清胰陷胸汤联合血液净化对重症急性胰腺炎患者临床疗效及免疫功能的影响

Clinical Effects and Immune Function of Qingyi Xianxiong Decoction with Continuous Blood Purification Combined in the Treatment of Severe Acute Pancreatitis

目的:探讨清胰陷胸汤联合血液净化对重症急性胰腺炎患者临床疗效及免疫功能的影响。方法:选取重症急性胰腺炎患者92例,依据随机数表法均分为观察组和对照组。两组均给予常规干预治疗,包括胃肠减压/禁食、抗感染、抑酸、抑制腺体分泌、维持水/电解质平衡、营养支持治疗,必要时给予经口气管插管机械通气。对照组在常规治疗基础上,给予连续性血液净化治疗。观察组在对照组的治疗基础上,同时应用中药清胰陷胸汤,一煎经胃管或者空肠营养管注入,二煎经直肠注入。两组持续治疗14 d。观察比较两组患者的临床疗效、治疗前后血清炎性因子水平和血清T淋巴细胞亚群水平。结果:观察组患者膀胱压力恢复正常时间、肠蠕动恢复时间、血液淀粉酶恢复正常时间和患者住院时间均短于对照组,差异有统计学意义(均P<0.05)。两组患者治疗后第1、3、7天的TNF-α、IL-6、IL-10水平均显著低于治疗前(均P<0.05);且观察组在治疗第1、3、7天的TNF-α、IL-6、IL-10水平均显著低于对照组同时间点(均P<0.05)。两组患者治疗后第1、3、7天的血清CD3^(+)、CD4^(+)及CD8^(+)水平均较治疗前升高,而血清CD3^(+)/CD8^(+)均较治疗前降低,差异有统计学意义(均P<0.05),且治疗后第1、3、7天,观察组血清CD3^(+)、CD4^(+)及CD8^(+)高于对照组,血清CD3^(+)/CD8^(+)低于对照组,差异有统计学意义(均P<0.05)。结论:清胰陷胸汤联合血液净化治疗能够清除重症急性胰腺炎患者炎症介质、减轻机体炎症反应,改善机体免疫状态,维持血流动力学稳定,减轻器官的损伤,提高临床治疗效果,值得临床应用和推广。

Objective To explore the effects of Qingyi Xianxiong decoction combined with blood purification on the clinical efficacy and immune function of patients with severe acute pancreatitis.Methods 92 patients with severe acute pancreatitis were randomly divided into control group and observation group.Both groups were given routine intervention treatment,including gastrointestinal decompression/fasting,anti infection,acid suppression inhibition of gland secretion,maintenance of water/electrolyte balance,application of supportive treatment,if necessary,tracheal intubation mechanical ventilation.The control group was treated with continuous blood purification on the basis of the above conventional treatment.In the observation group,on the basis of the treatment in the control group,Qingyi Xianxiong decoction was used at the same time.The two groups were treated continuously for 14 days.To observe and compare the clinical therapeutic effect,the level of serum inflammatory factors and the level of serum T lymphocyte subpopulation before and after treatment between the control group and the observation group were analyzed.Results The recovery time of bladder pressure,intestinal peristalsis,blood amylase and hospital stay in the observation group were shorter than those in the treatment group(P<0.05).The levels of TNF-α,IL-6 and IL-10 in the first,third and seventh day after admission were significantly lower than those before treatment(P<0.05).The levels of TNF-α,IL-6 and IL-10 in the observation group were significantly lower than those in the control group at the same time(P<0.05).After treatment,the serum CD3^(+),CD4^(+)and CD8^(+)of the two groups were higher than those before treatment,while the serum CD3^(+)/CD8^(+)were lower than those before treatment,which the difference were statistically significant(P<0.05).After treatment,the serum CD3^(+),CD4^(+)and CD8^(+)of the observation group were higher than those of the control group,and the serum CD3^(+)/CD8^(+) were lower than those of the control group, which the difference were statistically significant (P <0.05). Conclusion Qingyi Xianxiong decoction combined with blood purification can clear the inflammatory mediatorsof SAP patients, reduce the inflammatory response of the body, improve the immune status of the body, maintainthe hemodynamic stability, reduce organ damage, and improve the clinical treatment effect, which is worth clinicalapplication and promotion.