CAJ | 학술논문

目的观察在常规治疗重症急性胰腺炎(SAP)的同时行连续性血液净化(CBP)及中药治疗对全身炎症反应综合征(SIRS)的疗效.方法 60例SAP患者随机分为治疗组(应用血液净化及中药)30例和对照组30例,每日除记录生命体征外,入院第0、1、3、5、7天抽血化验血常规、生化、肝功能、肾功能等;记录治疗前、治疗后第7天APACHEⅡ评分变化;观察记录腹部症状缓解时间(以腹痛症状消失为准的天数计算),第1次排便时间;中转手术率、多器官功能障碍综合征(MODS)发生率、病死率及平均住院日.结果治疗后第1、3、5、7天,治疗组的各项指标水平(体温、心率、呼吸、外周血白细胞及炎性指标C反应蛋白、乳酸值)均低于对照组,差异有统计学意义(P＜0.05);治疗后第7天两组APACHEⅡ评分均显著下降(P＜0.05),治疗组降低更明显(P＜0.01);治疗组腹痛缓解时间小于对照组(P<0.01),第1次排便时间治疗组亦小于对照组(P<0.01);治疗后第1天,两组血清淀粉酶均有下降趋势,但差异无统计学意义(P＞0.05),第3、5、7天两组血清淀粉酶均较治疗前明显下降,但同一时间点治疗组明显低于对照组(P＜0.01);治疗组中转手术率、MODS发生率、病死率低于对照组(P＜0.05),平均住院日明显低于对照组(P＜0.01).结论在常规治疗的基础上加用连续性血液净化及中药治疗能有效阻断全身炎症反应发展,从而改善预后,值得早期应用.
목적 관찰재상규치료중증급성이선염(SAP)적동시행련속성혈액정화(CBP)급중약치료대전신염증반응종합정(SIRS)적료효.방법 60례SAP환자수궤분위치료조(응용혈액정화급중약)30례화대조조30례,매일제기록생명체정외,입원제0、1、3、5、7천추혈화험혈상규、생화、간공능、신공능등;기록치료전、치료후제7천APACHEⅡ평분변화;관찰기록복부증상완해시간(이복통증상소실위준적천수계산),제1차배편시간;중전수술솔、다기관공능장애종합정(MODS)발생솔、병사솔급평균주원일.결과 치료후제1、3、5、7천,치료조적각항지표수평(체온、심솔、호흡、외주혈백세포급염성지표C반응단백、유산치)균저우대조조,차이유통계학의의(P＜0.05);치료후제7천량조APACHEⅡ평분균현저하강(P＜0.05),치료조강저경명현(P＜0.01);치료조복통완해시간소우대조조(P<0.01),제1차배편시간치료조역소우대조조(P<0.01);치료후제1천,량조혈청정분매균유하강추세,단차이무통계학의의(P＞0.05),제3、5、7천량조혈청정분매균교치료전명현하강,단동일시간점치료조명현저우대조조(P＜0.01);치료조중전수술솔、MODS발생솔、병사솔저우대조조(P＜0.05),평균주원일명현저우대조조(P＜0.01).결론 재상규치료적기출상가용련속성혈액정화급중약치료능유효조단전신염증반응발전,종이개선예후,치득조기응용.
Objective To observe the therapeutic effects of continuous blood purification(CBP) combined with traditional Chinese medicine on systemic inflammatory response syndrome(SIRS) of severe acute pancreatitis(SAP) patients on the base of routine treatment. Methods A total of 60 cases of severe acute pancreatitis patients were randomly divided into treatment group (continuous blood purification plus traditional Chinese medicine group,n=30) and control group(n=30).For all SAP patients,except recording vital signs daily, the changes of WBCs and biochemical indicator were recorded at the 0,1st,3rd,5th,7th day. The scores of APACHEⅡ were measured before and 7 days after treatment. The relief time of abdominal pain, the first defecation time, the incidence of operation and multiple organ dysfunction syndrome (MODS), case-fatality rate and mean hospitalized days were recorded and compared between the two groups. Results The 1st,3rd,5th,7th day after treatment every indicator (including body temperature, heart rate, respiratory rate, the sum of white blood cell and the level of plasma CRP and arterial blood lactate) in treatment group was reduced significantly more than that in control group(P＜0.05). At the 7th day after treatment, the score of APACHEⅡwas lower than that before treatment in the two groups(P＜0.05), and in treatment group that was more dramatically lowered(P＜0.01). The relief time of abdominal pain and the first defecation time in treatment group were significantly less than those in control group(P＜0.01). In the two groups,the serum amylase levels decreased at 1st compared to the value before therapy,but there was no difference between the two groups(P＞0.05),and the declination was most significant after therapy for 3,5 and 7 days. In addition, the serum amylase value was much lower in treatment group than that in control group at 3,5,7 days(P＜0.01); In treatment group, the incidence of operation and MODS, case-fatality rate were lower than those in control group(P＜0.05),and mean hospitalized days were lower significantly(P＜0.01).Conclusions On the base of routine treatment, application of continuous blood purification(CBP) combining with traditional Chinese medicine could significantly prevent SIRS development, improve prognosis.So we suggest early use of CBP and traditional Chinese medicine in SAP patients.