大承气汤联合低分子肝素钙配合双重血液滤过治疗高脂血症性重症急性胰腺炎

Therapeutic effect of Dachengqi decoction and low molecular weight heparin calcium combined with double hemofiltration in the treatment of hyperlipidemic severe acute pancreatitis

目的探讨大承气汤、低分子肝素钙配合双重血液滤过治疗高脂血症性重症急性胰腺炎(HLSAP)的临床效果。方法选取2019年3月-2021年9月本院收治的64例HLSAP患者作为研究对象,采用随机数表法分为观察组和对照组,各32例。2组均接受低分子肝素钙配合双重血液滤过干预,观察组加用大承气汤。比较2组治疗前后血液流变学和炎性因子水平;记录术后恢复效果;记录术后并发症和预后。结果治疗后观察组Fib、红细胞沉降率及血浆比黏度均显著低于治疗前,且均低于对照组,差异均有统计学意义(P<0.05);治疗后对照组Fib、红细胞沉降率及血浆比黏度均显著低于治疗前,差异均有统计学意义(P<0.05);治疗后2组血清WBC、CRP及AMY较治疗前均显著降低,且观察组显著低于对照组,差异均有统计学意义(P<0.05);观察组胃管留置时间、肠鸣音恢复时间、腹痛缓解时间及住院时间较对照组均显著缩短,差异均有统计学意义(P<0.05);观察组ARDS、胸腹腔积液发生率及Ranson评分均显著低于对照组,差异均有统计学意义(P<0.05)。结论大承气汤联合低分子肝素钙配合双重血液滤过治疗HLSAP效果显著,有助于抑制炎性反应,改善血液微循环,改善患者预后。

Objective To explore the clinical effect of Dachengqi decoction and low molecular weight heparin calcium combined with double hemofiltration in the treatment of hyperlipidemic severe acute pancreatitis(HLSAP).Methods 64 HLSAP patients admitted to Ankang Hospital of Traditional Chinese Medicine from March 2019 to September 2021 were selected as the research subjects,and they were divided into the observation group and the control group according to random number table method,with 32 patients in each group.The two groups received low molecular weight heparin calcium combined with double hemofiltration intervention,the observation group received Dachengqi decoction on the basis of this treatment.Hemorheology and inflammatory factors levels were compared between the two groups before and after treatment.The postoperative recovery effect,postoperative complications and prognosis were recorded.Results After treatment,the fibrinogen(Fib),erythrocyte sedimentation rate and plasma specific viscosity in the observation group were significantly lower than those before treatment,and all were lower than those in the control group,there were statistically significant differences(P<0.05).After treatment,the Fib level,erythrocyte sedimentation rate and plasma specific viscosity of the control group were significantly lower than those before treatment(P<0.05),there were statistically significant differences;After treatment,the serum white blood cell(WBC)count,C-reactive protein(CRP)and amylase(AMY)levels in the two groups were significantly lower than those before treatment,and the observation group was significantly lower than the control group,there were statistically significant differences(P<0.05).The gastric tube indwelling time,bowel sound recovery time,abdominal pain relief time and hospital stay time in the observation group were significantly shorter than those in the control group,there were statistically significant differences(P<0.05).The incidence of acute respiratory distress syndrome(ARDS)and pleural and abdominal effusion,and Ranson score in observation group were significantly lower than those in control group,there were statistically significant differences(P<0.05).Conclusion Dachengqi decoction,low molecular weight heparin calcium combined with double hemofiltration has a significant effect on the treatment of HLSAP,which is helpful to inhibiting inflammatory response,improving blood microcirculation and improving the prognosis of patients.