清下化瘀方联合早期肠内营养支持治疗重症急性胰腺炎临床研究

Clinical Study on Qingxia Huayu Prescription Combined with Early Enteral Nutrition Support for Severe Acute Pancreatitis

目的:观察清下化瘀方联合早期肠内营养支持治疗重症急性胰腺炎(SAP)的临床疗效,以及对患者肠黏膜屏障功能与免疫功能的影响。方法:选取90例SAP患者,采用随机数字表法分为观察组和对照组各45例。2组均给予禁食、胃肠减压等常规治疗,对照组在此基础上给予早期肠内营养支持治疗,观察组在对照组基础上加用清下化瘀方治疗,2组均治疗14 d。比较2组临床疗效及治疗前后肠黏膜屏障功能指标(内毒素、二胺氧化酶)、免疫球蛋白(Ig)和中医证候积分,观察不良反应。结果:观察组总有效率88.89%,高于对照组71.11%(P<0.05)。治疗后,2组内毒素、二胺氧化酶水平均较治疗前降低(P<0.05),观察组内毒素、二胺氧化酶水平均低于对照组(P<0.05);2组IgA、IgM、IgG水平均较治疗前升高(P<0.05),观察组IgA、IgM、IgG水平均高于对照组(P<0.05)。治疗后,2组主症、次症积分均较治疗前降低(P<0.05),观察组主症、次症积分均低于对照组(P<0.05)。治疗期间,2组均未出现严重不良反应。结论:清下化瘀方联合早期肠内营养支持治疗SAP,可改善患者的肠黏膜屏障功能与免疫功能,缓解临床症状,提高临床疗效。

Objective:To observe the clinical effect of Qingxia Huayu prescription combined with early enteral nutrition support for severe acute pancreatitis(SAP), and its effect on intestinal mucosal barrier function and immune function of patients. Methods:A total of 90 cases of SAP patients were selected and divided into the observation group and the control group according to the random number table method,with 45 cases in each group. Both groups were given routine treatment such as fasting and gastrointestinal decompression;the control group was additionally treated with early enteral nutrition support,and the observation group was additionally treated with Qingxia Huayu prescription based on the treatment of the control group. Both groups were treated for 14 days. The indexes of intestinal mucosal barrier function including endotoxin and diamine oxidase, immunoglobulin(Ig) and Chinese medicine syndrome scores before and after treatment as well as the clinical effects in the two groups were compared;the adverse reactions were observed. Results:The total effective rate was88.89% in the observation group,higher than that of 71.11% in the control group(P<0.05). After treatment,the levels of endotoxin and diamine oxidase in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of endotoxin and diamine oxidase in the observation group were lower than those in the control group(P<0.05);the levels of IgA,IgG and IgM in the two groups were increased when compared with those before treatment(P<0.05),and the levels of IgA,IgG and IgM in the observation group were higher than those in the control group(P<0.05). After treatment,the scores of primary and secondary symptoms in the two groups were decreased when compared with those before treatment(P<0.05),and the scores of primary and secondary symptoms in the observation group were lower than those in the control group(P<0.05). During treatment,there was no serious adverse reaction in the two groups. Conclusion:The therapy of Qingxia Huayu prescription combined with early enteral nutrition support for SAP can improve the intestinal mucosal barrier function and immune function of patients,relieve their clinical symptoms and enhance the clinical effect.