新斯的明联合大黄灌肠对重症急性胰腺炎腹内高压患者的作用  

Effect of neostigmine combined with raw rhubarb enema on reducing intra-abdominal hypertension in severe acute pancreatitis

作　　者：赵瑞雪 崔娟[1] 曹丽林 王磊[1] Zhao Ruixue;Cui Juan;Cao Lilin;Wang Lei(Department of Intensive Care Unit,First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院重症医学科,张家口075000

出　　处：《中华胰腺病杂志》2023年第6期418-424,共7页Chinese Journal of Pancreatology

基　　金：河北省科技厅省级课题(203777102D)。

摘　　要：目的探讨新斯的明联合大黄灌肠治疗SAP患者腹内高压(IAH)的疗效。方法回顾性分析2018年1月至2022年6月间河北北方学院附属第一医院重症监护室(ICU)收治的89例行持续性肾脏替代疗法(CRRT)的SAP患者临床资料。根据治疗方式分为对照组(44例)和研究组(45例),对照组患者给予大黄灌肠+芒硝盐外敷,2次/d,持续7 d;研究组患者在对照组治疗的基础上,加用肌肉注射新斯的明0.5 mg,2次/d,持续7 d。监测腹内压,记录两组患者急性生理和慢性健康评估(APACHE)Ⅱ、改善肾脏整体预后分级(KDIGO)和肺损伤(LIS)评分及治疗前后血清白细胞、CRP、降钙素原(PCT)、IL-6、IL-8和肿瘤坏死因子(TNF)-ɑ水平。主要研究终点为24 h腹内压变化量,次要终点包括治疗后1~7 d粪便增加量、新出现腹腔间隔室综合征(ACS)、新出现器官功能障碍、血管并发症、ICU住院时间、总住院时间、存活率及治疗结束6个月后的治疗干预和并发症的发生。结果研究组和对照组腹内压均于治疗后9 h开始下降,与治疗前相比,两组治疗7 d后腹内压下降显著,且研究组7 d内下降幅度显著高于对照组,差异均有统计学意义(P值均<0.05)。较治疗前,对照组和研究组治疗后APACHEⅡ、KDIGO和LIS评分均显著下降,但研究组比对照组下降更明显。治疗后研究组患者血清WBC计数及炎症因子CRP、PCT、IL-6、IL-8、TNF-ɑ水平均显著低于对照组,差异均有统计学意义(P值均<0.05)。与对照组比较,研究组在治疗24 h后腹内压变化量显著增加,在治疗1、2、3、5、7 d后粪便量也显著增加(P值均<0.05),但两组患者腹内压加重、新出现ACS、新出现的器官功能衰竭、血管并发症、ICU住院和总住院时间及存活率比较差异均无统计学意义。随访6个月后,胰腺炎再发及其治疗干预比较差异也无统计学意义。结论新斯的明的协助治疗可降低SAP患者腹内压和增加排便量,改善SAP的�Objective To investigate the efficacy of neostigmine combined with raw rhubarb enema on severe acute pancreatitis(SAP)patients with intra-abdominal hypertension(IAH).Methods The clinical data of 89 SAP patients,who were admitted and underwent continuous renal replacement treatment(CRRT)in intensive care unit(ICU)department of the First Affiliated Hospital of Hebei North University from January 2018 to June 2022,were retrospectively analyzed.Patients were divided into control group(n=44)and experimental group(n=45)according to the treatment mode.Raw rhubarb enema plus sodium sulfate topical application were administrated twice a day for 7 days in control group;besides the treatment above,intramuscular injection of neostigmine 0.5 mg twice a day for 7 days was given in experimental group.Intra-abdominal pressure was monitored,acute physiology and chronic health evaluation(APACHE)Ⅱ,kidney disease:improving global outcome stage(KDIGO),lung injury score(LIS)were recorded,and serum leukocyte,CRP,procalcitonin(PCT),IL-6,IL-8 and tumor necrosis factor(TNF)-ɑlevel were examined before and after treatment in both groups.The primary endpoint was the amount change of intra-abdominal pressure within 24 hours,and secondary endpoints included increased fecal volume within 7 days after treatment,new abdominal compartment syndrome(ACS),new organ dysfunction,vascular complications,length of ICU stay,total length of stay,survival rate and treatment intervention and occurrence of complications within 6 months after the end of treatment.Results Intra-abdominal pressure began to decrease at 9 hours after treatment both in control group and experimental group.Compared with that before treatment,the intra-abdominal pressure of the two groups decreased significantly after 7 days of treatment,and the decrease rate of the experimental group within 7 days was obviously higher than that of the control group,with statistical significance(all P values<0.05).Compared with those before treatment,APACHEⅡ,KDIGO and LIS in both groups were sig

关 键 词：重症急性胰腺炎 腹内高压 肾替代疗法 新斯的明 炎症因子 

分 类 号：R576[医药卫生—消化系统]