大柴胡汤联合血液灌流早期联合治疗重症急性胰腺炎的临床观察  

Effect of Dachaihu decoction combined hemoperfusion on early-stage severe acute pancreatics (SAP) patients

作　　者：刘建军[1] 郭瑞敏[1] 于明忠[1] 张淑芳[1] 赵会文[1] 董军[1] 张蕾[1] 苏雅平[1] 

机构地区：[1]河北联合大学附属医院,河北唐山063000

出　　处：《现代预防医学》2013年第15期2933-2935,共3页Modern Preventive Medicine

基　　金：河北省2011医学科学研究重点课题计划(20110532)

摘　　要：目的对大柴胡汤联合血液灌流(hemoperfusion,HP)早期联合治疗重症急性胰腺炎(SAP),进行临床评价。方法将32例SAP患者随机分为对照组和治疗组,对照组行常规治疗包括抑制胰酶、早期ICU监护、补充体液、镇痛、预防性应用抗生素以及营养支持等。治疗组在常规治疗的基础上加用血液灌流和大柴胡汤。观察2组患者临床指标,包括首次排便时间、腹痛和腹胀缓解时间、肠鸣音恢复时间;并发症发生率、手术中转率及病死率、平均住院天数以及治疗前和治疗7d后的APACHEⅡ评分;检测血清淀粉酶、白细胞计数以及C反应蛋白(CRP)。结果与对照组比较,治疗组在恢复排气、排便的时间,症状、体征消失时间,住院天数,总疗效及APACHEⅡ评分等临床指标评价、急性呼吸窘迫综合征(ARDS)发生率、血清淀粉酶、白细胞计数和CRP水平恢复正常时间,差异均有统计学意义(P﹤0.05,P﹤0.01)。结论大柴胡汤联合HP治疗SAP,有利于早期控制炎症反应,减轻临床症状,降低并发症发生率。OBJECTIVE To investigate the effects of hemoperfusion combined with Dachaihu decoction on early-stage SAP patients. METHODS The SAP patients at early-stage were divided randomly two groups： control group was treated with pancreatic enzyme inhibition, early ICU monitoring, analgesia, preventive use of antibiotics, nutrition and body fluid support, etc. treatment group was treated with above schemes adding to Dachaihu decoction combined with hemoperfusion , and clinical indexes such as the first defecate time, the abdominal pain and abdominal distention ease time, bowel sounds recovery time, the main complications （ARDS/ARF） rate, transfer-surgery and mortality rate, average inpatient days, APACHEⅡ score, serum amylase, white blood count and C-reactive protein （CRP） were observed. RESULTS Compared with controls, clinical indexes in the treatment group, such as first defecate time, the abdominal pain and abdominal distention ease time, bowel sounds recovery time, ARDS rate and recovery time of serum amylase, white blood count and CRP level, were significantly different （P﹤0.05, P﹤0.01）. CONCLUSION The treatment of hemoperfusion combined with Dachaihu for early-stage SAP patients is helpful to control inflammation, alleviate clinical symptoms and reduce the incidence of complications.

关 键 词：重症急性胰腺炎 大柴胡汤 血液灌流 通里攻下 C反应蛋白 

分 类 号：R657.51[医药卫生—外科学]