抗凝治疗联合大承气汤高位灌肠在高脂血症性急性胰腺炎中的应用  

Anticoagulant Therapy Combined with Dachengqi Decoction High Enema for Hyperlipidemic Acute Pancreatitis

作　　者：詹亚琨[1] 罗艳[2,4] 邹蓓 ZHAN Ya-kun;LUO Yan;ZOU Bei(Department of Emergency Medicine,the Second Affiliated Hospital of Nanchang University;Medical Imaging Center,the Second Affiliated Hospital of Nanchang University;Department of Clinical Laboratory,the Second Affiliated Hospital of Nanchang University;Jiangxi Provincial Key Laboratory of Intelligent Medical Imaging,Nanchang 330006,China)

机构地区：[1]南昌大学第二附属医院急诊科 [2]南昌大学第二附属医院医学影像中心 [3]南昌大学第二附属医院检验科 [4]智能医学影像江西省重点实验室,南昌330006

出　　处：《实用临床医学(江西)》2025年第1期26-29,共4页Practical Clinical Medicine

基　　金：江西省卫健委中医药科技计划(2020A0265)。

摘　　要：目的 评价抗凝联合大承气汤高位灌肠治疗高脂血症性急性胰腺炎的效果。方法 选择2020年6月至2024年6月收治的121例高脂血症性急性胰腺炎患者为研究对象,按照治疗方法的不同将患者分为对照组(58例)和治疗组(63例)。对照组行抑酸、禁食、胃肠减压、镇痛、抗炎、纠正水电解质紊乱等常规治疗,入院第1天注射依诺肝素钠注射液抗凝治疗;治疗组在对照组基础上增加大承气汤高位灌肠治疗,2组疗程均为1周。比较2组治疗前及治疗后1周甘油三酯、血清淀粉酶、白细胞、凝血功能及临床症状恢复所需时间。结果 治疗组因高位灌肠失败脱落2例。治疗后1周,治疗组血清淀粉酶、甘油三酯及白细胞数值较治疗前下降,且优于对照组(P <0.05);治疗组凝血酶时间、凝血酶原时间短于对照组,纤维蛋白原低于对照组(P <0.05),且腹痛、发热、腹胀缓解及CT表现好转所需时间短于对照组(P <0.05)。结论 在常规治疗基础上,抗凝联合大承气汤高位灌肠治疗高脂血症性急性胰腺炎疗效确切。Objective To evaluate the efficacy of anticoagulant therapy combined with Dachengqi decoction high enema in the treatment of hyperlipidemic acute pancreatitis.Methods A total of 121 patients with hyperlipidemic acute pancreatitis admitted from June 2020 to June 2024 were selected as the study subjects.They were divided into a control group(58 cases)and a treatment group(63 cases)based on different treatment methods.The control group underwent conventional treatments such as acid suppression,fasting,gastrointestinal decompression,analgesia,anti-inflammation,and correction of water and electrolyte disorders,and were administered with enoxaparin sodium injection for anticoagulant therapy on the first day of admission,whereas the treatment group received high enema with Dachengqi decoction in addition to the treatments above,with one-week treatment duration for both groups.Triglycerides,serum amylase,leukocytes,coagulation function and recovery time of clinical symptoms were compared between the 2 groups before and after 1 week of treatment.Results 2 patients in the treatment group were excluded due to failure of high enema.At 1 week after treatment,the levels of serum amylase,triglycerides,and white blood cell counts in the treatment group decreased compared to before treatment,and were better than those in the control group(P<0.05).The thrombin time and prothrombin time in the treatment group were shorter than those in the control group;the fibrinogen level was lower(P<0.05);the time required for relief of abdominal pain,fever,and abdominal distension,as well as improvement in CT findings was shorter in the treatment group compared to the control group(P<0.05).Conclusion On the basis of conventional treatment,anticoagulant therapy combined with Dachengqi decoction high enema may produce more definite clinical efficacy for hyperlipidemic acute pancreatitis.

关 键 词：高脂血症性胰腺炎 大承气汤 高位灌肠 低分子肝素 抗凝治疗 

分 类 号：R657.51[医药卫生—外科学]