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鼻饲中药联合早期血液滤过治疗重症急性胰腺炎的疗效观察

费丽燕1,夏丽丽2,朱佳红1,吕素兰1,孟丽华1,高芸1   

  1. 1. 无锡市中医医院
    2. 无锡市中医医院重症监护室
  • 收稿日期:2013-07-11 修回日期:2013-12-20 出版日期:2014-04-15 发布日期:2014-04-15
  • 通讯作者: 费丽燕

Effect of Early Hemofiltration Combined with Traditional Chinese Medicine on Nasal Feeding on Severe Acute Pancreatitis Patients

  • Received:2013-07-11 Revised:2013-12-20 Published:2014-04-15 Online:2014-04-15

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摘要：

【摘要】目的 探讨鼻饲中药联合早期血液滤过治疗重症急性胰腺炎（SAP）的方法及疗效。方法74例患者分为中药组（35例）和中药+血滤组（39例）。中药组采用禁食、胃肠减压、液体复苏，抑制胰液分泌，预防性应用抗生素，胃肠外营养，鼻饲中药等治疗；中药+血滤组在中药组治疗基础上加用连续性肾脏替代治疗（CRRT）。分别观察并检测2组患者入院时及治疗后第1、3、7天血肿瘤坏死因子（TNF）-α、白细胞介素（IL）-6、IL-8水平；记录2组患者治疗前及治疗后第1、3、7天急性生理和慢性健康状况（APACHE Ⅱ）评分，比较2组患者住院天数、局部并发症、器官功能不全、外科干预、病死率、住院总费用。结果2组患者入院时血细胞比容、白细胞计数、乳酸脱氢酶、血尿素氮、血糖、APACHE Ⅱ评分、Ranson评分及病因分类比较差异均无统计学意义（P>0.05）。与中药组相比，中药+血滤组器官功能不全发生率、外科干预例次均低于中药组患者。中药+血滤组患者血清TNF-α、IL-6、IL-8水平、APACHE Ⅱ评分下降幅度大于中药组（P<0.05）。结论鼻饲中药联合早期血液滤过治疗SAP能有效减轻过度炎症反应，降低并发症发生率，提高抢救成功率，改善患者预后。

关键词: 胰腺炎, 急性坏死性, 血液滤过, 肿瘤坏死因子α, 白细胞介素6, 白细胞介素8, 中草药

Abstract: [Abstract] Objective To investigate the effects of severe acute pancreatitis (SAP) patients undergoing early hemofiltration combined with traditional Chinese medicine on nasal feeding. Methods 74 patients were divided into traditional Chinese medicine group (group A, 35 cases) and traditional Chinese medicine + hemofiltration group (group B, 39 cases). In traditional Chinese medicine group, patients were given fasting, gastrointestinal decompression, fluid resuscitation, inhibition of pancreatic secretion, antibiotic prophylaxis, parenteral nutrition, traditional Chinese medicine on nasal feeding; In traditional Chinese medicine + hemofiltration group, patients received continuous veno-venous hemofiltration treatment. On admission and first, 3, 7 days post-treatment, the scores of acute physiology and chronic health evaluation (APACHE II), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8) levels were observed. Length of hospital stay, local and systemic complications, surgical intervention, mortality and hospitalization expenses were compared between two groups. Results On admission between the two groups, no statistical significance was seen in the hematocrit, white blood cell count, lactic acid dehydrogenase, blood urea nitrogen, blood glucose, APACHE II score, Ranson’s score and classification of etiology (P>0.05). But APACHE II, TNF-α, IL-6, IL-8 were decreased significantly in group B than in group A after first, 3, 7 days post-treatment (P<0.05). Compared to the traditional Chinese medicine group, the length of hospital stay, local complications, systemic complications, surgical intervention, mortality and hospitalization expense were lower in traditional Chinese medicine + hemofiltration group. Conclusion Traditional Chinese medicine on nasal feeding combined with early hemofiltration could effectively reduce complications, incidence of organ dysfunction and improve the prognosis of SAP patients.

Key words: pancreatitis, acute necrotizing, hemofiltration, tumor necrosis factor-alpha, interleukin 6, interleukin 8, drugs