经皮穿刺置管引流术联合通腑化瘀解毒方对急性重症胰腺炎并胰腺感染患者P物质、胰蛋白酶原激活肽水平的干预作用  

Intervention of PCD and Tongfu Huayu Jiedu Decoction on the Levels of Substance P and TAP in SAP Complicated with Pancreatic Infection

作　　者：张远军[1] 汪建[1] 钟建 Zhang Yuanjun;Wang Jian;Zhong Jian(Ziyang First People′s Hospital,Sichuan,Ziyang 641300,China)

机构地区：[1]四川省资阳市第一人民医院,四川资阳641300

出　　处：《中国中医急症》2020年第4期641-645,共5页Journal of Emergency in Traditional Chinese Medicine

基　　金：四川省科技计划项目(2014SZ0220)。

摘　　要：目的观察经皮穿刺置管引流术(PCD)联合通腑化瘀解毒方对急性重症胰腺炎(SAP)并胰腺感染P物质、胰蛋白酶原激活肽(TAP)水平的干预作用。方法SAP并胰腺感染患者82例,根据治疗方案分为研究组与对照组各41例。常规干预基础上对照组采取PCD,研究组于对照组基础上加予通腑化瘀解毒方。统计两组症状改善时间、临床疗效、P物质、TAP、前列环素I2(PGI2)及血浆血栓素2(TXA2)、炎性因子[白细胞介素-4(IL-4)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、腹腔积液及腹内压。结果研究组发热、腹内积液、呕吐恶心、腹胀、腹痛消失及恢复排便排气、肠鸣音恢复时间短于对照组(P<0.05);研究组总有效率为92.68%,高于对照组的75.61%(P<0.05);治疗后两组P物质及TAP水平较治疗前降低,且研究组低于对照组(P<0.05);治疗后两组PGI2水平较治疗前增高、TXA2水平较治疗前降低,且研究组PGI2水平高于对照组、TXA2水平低于对照组(P<0.05);治疗后两组IL-4水平较治疗前增高,IL-6、TNF-α血清水平较治疗前降低,且研究组IL-4水平高于对照组,IL-6、TNF-α血清水平低于对照组(P<0.05);治疗后两组腹腔积液高度及腹内压较治疗前降低,且研究组低于对照组(P<0.05)。结论联合采取PCD及通腑化瘀解毒方治疗SAP并胰腺感染,可有效缓解患者临床症状,降低腹腔积液高度及腹内压,提高疾病治疗效果,其机制可能与调节P物质、TAP、PGI2及TXA2含量,减轻炎性反应具有一定关联性。Objective:To investigate the effect of percutaneous catheter drainage(PCD)combined with Tongfu Huayu Jiedu Decoction on acute severe pancreatitis(SAP)and pancreatic infection with substance P and trypsinogen activation peptide(TAP).Methods:82 patients were divided into the study group and the control group,41 cases in each.On the basis of routine intervention,the control group was treated with PCD,and the study group was treated with Tongfu Huayu Jiedu Decoction on that basis.The time to symptom improvement,clinical efficacy,substance P,TAP,PGI2 and plasma TXA2,inflammatory factor levels(IL-4,IL-6,TNF-α),ascites and intra-abdominal pressure were observed and compared.Results:The study group had fever,intra-abdominal effusion,vomiting nausea,abdominal distension,abdominal pain disappeared and recovery of bowel movements,bowel sound recovery.The recovery time was shorter than that of the control group(P<0.05).The total effective rate of the study group(92.68%)was higher than that of the control group(75.61%)(P<0.05).The levels of substance P and TAP in both groups were lower than those before treatment,and the study group was lower than the control group.PGI2 levels in the two groups were higher;that in the study group was higher than that in the control group,and TXA2 levels were lower than before treatment;that in the study group was lower than that in the control group(P<0.05).After treatment,the levels of IL-4 in both groups were higher than those before treatment,and the serum levels of IL-6 and TNF-α were lower than before treatment,and the level of IL-4 in the study group was higher than that in the control group.The serum levels of IL-6 and TNF-α were lower than those of the control group(P<0.05).After treatment,the height of peritoneal effusion and intra-abdominal pressure were lower than those before treatment.The study group was lower than the control group(P<0.05).Conclusion:The combination of PCD and Tongfu Huayu Jiedu Decoction on SAP and pancreatic infection can effectively alleviate the clinical

关 键 词：急性重症胰腺炎 胰腺感染 经皮穿刺置管引流术 通腑化瘀解毒方 P物质 胰蛋白酶原激活肽 

分 类 号：R576[医药卫生—消化系统]