血必净联合ERCP治疗对重症急性胰腺炎并发脓毒血症疗效、胃肠功能及炎症因子的影响

The effect of combination of Xuebijing with ERCP on the curative effect,gastrointestinal function and inflammatory factors of severe acute pancreatitis complicated by sepsis

目的 探讨血必净联合内镜逆行性胰胆管造影术(ERCP)治疗对重症急性胰腺炎并发脓毒血症的临床疗效、胃肠功能及炎症因子的影响。方法 选取2019年2月~2020年9月我院重症监护室接受住院治疗的重症急性胰腺炎并发脓毒血症患者98例,利用随机数字表法分为观察组(n=50)和对照组(n=48)。两组患者均给予对症的支持疗法,对照组行ERCP,观察组在对照组治疗的基础上联合血必净注射液治疗7 d。比较两组患者在治疗结束后的临床疗效,检测患者C反应蛋白及白细胞水平对比感染缓解情况,同时监测对比两组患者胃肠道激素水平及炎症因子水平的变化情况。结果 经7 d治疗后,观察组的临床痊愈率(62.0%)显著高于对照组(37.5%)(P<0.05);治疗后,观察组的住院时间、恢复正常体温时间、恢复自主排便时间、腹痛的缓解时间及腹胀的改善时间均显著短于对照组(P<0.05);治疗后,两组血清PAMY、CRP、WBC水平及APACHEⅡ评分显著低于治疗前,且观察组显著低于对照组(均P<0.05);治疗后,两组APTT、PT、TT质量浓度显著降低,FIB质量浓度显著升高,且观察组APTT、PT、TT质量浓度显著低于对照组,FIB质量浓度显著高于对照组(均P<0.05);治疗后,观察组B细胞、NK细胞、T淋巴细胞亚群(CD4+、CD8+)及CD4+/CD8+值显著高于对照组(均P<0.05);治疗后,两组血清中MTL水平显著提高,GAS水平显著降低,且观察组患者血清中MTL水平显著高于对照组,GAS水平显著低于对照组(均P<0.05);治疗后,两组血清中IL-6、IL-8及TNF-α水平显著低于治疗前,且观察组显著低于对照组(均P<0.05)。结论 血必净联合ERCP治疗重症急性胰腺炎并发脓毒血症临床疗效确切,可有效控制感染,降低炎症细胞因子水平,同时改善患者的胃肠功能,临床总体疗效优于ERCP单独治疗。

Objective To investigate the clinical efficacy of combination of Xuebijing with ERCP in the treatment of severe acute pancreatitis complicated by sepsis and its influence on gastrointestinal function and inflammatory factors.Methods A total of 98 patients with severe acute pancreatitis and sepsis who were hospitalized in the intensive care unit of our hospital from February 2019 to September 2020 were selected and divided into two groups by random number table method,including 50 cases in the observation group,48 cases in the control group.Patients in both groups were given symptomatic supportive therapy.Patients in the control group underwent endoscopic retrograde cholangiopancreatography(ERCP),and patients in the observation group were treated with Xuebijing injection for 7 days on the basis of the treatment of the control group.The clinical efficacy of the two groups of patients after the end of treatment was compared,the levels of C-reactive protein and white blood cells of the patients were detected to compare the remission of infection,and the changes in the levels of gastrointestinal hormones and inflammatory factors in the two groups were monitored and compared.Results After 7 days of treatment,the clinical recovery rate(62.0%)of the observation group was significantly higher than that of the control group(37.5%)(P<0.05).After treatment,the observation group's hospital stay,time to return to normal body temperature,and recovery Spontaneous defecation time,relief time of abdominal pain and improvement time of abdominal distension were significantly shorter than those of the control group(P<0.05).Compared with the patients in this group before treatment,the serum levels of PAMY,CRP,WBC and APACHEⅡscore of the two groups of patients were significantly reduced after treatment(P<0.05).Compared with the control group after treatment,the observation group The levels of PAMY,CRP,WBC and APACHEⅡscore were significantly reduced(P<0.05).Compared with patients in this group before treatment,the mass concentrations of APTT,PT,and TT were significantly reduced after treatment in the two groups,and the mass concentration of FIB was significantly increased(P<0.05).Compared with the control group after treatment,the APTT,PT,TT mass concentration of the observation group was significantly reduced,and the FIB mass concentration was significantly increased(P<0.05).After treatment,the observation group had B cells,NK cells,T lymphocyte subsets(CD4+,CD8+)and CD4+/CD8+valueswere significantly higher than those of the control group(P<0.05);compared with this group before treatment,the serum MTL levels of the two groups were significantly increased,and the GAS levels were significantly reduced(P<0.05),and the serum MTL level of the observation group was significantly higher than that of the control group,and the GAS level was significantly lower than that of the control group(P<0.05).Compared with this group before treatment,the serum levels of IL-6 and IL-8 and TNF-αlevels were significantly reduced(P<0.05).Compared with the control group,the serum levels of IL-6,IL-8 and TNF-αin the observation group were significantly reduced(P<0.05).Conclusion Xuebijing combined with ERCP in the treatment of severe acute pancreatitis with sepsis,the clinical effect is definite,which can effectively control infection,reduce inflammatory cytokine levels,and improve the gastrointestinal function of patients.The overall clinical effect is better than ERCP alone.