加味大承气汤灌肠辅助分级护理对急性胰腺炎患者疗效及血清IL-6、TNF-α的影响

Therapeutic Effects of Modified Dachengqi Tang Enema-assisted Hierarchical Nursing in the Treatment of Acute Pancreatitis and Its Influence on Serum IL-6 and TNF-αLevels

目的:探讨加味大承气汤灌肠辅助分级式护理对急性胰腺炎(acute pancreatitis,AP)腑实热结型患者疗效及血清白细胞介素6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factorα,TNF-α)水平的影响。方法:将84例腑实热结型AP患者按照随机数字表法分为对照组和观察组各42例,两组患者均行常规支持治疗,对照组予分级式护理干预,观察组在对照组基础上应用加味大承气汤灌肠,干预1周后观察两组患者血清IL-6、TNF-α、水通道蛋白5(aquaporin 5,AQP5)、水通道蛋白6(AQP6)、淀粉酶(amylase,AMY)、二胺氧化酶(diamine oxidase,DAO)、D-乳酸(D-lactic acid,D-LA)水平及临床症状缓解时间、急性胰腺炎严重程度估计指标(Ranson评分)、胰腺CT严重程度评估(CTSI评分)、急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、中医症状评分等变化情况,并评估两组患者临床疗效。结果:治疗后,两组患者血清IL-6、TNF-α水平较治疗前下降,AQP5、AQP6水平较治疗前上升,观察组各指标改善均优于对照组(P<0.05);治疗后,两组患者血清AMY、DAO和D-LA水平较治疗前下降,观察组低于对照组(P<0.05);治疗后,观察组腹痛缓解、腹胀缓解、肛门排气、肠鸣音恢复、肛门排便时间均短于对照组(P<0.05);治疗后,两组患者Ranson、CTSI、APACHEⅡ评分较治疗前下降,观察组低于对照组(P<0.05);治疗后,两组患者腹痛、腹胀、恶心呕吐、发热、口干渴、尿赤短和大便秘结等评分较治疗前下降,观察组低于对照组(P<0.05);观察组总有效率为95.24%(40/42),高于对照组的78.57%(33/42)(P<0.05)。结论:加味大承气汤灌肠辅助分级护理可通过减轻肠黏膜损伤,促进胃肠功能恢复,抑制血清IL-6、TNF-α表达水平,增加AQP5、AQP6表达,来改善腑实热结型AP患者临床症状。

Objective:To explore the curative effects of modified Dachengqi Tang enema-assisted hierarchical nursing in the treatment of acute pancreatitis(AP)of Fu-organs excess and heat accumulation pattern and its influence on the levels of IL-6 and TNF-α.Methods:All 84 AP patients were separated into the control group and the observation group with 42 cases in each group according to random number table method,both groups accepted conventional supportive treatment,the control group was given graded nursing intervention,and the observation group accepted modified Dachengqi Tang enema on the foundation of the therapy the control group received,after one week of the intervention,to observe the levels of serum IL-6,TNF-α,AQP5,AQP6,AMY,DAO and D-LA,clinical symptoms remission time,Ranson scores,CTSI,APACHEⅡand TCM symptoms scores between both groups,and to assess clinical effects between the two groups.Results:After the treatment,the levels of serum IL-6 and TNF-αwere lowered in the two groups than before the treatment,the levels of AQP5 and AQP6 were increased than before the treatment,the improvements of these indexes of the observation group were better than those of the control group(P<0.05);after the treatment,the levels of serum AMY,DAO and D-LA were reduced in the two groups than before the treatment,the observation group was lower than the control group(P<0.05);after the treatment,the observation group was less than the control group in abdominal pain relief time,abdominal distension relief time,anal exhaust time,the recovery time of bowel sound and anal defecation time(P<0.05);after the treatment,Ranson scores,CTSI and APACHEⅡscores of the groups were decreased than before the treatment,the observation group was lower than the control group(P<0.05);after the treatment,the scores of abdominal pain,abdominal distension,nausea and vomiting,fever,dry mouth and thirsty,painful urination and constipation were reduced in the two groups than those before the treatment,the observation group was lower than the control group(P<0.05);total effective rate of the observation group was 95.24%(40/42),higher than 78.57%(33/42)of the control group(P<0.05).Conclusion:modified Dachengqi Tang enema-assisted hierarchical nursing could improve clinical symptoms of AP patients of Fu-organs excess and heat accumulation pattern by reducing intestinal mucosal damage,promoting gastrointestinal function recovery,lowering the levels of serum IL-6 and TNF-α,enhancing the expressions of AQP5 and AQP6.