Effect of rhubarb retention enema on interleukin-33 expression and uncontrolled inflammation in patients with severe acute pancreatitis complicated with ARDS

Objective:To investigate the effects of rhubarb enema on the expression of inflammatory factors and interleukin-33(IL-33)and its prognosis in patients with SAP complicated with sepsis.Methods:A total of 47 patients with SAP complicated with ARDS admitted to the Department of Critical Care Medicine,the First Affiliated Hospital of Chongqing Medical University from June 2016 to December 2018 were randomly divided into SAP with ARDS sepsis group(sepsis group)and SAP.In the ARDS non-sepsis group(non-sepsis group),20 patients were treated according to the guidelines for the diagnosis and treatment of acute pancreatitis in China in 2013.They were given regular fasting,gastrointestinal decompression,fluid resuscitation,acid suppression,and growth.On the basis of the inhibition of water,electrolytes,acid-base balance,add rhubarb 3 g/kg,water 200 mL,filter the slag juice to 37~38℃for retention enema for more than 15min,2 times a day For a total of 7 days.The inflammatory markers WBC,PCT,heart rate,respiratory rate,oxygenation index(PaO2/FiO2),pancreatic severity score(BISAP),and IL-33 and various cytokine changes were recorded in the two groups.Results:On the first day of admission,the patients in the sepsis group had more severe inflammation index(WBC:14.23±2.95,PCT:3.62±2.04,heart rate:104.02±8.89,respiration:26.81±2.44),and the oxygenation index was more.Poor(PaO2/FiO2:164.08±21.05),IL-33(46.32±7.82)and higher cytokine expression(TNF-α:266.78±72.89,IL-1:53.47±10.52,IL-6:1824.68±598.53,IL-8:160.42±50.34),the difference was statistically significant compared with the non-sepsis group,P<0.01.After the treatment of rhubarb enema,the above indicators were significantly decreased in both groups,and admission.The difference was statistically significant on the first day,P<0.01.However,on the seventh day after treatment,the sepsis patients hadΔIL-33(41.63±7.86)and cytokines(ΔTNF-α:258.90±72.18,ΔIL-1:47.87±11.85,ΔIL-6:1775.57±598.31,ΔIL-8:143.12±51.98),oxygenation index(162.01±43.23)improved better than non-sepsis group,P<0.01,and the rate of invasive ventilation was not statistically significant.P>0.05.Conclusion:SAP combined with sepsis leads to the use of rhubarb enema in patients with ARDS to significantly improve the concentration of IL-33 as a"target"factor and reduce the proinflammatory factors TNF-α,IL-1,IL-6 and IL-8.Level,improve the patient's oxygenation,has clinical application value.