大黄联合早期肠内营养辅助治疗重症急性胰腺炎疗效观察

Observation on curative effect of rhubarb combined with early enteral nutrition on severe acute pancreatitis

目的观察大黄联合早期肠内营养辅助治疗重症急性胰腺炎的疗效。方法将2017年1月—2018年12月河北省人民医院重症医学科收治的50例重症急性胰腺炎患者随机分为大黄治疗组和常规治疗组,每组25例。2组均给予常规治疗,大黄治疗组同时经鼻饲给予大黄制剂,常规治疗组鼻饲温开水。检测2组入组当天及第3天炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)、血清淀粉酶(AMY)],比较2组临床疗效指标(腹痛缓解时间、肠鸣音恢复时间、首次排便时间及胃肠不耐受情况)的差异。结果入组当天,2组患者白细胞计数、CRP及血AMY水平比较差异均无统计学意义(P均>0.05);入组第3天,2组患者WBC、CRP及AMY较入组当天均有不同程度降低(P<0.05),但大黄治疗组较常规治疗组下降更明显(P均<0.05)。大黄治疗组腹痛缓解时间、肠鸣音恢复时间、首次排便时间均明显短于常规治疗组(P均<0.05),喂养不耐受率明显低于常规治疗组(P<0.05)。结论大黄联合早期肠内营养可减轻重症急性胰腺炎患者炎症反应,促进胃肠功能恢复。

Objective It is to observe the curative effect of rhubarb combined with early enteral nutrition in the treatment of severe acute pancreatitis.Methods Fifty patients with severe acute pancreatitis admitted to the Department of Intensive Care Medicine of Hebei General Hospital from January 2017 to December 2018 were randomly divided into rhubarb treatment group and conventional treatment group,with 25 cases in each group.Both groups were given conventional treatment.The rhubarb treatment group was given rhubarb preparations via nasal feeding at the same time,and the conventional treatment group was given warm water via nasal feeding at the same time.The inflammation indicators[white blood cell count(WBC),C-reactive protein(CRP),serum amylase(AMY)]of the two groups were detected on the first day of of enrollment and on the third day of enrollment,and the differences in clinical efficacy indicators(abdominal pain relief time,bowel sound recovery time,first defecation time and gastrointestinal intolerance)of the two groups were compared.Results On the first day of enrollment,the white blood cell count,CRP and blood AMY levels between the two groups were not statistically different(P>0.05);on the third day of enrollment,the levels of WBC,CRP and AMY of the two groups were decreased more or less compared with those on the first day of enrollment,and the differences were significant(P<0.05),the decrease in the rhubarb treatment group was more significant than that in the conventional treatment group(P<0.05).The abdominal pain relief time,bowel sound recovery time,and first defecation time in the rhubarb treatment group were significantly shorter than those in the conventional treatment group(P<0.05),and the feeding intolerance rate was significantly lower than that in the conventional treatment group(P<0.05).Conclusion Rhubarb combined with early enteral nutrition can reduce the inflammatory response in patients with severe acute pancreatitis and promote the recovery of gastrointestinal function.