生大黄水浸液灌胃与芒硝外敷结合谷氨酰胺治疗重症急性胰腺炎的疗效观察

Clinical efficacy of rhubarb water and mirabilite combined with glutamine in patients with severe acute pancreatitis

目的研究在重症急性胰腺炎患者中采用生大黄水浸液灌胃与芒硝外敷结合谷氨酰胺治疗的效果,并探讨其对患者炎性细胞因子及肠黏膜屏障相关因子水平的影响。方法将延安市中医医院2017年5月至2018年7月收治的66例重症急性胰腺炎患者作为研究对象,采用随机数表法分为观察组和对照组,每组33例。对照组患者接受常规西药治疗,观察组在对照组治疗的基础上加生大黄水浸液灌胃、芒硝外敷、谷氨酰胺共治疗28 d。比较两组患者治疗后的临床治疗效果,以及治疗后1周、2周、3周的炎性细胞因子及肠黏膜屏障相关因子变化情况。结果观察组患者的持续血液净化时间(CBP)、腹痛消失时间、血淀粉酶恢复时间、肠蠕动恢复时间、住院时间分别为(3.21±1.43)d、(4.43±1.43)d、(6.43±1.11)d、(4.54±0.76)d、(17.98±4.01)d,明显少于对照组[(4.65±1.43)d、(6.21±1.43)d、(7.76±1.54)d、(6.01±0.98)d、(21.54±5.43)d]、差异均具有统计学意义(P<0.05);治疗后1周、2周、3周,观察组患者的D-乳酸分别为(1 244.65±293.46)mg/mL、(955.37±244.19)mg/mL、(763.25±125.49)mg/mL,明显低于对照组[(1 436.72±323.37)mg/mL、(1 218.65±194.25)mg/mL、(903.58±117.43)mg/mL],差异均具有统计学意义(P<0.05);二胺氧化酶(DAO)分别为(7.54±0.86)U/L、(5.43±0.64)U/L、(4.07±0.86)U/L,明显低于对照组[(8.43±0.91)U/L、(6.55±0.72)U/L、(4.82±0.83)U/L],差异均具有统计学意义(P<0.05);血管内皮素(ET)分别为(244.81±49.46)EU/mL、(136.44±35.97)EU/mL、(65.26±25.74)EU/mL,明显低于对照组[(324.67±59.81)EU/mL、(193.94±45.25)EU/mL、(113.51±39.81)EU/mL],差异具有统计学意义(P<0.05);超敏C反应蛋白(hs-CRP)分别为(17.48±2.45)mg/L、(9.24±2.29)mg/L、(4.56±1.73)mg/L,明显低于对照组[(22.19±3.35)mg/L、(13.16±2.91)mg/L、(7.49±2.68)mg/L]、降钙素原(PCT)分别为(18.24±3.38)ng/mL、(11.03±2.96)ng/mL、(7.98±2.57)ng/mL,明显低于对照组[(21.63±2.25)ng/mL、(17.36±2.94)ng/mL、(11.47±2.41)ng/mL]、急性慢性生理健康评分(APACHE-Ⅱ)分别为(17.46±3.11)分、(15.14±2.22)分、(8.53±3.36)分,明显低于对照组[(20.83±2.26)分、(17.47±3.22)分、(12.49±2.35)分],差异均具有统计学意义(P<0.05)。结论生大黄水浸液灌胃与芒硝外敷结合谷氨酰胺治疗重症急性胰腺炎有利于保护患者的肠黏膜屏障,降低炎性反应,提升症状舒缓的速度,具有较高的临床治疗效果。

Objective To investigate the clinical efficacy of rhubarb water and mirabilite combined with glutamine in patients with severe acute pancreatitis(SAP),and to analyze its effects on inflammatory cytokines and intestinal mucosal barrier-related factors.Methods Sixty-six patients with SAP admitted to Yan'an Traditional Chinese Medicine Hospital from May 2017 to July 2018 were randomly divided into observation group(n=33)and control group(n=33).The patients in the control group were treated with routine western medicine,and those in the observation group were treated with intragastric administration of rhubarb water,external application of mirabilite,and glutamine for 28 days on the basis of the treatment in the control group.The clinical therapeutic effect was compared between the two groups,and the changes of inflammatory cytokines and intestinal mucosal barrier-related factors at 1 week,2 weeks and 3 weeks after treatment were analyzed.Results The time of continuous blood purification,the disappearance time of abdominal pain,the recovery time of serum amylase,the recovery time of intestinal peristalsis,and length of hospital stay in the observation group were(3.21±1.43)d,(4.43±1.43)d,(6.43±1.11)d,(4.54±0.76)d,(17.98±4.01)d,respectively,which were significantly lower than(4.65±1.43)d,(6.21±1.43)d,(7.76±1.54)d,(6.01±0.98)d,(21.54±5.43)d in the control group(P<0.05).At 1 week,2 weeks and 3 weeks after treatment,the D-lactic acid levels in the observation group were(1 244.65±293.46)mg/mL,(955.37±244.19)mg/mL,(763.25±125.49)mg/mL,respectively,which were significantly lower than(1 436.72±323.37)mg/mL,(1 218.65±194.25)mg/mL,(903.58±117.43)mg/mL in the control group(P<0.05);the diamine oxidase(DAO)levels were(7.54±0.86)U/L,(5.43±0.64)U/L,(4.07±0.86)U/L,respectively,which were significantly lower than(8.43±0.91)U/L,(6.55±0.72)U/L,(4.82±0.83)U/L of the control group(P<0.05);the endothelin(ET)levels were(244.81±49.46)EU/mL,(136.44±35.97)EU/mL,(65.26±25.74)EU/mL,respectively,which were significantly lower than(324.67±59.81)EU/mL,(193.94±45.25)EU/mL,(113.51±39.81)EU/mL in the control group(P<0.05);the high sensitive C-reactive protein(hs-CRP)levels were(17.48±2.45)mg/L,(9.24±2.29)mg/L,(4.56±1.73)mg/L,respectively,which were significantly lower than(22.19±3.35)mg/L,(13.16±2.91)mg/L,(7.49±2.68)mg/L in the control group(P<0.05);the calcitonin(PCT)levels were(18.24±3.38)ng/mL,(11.03±2.96)ng/mL,and(7.98±2.57)ng/mL,respectively,which were significantly lower than(21.63±2.25)ng/mL,(17.36±2.94)ng/mL,(11.47±2.41)ng/mL in the control group;the acute chronic physiological health scores(APACHE-Ⅱ)were 17.46±3.11,15.14±2.22,and 8.53±3.36,respectively,which were significantly lower than 20.83±2.26,17.47±3.22,12.49±2.35 in the control group(P<0.05).Conclusion During the clinical treatment of SAP patients,intragastric administration of rhubarb water and external application of mirabilite combined with glutamine treatment is beneficial to protect the intestinal mucosal barrier,reduce the inflammatory reaction,improve the speed of symptom relief,and promote the curative effect,which has high application value.