅主要症状积分均降低(P<0.05),且治疗组上述症状积分降低优于对照组(P<0.05)。治疗后2组D-乳酸、DAO、内毒素、血淀粉酶、尿淀粉酶水平均降低(P<0.05),且治疗组D-乳酸、DAO、内毒素、血淀粉酶、尿淀粉酶改善优于对照组(P<0.05)。治疗后2组TNF-α、IL-6、CRP水平均降低(P<0.05),IL-10水平均升高(P<0.05),且治疗组TNF-α、IL-6、CRP水平降低,IL-10水平升高均优于对照组(P<0.05)。结论大黄牡丹汤加味保留灌肠联合低分子肝素钙能够有效调节重症急性胰腺炎患者血清炎症因子水平,改善患者肠黏膜屏障功能,快速缓解患者临床症状,有助于改善临床预后。

Objective To observe the clinical effects of modified Dahuang Mudan decoction retention enema combined with low molecular weight heparin on intestinal mucosal barrier function and inflammatory factors in patients with severe acute pancreatitis. Methods 60 patients with severe acute pancreatitis were divided into two groups according to random number table method. 30 cases in control group were treated by routine regimen plus low molecular weight heparin. 30 cases in observation group were treated by Dahuang Mudan decoction retention enema on the basis of the treatment in the control group. The clinical efficacy was calculated after 2 weeks of treatment in both groups, and the changes of main symptom scores (abdominal pain, abdominal distension, nausea and vomiting, fever, yellowing of body and eyes, inhibited defecation), intestinal mucosal barrier function indexes [D-lactic acid, diamine oxidase (DAO), endotoxin], amylase (AMY), inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-6 (IL-6) and IL-10] were observed before and after treatment. Results The total effective rate was 96.7 % in treatment group and 76.7% in control group. The clinical effect of the treatment group was better than that of the control group ( P <0.05). After treatment, the main symptoms of nausea and vomiting, abdominal distension, abdominal pain, fever, yellowing of body and eyes, inhibited defecation were decreased ( P <0.05), and the treatment group were lower than the control group ( P < 0.05 ). After treatment, the levels of D-lactic acid, DAO, AMY and endotoxin were decreased in the two groups ( P <0.05), and the improvement in the treatment group was better the control group ( P <0.05). After treatment, the levels of TNF-α, IL-6 and CRP in both groups were decreased ( P <0.05), the levels of IL-10 were increased ( P <0.05), and the levels of TNF-α, IL-6 and CRP in the observation group were decreased, and the IL-10 level were higher than that in the control group ( P <0.05). Conclusion The modified Dahuang Mudan decoction retention enema combined with low molecular weight heparin can effectively regulate the level of serum inflammatory factors in patients with severe acute pancreatitis, improve intestinal mucosal barrier function, rapidly relieve clinical symptoms, and help to improve clinical prognosis.