柴芍承气汤鼻饲联合生大黄灌肠治疗重症急性胰腺炎合并肠麻痹临床研究

Clinical Study on Nasal Feeding with Chaishao Chengqi Decoction Combined with Raw Rhubarb Enema for Severe Acute Pancreatitis Complicated with Enteroparalysis

目的:观察柴芍承气汤鼻饲联合生大黄灌肠治疗重症急性胰腺炎合并肠麻痹的临床疗效。方法:采用随机数字表法将72例重症急性胰腺炎合并肠麻痹患者分为对照组、治疗组各36例。对照组给予常规西医治疗,治疗组在对照组基础上加用柴芍药承气汤鼻饲联合生大黄灌肠治疗,2组均连续治疗7 d。比较2组临床疗效及胃肠功能恢复时间;比较2组治疗前后中医证候积分、血钙、炎症指标及肠道菌群水平。结果:治疗期间,对照组脱落2例,完成研究34例;治疗组脱落2例,完成研究34例。治疗组总有效率91.18%,高于对照组70.59%(P<0.05);腹胀和腹痛缓解时间、肠鸣音恢复正常时间、首次自主排便时间、首次自主排气恢复时间、禁食时间及腹内高压恢复正常时间均较对照组缩短(P<0.05)。治疗后,2组中医证候积分、白细胞计数、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)水平均较治疗前降低(P<0.05),血钙水平升高(P<0.05);治疗组治疗后中医证候积分、白细胞计数、CRP、TNF-α、IL-6水平均低于对照组(P<0.05),血钙水平高于对照组(P<0.05)。治疗后,2组肠球菌、大肠埃希菌含量均较治疗前减少(P<0.05),乳酸杆菌、双歧杆菌含量增多(P<0.05);治疗组治疗后肠球菌、大肠埃希菌含量低于对照组(P<0.05),乳酸杆菌、双歧杆菌含量高于对照组(P<0.05)。结论:柴芍承气汤鼻饲联合生大黄灌肠治疗重症急性胰腺炎合并肠麻痹,能够加快患者胃肠道功能恢复,减轻炎症反应,改善肠道菌群,临床疗效显著。

Objective:To observe the clinical effect of nasal feeding with Chaishao Chengqi Decoction combined with raw rhubarb enema for severe acute pancreatitis complicated with enteroparalysis.Methods:A total of 72 cases of patients with severe acute pancreatitis complicated with enteroparalysis were divided into the control group and the treatment group according to the random number table method,with 36 cases in each group.The control group was treated with routine western medicine,and the treatment group was additionally treated with nasal feeding with Chaishao Chengqi Decoction combined with raw rhubarb enema based on the treatment of the control group.Both groups were treated for 7 days.The clinical effects and recovery time of gastrointestinal function were compared between the two groups.Before and after treatment,traditional Chinese medicine(TCM)syndrome scores,and levels of blood calcium,inflammatory indexes and intestinal flora were compared between the two groups.Results:During treatment,2 cases were lost and 34 cases were completed in the control group;2 cases were lost and 34 cases were completed in the treatment group.The total effective rate was 91.18%in the treatment group,higher than that of 70.59%in the control group(P<0.05).The relief time of abdominal distension and abdominal pain,recovery time of bowel sounds recovering to normal,first spontaneous defecation time,first spontaneous exhaust recovery time,fasting time,and time of intra-abdominal hypertension recovering to normal were all shorter than those in the control group(P<0.05).After treatment,the TCM syndrome scores,and levels of white blood cell count,C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),and interleukin-6(IL-6)in the two groups were decreased when compared with those before treatment(P<0.05),and blood calcium levels were increased(P<0.05).After treatment,TCM syndrome scores,and levels of white blood cell count,CRP,TNF-αand IL-6 were lower than those in the control group(P<0.05),and the blood calcium level was higher than that in the control group(P<0.05).After treatment,the levels of Enterococcus and Escherichia coli in the two groups were decreased when compared with those before treatment(P<0.05),and the levels of Lactobacillus and Bifidobacterium were increased(P<0.05).After treatment,the levels of Enterococcus and Escherichia coli in the treatment group were lower than those in the control group(P<0.05),and the levels of Lactobacillus and Bifidobacterium were higher than those in the control group(P<0.05).Conclusion:Nasal feeding with Chaishao Chengqi Decoction combined with raw rhubarb enema for severe acute pancreatitis complicated with enteroparalysis can accelerate the recovery of gastrointestinal function,reduce inflammatory responses,improve intestinal flora,and have a significant clinical effect.