生大黄联合连续性血液滤过治疗重症急性胰腺炎并发腹腔高压疗效  

Combination of rhubard with continuous hemofiltration in treatment of severe acute pancreatitis with intra-abdominal hypertension

作　　者：颉永乐[1] 刘健[2] 苏文涛[1] 卿楠 辛宏伟[1] 田静[1] 李云[1] 

机构地区：[1]天水市第一人民医院重症医学科,甘肃天水741000 [2]兰州大学附属第一医院重症医学科,甘肃兰州730000

出　　处：《临床荟萃》2015年第10期1148-1151,共4页Clinical Focus

摘　　要：目的探讨生大黄联合连续性血液滤过在治疗重症急性胰腺炎(SAP)并发腹腔高压(IAH)中的疗效。方法 SAP并发IAH患者67例分为3组:A组19例,采用常规治疗;B组23例,在常规治疗基础上加用生大黄水保留灌肠,每日3次,直至肠道功能恢复后停药;C组25例,在B组治疗基础上,行连续性静脉-静脉血液滤过(CVVH)治疗。观察3组患者治疗后第1、3、5、7天的腹内压变化;开始排便时间、肠鸣音恢复时间、和首次排便开始24h内排便次数以及治疗后第7天的APACHEⅡ评分和ICU停留时间。结果 C组腹内压降低、肠功能恢复、治疗后第7天的APACHEⅡ评分和ICU停留时间均明显优于A、B组,B组优于A组(P<0.05)。结论生大黄水保留灌肠治疗SAP并发IAH患者,可有效降低腹内压,促进肠功能恢复,联合CVVH则疗效更佳。Objective To study the therapeutic effect of combining rhubard and continuous hemofiltration in treating severe acute pancreatitis（SAP）with intra-abdominal hypertension（IAH）.Methods Sixty-seven SAP with IAH patients were divided into three groups：group A（n=19）,treated with conventional threapy;group B（n=23）,treated by conventional therapy plus retention-enema with rhubard,triple daily until the intestinal function recovery recovery;group C（n=25）,treated by continuous veno-venous hemofiltration on the basis of group B treatment.The changes of intra-abdominal pressure（the 1,3,5and 7days after admission）were evaluated.The time of beginning defecation,rugitus recovery and defecating frequency of the first 24 hours after beginning defecation were observed.APACHE Ⅱ score of the seventh day after treatment and ICU staying were determined.Results The intra-abdominal pressure,recovery of intestinal function,APACHE Ⅱscore of the seventh day after treatment and ICU staying of group C were much better than group A and B.The curative effect of group B was superior to group A（P 0.05）.Conclusion The retention-enema with rhubard could not only decrease the raised intra-abdominal pressure and accelerate the recovery of intestinal function in SAP patients with IAH.but also achieve better curative effect by combining continuous hemofiltratio.

关 键 词：胰腺炎 急性坏死性 腹腔高压 大黄 血液滤过 

分 类 号：R576[医药卫生—消化系统]