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纸质出版日期:2016
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陈英杰, 谢良杰, 张宏伟, 等. 清胰汤鼻空肠管滴入辅助治疗急性胰腺炎的临床观察[J]. 中国实验方剂学杂志, 2016,22(23):166-170.
CHEN Ying-jie, XIE Liang-jie, ZHANG Hong-wei, et al. Clinical Observation of Qingyi Decoction with Naso-jejunum Instillation Therapy for Acute Pancreatitis[J]. Chinese journal of experimental traditional medical formulae, 2016, 22(23): 166-170.
陈英杰, 谢良杰, 张宏伟, 等. 清胰汤鼻空肠管滴入辅助治疗急性胰腺炎的临床观察[J]. 中国实验方剂学杂志, 2016,22(23):166-170. DOI: 10.13422/j.cnki.syfjx.2016230166.
CHEN Ying-jie, XIE Liang-jie, ZHANG Hong-wei, et al. Clinical Observation of Qingyi Decoction with Naso-jejunum Instillation Therapy for Acute Pancreatitis[J]. Chinese journal of experimental traditional medical formulae, 2016, 22(23): 166-170. DOI: 10.13422/j.cnki.syfjx.2016230166.
目的:观察清胰汤鼻空肠管滴入治疗中度急性胰腺炎(MSAP)的疗效及炎症因子,并探讨其对肠黏膜屏障功能的影响。方法:将150例MSAP患者随机分为对照组和观察组,各75例。基础治疗,注射用埃索美拉唑钠,40 mg,静脉注射,1次/12 h;注射用乌司他丁,30万单位,持续静脉泵入,1次/12 h;注射用美罗培南,1 g/次,缓慢静脉泵入4 h,1次/8 h。两组均给予清胰汤,1剂/d,对照组分2~3次经常规胃管注入;观察组经鼻空肠管滴入,100~150 mL/次,滴入速率50~100 mL·h-1,4~6次/d。两组疗程均为10 d。记录腹痛、腹胀缓解、肠鸣音恢复及通气排便时间;监测血常规、血和尿淀粉酶、血糖、血钙,治疗前后各评价1次;检测治疗前后血清白细胞介素(IL)-1,IL-6和肿瘤坏死因子-α(TNF-α)水平;检测治疗前后血浆D-乳酸、内毒素、尿乳果糖/甘露醇(L/M)水平。结果:经Ridit分析,观察组临床疗效优于对照组(P<0.05);观察组肠麻痹相关指标(腹痛、腹胀缓解时间,肠鸣音恢复时间和首次排便时间)均短于对照组(P<0.01);治疗后观察组空腹血糖、白细胞和血、尿淀粉酶水平均低于对照组(P<0.01),血清钙水平高于对照组(P<0.01);治疗后观察组IL-1,IL-6和TNF-α水平低于对照组(P<0.01);治疗后观察组D-乳酸、尿L/M值和内毒素水平低于对照组(P<0.01)。结论:采用清胰汤经鼻空肠管滴入辅助西医常规疗法治疗MSAP患者,能更有效改善肠麻痹,加快胃肠功能恢复,减轻炎症反应,保护肠道黏膜屏障功能,改善理化指标,从而促进疾病的恢复。
Objective: To observe the clinical efficacy of Qingyi decoction with naso-jejunal instillation therapy in treating moderate acute pancreatitis (MSAP) and investigate its effects on inflammatory factors and intestinal mucosal barrier function. Method: One hundred and fifty patients with MSAP were randomly divided into control group (75 cases) and observation group (75 cases) by random number table. Basic treatment
Esomeprazole sodium injection
40 mg
intravenous injection
1 time/12 hours
ulinastatin injection
300 thousand units
continuous venous pump
1 time/12 hours
meropenem injection
1 g/time
with slow venous pump for 4 hours
1 time/8 hours. Patients in both groups received Qingyi decoction
1 dose/day. It was injected in 2-3 times by conventional gastric tube in control group
while in observation group
it was used by naso-jejunal instillation method
100-150 mL/time
at 50-100 mL·h-1
4-6 times/day. The treatment course was 10 days for both groups. Time of bellyache
abdominal distension
recovery of bowel sound and ventilation defecation were recorded. Before and after treatment
the blood routine examination
amylase in blood and urine
blood glucose and blood calcium were monitored. Levels of interleukin-1 (IL-1)
interleukin-6 (IL-6)
and tumor necrosis factor-α (TNF-α) in serum were detected both before and after treatment
and the levels of D-lactic acid
endotoxin and urinary lactulose/mannitol (L/M) in plasma were detected both before and after treatment. Result: The clinical efficacy in observation group was superior to that in control group (P<0.05) by Ridit analysis. After treatment
the enteroplegia related indexes (time of bellyache
abdominal distension
recovery of bowel sound and ventilation defecation) in observation group were lower than those in control group (P<0.01). After treatment
the levels of leukocyte
amylase in blood and urine
and fasting blood-glucose in observation group were lower than those in control group (P<0.01)
and the level of serum calcium was higher than that in control group (P<0.01). Levels of IL-1
IL-6 and TNF-α in observation group were lower than those in control group after treatment (P<0.01)
levels of D-lactic acid and urinary lactulose/mannitol (L/M) in observation group were also lower than those in control group (P<0.01). Conclusion: Qingyi decoction with naso-jejunal instillation therapy combined with conventional western medicine can more effectively improve the enteroplegia indexes
promote the recovery of gastrointestinal function
relieve inflammatory reaction
and promote intestinal mucosal barrier function in treating moderate acute pancreatitis.
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