丹参川芎嗪对重症急性胰腺炎肠屏障保护作用的疗效观察

Curative effect of Salvia miltiorrhiza ligustrazine on the protection of intestinal barrier in severe a-cute pancreatitis

目的：动态观察重症急性胰腺炎患者的血浆内毒素（ET）、血浆 TXA2、血浆 PGI2水平和临床症状缓解时间，研究丹参川芎嗪对重症急性胰腺炎肠屏障的保护作用。方法将2014年8月至2015年10月就诊于本院的60例重症急性胰腺炎患者作为研究对象，并将其随机分为对照组和丹川组。两组患者均接受常规综合治疗，如禁饮食、胃肠减压、早期积极液体复苏、维持电解质平稳、抗感染、抑制胰腺分泌、肠内外营养等支持治疗，丹川组在上述常规综合治疗的基础上加用复方丹参川芎嗪注射液10ml 联合5％葡萄糖注射液250ml 静脉滴注，1次／d。两组患者均以14d 为1个疗程，治疗结束后观察两组患者临床症状缓解时间、预后以及实验室指标的变化。结果⑴丹川组患者肠积气或肠梗阻缓解时间、腹痛缓解时间均短于对照组（P ＜0．05）。⑵丹川组患者血浆内毒素、血清淀粉酶、白细胞计数恢复正常的时间均优于对照组（P ＜0．05）；⑶丹川组并发症发生率、病死率及手术发生率均稍低于对照组，但差异无统计学意义（P ＞0．05）。结论丹参川芎嗪对重症急性胰腺炎有显著疗效，丹参川芎嗪可能通过纠正 TXA2／PGI2之间的平衡而改善肠道微循环，进而对肠屏障起到良好的保护作用，促进肠道功能恢复，降低肠源性细菌及内毒素移位发生率，降低并发症发生率，值得进一步在临床推广。

Objective Dynamic observation of plasma endotoxin (ET),plasma TXA2 and PGI2 levels and clinical symptoms in patients with severe acute pancreatitis (SAP),the protective effect of Salvia miltiorrhiza ligustrazine on the intestinal barrier in severe acute pancreatitis was studied.Methods The 60 cases of severe acute pancreatitis treated in our hospital from August,2014 to October 2015 were studied as the research object,and were randomly divided into the control group and the danchuan group.Two groups of patients received conventional treatment,such as diet,gastrointestinal decompression,early active fluid resuscitation,maintenance of stable electrolyte,anti infection,inhibition of pancreatic secretion,parenteral nutrition and other support treatment,Dan Chuan group on the basis of conventional treatment combined with 10 ml of compound Salvia miltiorrhiza ligustrazine injection of 5% glucose injection,250 ml intrave-nous drip,1 times a day.Two groups of patients with 14 days for a period of treatment,the clinical symp-toms of the two groups were observed after the end of treatment,the clinical symptoms and the changes of la-boratory index.Results ⑴In the group of Dan chuan,the time of patients relieve intestinal pneumatosis or intestinal obstruction,abdominal pain were less than the control group,the difference was statistically sig-nificant (P <0.05).⑵ The recovery time of plasma endotoxin,serum amylase,and leukocyte in the Dan Chuan group were shorter than those in the control group (P <0.05).⑶The incidence,mortality and inci-dence of complications in the control group were significantly lower than those in the control group,but the difference was not statistically significant (P >0.05).Conclusions Salvia miltiorrhiza ligustrazine has a significant effect on severe acute pancreatitis.It can improve the intestinal microcirculation by correcting the balance between PGI2 and TXA2 ,and can promote the recovery of intestinal function,reduce the incidence of intestinal bacterial and endotoxin,and reduce the incidence of complications.