大承气汤联合西药治疗重症急性胰腺炎胃肠功能障碍(阳明腑实)随机平行对照研究  

Randomized Controlled Study of Dachengqi Decoction combined with Western Medicine in the Treatment of Gastrointestinal Dysfunction in Severe Acute Pancreatitis(Yangming Fushi)

作　　者：杨小青 YANG Xiaoqing(The Department of Severe Medicine of Huaihua Hospital of Traditional Chinese Medicine,Huahuai 418000,Hunan,China)

机构地区：[1]怀化市中医医院重症医学科,湖南怀化418000

出　　处：《实用中医内科杂志》2018年第3期20-23,共4页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：[目的]观察大承气汤联合西药治疗重症急性胰腺炎胃肠功能障碍(阳明腑实)疗效。[方法]使用随机平行对照方法,将61例住院患者按病志号抽签方法随机分为两组,禁食,维持电解质平衡,早期肠外营养、胃肠减压、抗感染、抑制胃酸、抑制胰液。对照组29例,奥美拉唑钠40mg+生理盐水100mL,2次/d,静滴;奥曲肽0.3mg+生理盐水48mL,4mL/h,泵入,1次/12h;左氧氟沙星40mg+生理盐水100mL,1次/d;甲硝唑50mg/次,1次/12h。治疗组32例承气汤(大黄12g,芒硝9g,厚朴15g,枳实12g),水煎300mL,2次/d;西药治疗同对照组。连续治疗2周为1疗程。观测临床症状、腹痛、腹胀、腰围、肠鸣音、置留胃管时间、第1次排气、第1次排便、血尿淀粉酶、IL-6、TNF-α、禁食时间、住院时间、不良反应。治疗1疗程(2周),判定疗效。[结果]第1次排气、第1次排便、腹痛缓解、腹胀缓解、肠鸣音恢复时间治疗组优于对照组(P<0.01);平均禁食时间、平均腰围减少、平均住院时间、平均置留胃管时间治疗组优于对照组(P<0.05,P<0.01)。IL-6、TNF-α两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。S-Amy、U-Amy两组均有降低(P<0.01),治疗组降低多于对照组(P<0.05,P<0.01)。[结论]大承气汤联合西药治疗重症急性胰腺炎胃肠功能障碍(阳明腑实),疗效满意,无严重不良反应,值得推广。[Objective] To observe the effect of Dachengqi decoction combined with western medicine in the treatment of gastrointestinal dysfunction of severe acute pancreatitis （Yangming Fushi）. [Method] Using random parallel control method, 61 cases of hospitalized patients with fasting pathography, lots of methods were randomly divided into two groups, maintain electrolyte balance, early enteral nutrition, gastrointestinal decompression, anti infection, inhibition of gastric acid, inhibition of pancreatic juice. Control group 29 cases, omeprazole sodium 40mg＋normal saline 100mL, 2 times/d, intravenous drip; octreotide 0.3mg＋physiological saline 48mL, 4mL/h, pump, 1 times/12; Levofloxacin 40mg＋physiological saline 100mL, 1/d; metronidazole 50 mg/times, 1 times of 100mL. The treatment group of 32 cases of Chengqi decoction （Dahuang 12g, Mangxiao 9g, Houpo 15g, Zhishi 12g）, 2 time/d; westernmedicinewiththecontrolgroup. Continuous treatment for 2 weeks was the 1 course of treatment. Observation of clinical symptoms, abdominal pain, abdominal distension, waist circumference, bowel sounds, gastric tube retention time, first exhaust, first defecation, hematuria, amylase, IL-6, TNF-alpha, fasting time, hospital stay and adverse reactions. The 1 course of treatment （2 weeks） was treated and the curative effect was determined. [Results] First times, first times the exhaust defecation, abdominal pain, abdominal distension, recovery time of bowel sound treatment group than the control group （P〈0.01）; the average fasting time, average waist circumference, reduce the average hospitalization time, average retention time of gastric tube in the treatment group than the control group （P〈0.05, P〈0.01）. The two groups of IL-6 and TNF- alpha were improved （P〈0.01）, and the improvement of the treatment group was better than that of the control group （P〈0.01）. The two groups of S-Amy and U-Amy were reduced （P〈0.01）, and the treatment group decreased more than those in the control group （P〈0.

关 键 词：重症急性胰腺炎 胃肠功能障碍 阳明腑实 大承气汤 奥美拉唑钠 奥曲肽 左氧氟沙星 甲硝唑 腹胀 腹痛 禁食时间 腰围减少 住院时间 置留胃管 第1次排气时间 第1次排便时间 肠鸣音 IL-6 TNF-α 中西医结合治疗 中药复方 随机平行对照研究 

分 类 号：R576[医药卫生—消化系统]