清胰汤灌肠联合盐酸氨溴索治疗重症急性胰腺炎相关性肺损伤的临床观察

Clinical Observation of Qingyi Decoction Enema Combined with Ambroxol Hydrochloride in the Treatment of Severe Acute Pancreatitis Related Lung Injury

目的观察清胰汤灌肠联合盐酸氨溴索治疗重症急性胰腺炎相关性肺损伤的临床效果并探讨其作用机制。方法将患者60例随机分为两组各30例,两组均予以常规治疗,对照组采用盐酸氨溴索注射液30 mg加入0.9%氯化钠注射液100 mL静脉滴注,联合组在对照组治疗基础上加用清胰汤高位保留灌肠,疗程为7 d。比较两组炎症指标[白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)]、内毒素、降钙素原(PCT)、急性生理与慢性健康状况评分(APACHEⅡ)、血气分析指标(氧分压、二氧化碳分压、氧饱和度)以及体温恢复正常时间、血淀粉酶正常时间、机械通气时间。结果联合组治疗后IL-6、IL-1β、TNF-α水平显著低于对照组(P<0.05),内毒素、PCT及APACHEⅡ评分显著低于对照组(P<0.05),氧分压、氧饱和度明显高于对照组(P<0.05),二氧化碳分压明显低于对照组(P<0.05);联合组体温恢复正常时间、血淀粉酶正常时间、机械通气时间均短于对照组(P<0.05)。结论对重症急性胰腺炎相关性肺炎患者采用清胰汤灌肠联合盐酸氨溴索治疗,能够缓解患者炎症反应和肠道黏膜屏障功能受损,改善血气分析指标,缩短临床症状改善时间。

Objective:To observe the clinical effect of Qingyi Decoction enema combined with ambroxol hydrochloride on severe acute pancreatitis(SAP)related lung injury.Methods:60 patients were selected as the research subjects,and they were randomly divided into a combined group and a control group,30 cases in each group.Both groups were treated routinely.The control group was given intravenous infusion of ambroxol hydrochloride injection 30 mg+0.9%sodium chloride injection 100 m L.The combined group was added with Qingyi Decoction high retention enema on the basis of treatment in the control group.The inflammation indexes[IL-6、IL-1β,tumor necrosis factor-α(TNF-α)],endotoxin,procalcitonin(PCT),acute physiology and chronic health status score(APACHEⅡ),blood gas analysis indicators(oxygen partial pressure,carbon dioxide partial pressure,oxygen saturation),time to normal temperature return,blood amylase normal time,mechanical ventilation time were compared between the two groups.Results:The levels of IL-6,IL-1βand TNF-αin the combined group were significantly lower than those in the control group(P<0.05).The endotoxin,PCT and APACHEⅡscores of the combined group were significantly lower than those of the control group(P<0.05).The oxygen partial pressure and oxygen saturation of the combined group were significantly higher than those of the control group,and the carbon dioxide partial pressure was significantly lower than that of the control group(P<0.05).The time of normal temperature recovery,blood amylase normal time,and mechanical ventilation time of the combined group were shorter than those of the control group(P<0.05).Conclusion:For patients with SAP related lung injury,treatment with Qingyi Decoction enema combined with ambroxol hydrochloride can alleviate the patient′s inflammatory response and impaired intestinal mucosal barrier function,improve blood gas analysis indicators,and shorten the time for clinical symptoms.