大黄承气汤联合乌司他丁对重症急性胰腺炎患者肠黏膜功能及免疫功能的影响

摘要

目的:探讨大黄承气汤联合乌司他丁对重症急性胰腺炎( SAP)的治疗效果及对患者肠道黏膜功能、免疫功能的影响.方法:选取2014年1月至2017年6月广州中医药大学第三附属医院收治的SAP患者128例,按照乱数表法分为观察组与对照组,每组64例. 2组均给予SAP常规治疗及乌司他丁治疗,观察组同时给予大黄承气汤胃管注入治疗,对照组则给予生理盐水胃管注入治疗,疗程均为2周.观察2组治疗后急性生理与慢性健康评分(APACHE－Ⅱ)、全身炎性反应综合征(SIRS)改善时间、肠功能恢复时间、住院时间、多器官功能衰竭(MODS)发生率、死亡率.比较2组治疗前、后腹内压、血浆二胺氧化酶(DAO)、血浆D－乳酸、白细胞介素－6(IL－6)、白细胞介素－8(IL－8)、肿瘤坏死因子－α(TNF－α)以及免疫球蛋白IgM、IgA、IgG水平.结果:治疗后观察组APACHE－Ⅱ、SIRS改善时间、肠功能恢复时间及住院时间均明显低于对照组,MODS发生率和死亡率明显低于对照组(P＜0.05).治疗后,观察组腹内压、DAO及血浆D－乳酸明显低于对照组(P＜0.05).治疗后2组患者血清IL－6、IL－8及TNF－α水平均明显降低,且观察组明显低于对照组(P＜0.05).治疗后观察组患者血清IgM、IgA、IgG水平均明显升高,对照组IgM、IgA、IgG水平明显降低(P＜0.05),观察组患者血清IgM、IgA、IgG水平明显高于对照组(P＜0.05).结论:大黄承气汤联合乌司他丁治疗SAP时临床疗效较好,可有效降低炎性反应因子水平,增强免疫功能,值得临床推广应用.%Objective:To investigate the therapeutic effect of rhubarb chengqi decoction combine with ulinastatin on severe acute pancreatitis (SAP) and its influence on intestinal mucosal function and immune function of patients .Methods:A total of 128 pa－tients with SAP who were treated in our hospital from January 2014 to June 2017 were selected,they were divided into observation group ( n＝64 ) and control group ( n＝64 ) according to random number table.The two groups were given conventional treatment of SAP and ulinastatin treatment ,the observation group was given rhubarb chengqi decoction gastric tube injection ,the control group was given physiological saline gastric tube injection treatment ,the course of treatment was 2 weeks.The acute physiology and chron－ic health evaluation ( APACHE－Ⅱ ),improvement time of systemic inflammatory response syndrome (SIRS),recovery time of in－testinal function,Length of hospital stay,incidence of multiple organ failure (MODS) and mortality were observed.The intra－ab－dominal pressure,plasma two amine oxidase (DAO),plasma D－lactic acid,interleukin－6 ( IL－6 ),interleukin－8 ( IL－8 ),tumor necrosis factor－α( TNF－α),immunoglobulin IgM,IgA and IgG levels were compared between the two groups before and after treatment.Results:The improvement time of APACHE－Ⅱ,SIRS,the recovery time of intestinal function and the length of stay in the observation group after treatment were significantly lower than those in the control group ,the incidence of mortality and MODS were significantly lower than those of the control group ( P＜0.05 ).After treatment,the intra－abdominal pressure,DAO and plasma lac－tic acid in the observation group were significantly lower than those in the control group ( P＜0.05 ).After treatment,the serum levels of IL－6,IL－8 and TNF－αin the two groups were significantly decreased ,and the observation group was significantly lower than that of the control group (P＜0.05).After treatment,the serum levels of IgM,IgA and IgG in the observation group were sig－nificantly increased,and the levels of IgM,IgA and IgG in the control group were significantly decreased (P＜0.05).The serum levels of IgM,IgA and IgG in the observation group were significantly higher than those in the control group ( P＜0.05 ).Conclu－sion:Rhubarb chengqi decoction combine with ulinastatin in the treatment of SAP have good clinical curative effect ,can effectively reduce the level of inflammatory factors ,and enhancing immune function ,which is worthy of clinical application.