重症急性胰腺炎应用大黄、芒硝的临床研究

Clinical observation on the effects of rhubarb and mirabilite combination on severe acute pancreatitis

目的:探讨重症急性胰腺炎(SAP)患者应用大黄、芒硝(又名皮硝)对减少胰腺渗出,缓解腹痛腹胀,促进快速康复的效果。方法:通过筛选符合纳排标准的2016年1月~2019年6月就诊患者共76例,根据是否应用大黄及芒硝,将其分为对照组和观察组(各38例),对照组采用常规西医治疗,观察组同时应用大黄和芒硝治疗。研究两组患者腹胀或腹痛缓解时间、血或尿淀粉酶峰值恢复时间,血液中白细胞计数(WBC)、C反应蛋白(CRP)及白细胞介素-6(IL-6)水平变化情况,胰腺渗液吸收情况。结果:与对照组比较,观察组患者的腹胀或腹痛缓解时间、血或尿淀粉酶恢复正常时间均缩短(P<0.05)。比较两组炎症因子表达水平发现,两组治疗7 d和14 d的WBC、CRP和IL-6水平均较治疗前降低,且观察组低于对照组(P<0.05)。观察组吸收有效率和完全吸收率高于对照组(P<0.05)。结论:大黄、芒硝对SAP患者有较好的治疗作用,可缓解临床症状,抑制大量炎症因子释放,促进胰腺渗液吸收和快速康复,提高临床疗效。

Objective:To observe the effects of combined rhubarb with mirabilite on reducing pancreatic exudation,relieving the symptoms of bloating and abdominal pain patients with severe acute pancreatitis(SAP).Methods:A total of 76 eligible patients of SAP were included from January 2016 to June 2019,and equally divided into control group and observational group.Patients in the observational group received combination therapy with rhubarb and mirabilite besides routine medication,and those in the control group were managed with simple conventional western medicine as the guidelines.The two groups were observed on the length of bloating or abdominal pain relief,recovered normal level of blood/urine amylase,changes of WBC、serum CRP and IL-6 levels and absorption of pancreatic exudate.Results:Reduced length of abdominal distension or abdominal pain relief and early restored blood/urine amylase level were seen in the observational group compared to the controls(P<0.05).WBC、CRP and IL-6 levels were reduced at day 7 and 14 following medication in both groups,yet the decrease was more significant in observational group(P<0.05).Absorption efficiency and complete absorption rate of pancreatic exudate were higher in observational group than in control group(P<0.05).Conclusion:Rhubarb and mirabilite combination may produce better adjuvant treatment effect on SAP,significantly alleviate clinical symptoms,inhibit the release of large number of inflammatory factors,facilitate pancreatic exudate absorption and rapid recovery,and boost clinical efficacy.