CAJ | 학술논문

目的探讨大黄甘草汤联合间断短时静脉-静脉血液滤过对重症急性胰腺炎治疗作用及机制.方法 103例患者按随机数字表法分为3组.大黄甘草汤灌胃组(A组,25例),间断短时静脉-静脉血液滤过组(B组,35例)和间断短时静脉-静脉血液滤过联合大黄甘草汤组(C组,43例).在常规治疗的基础上,A组加用大黄甘草汤灌胃;B组加用间断短时静脉-静脉血液滤过;C组加用间断短时静脉-静脉血液滤过联合大黄甘草汤灌胃.观察3组患者的心率、呼吸、血压、肝、肾功能,氧合指数,血氧饱和度,血常规,血浆电解质,葡萄糖及C反应蛋白并行A-PACHE Ⅱ评分;所有患者入院时分别于治疗后24、48、96 h取血测苗肿瘤坏死因子α,白细胞介素10水平.结果治疗后24、48、96 h时,3组患者APACHE Ⅱ评分、肿瘤坏死因子α、白细胞介素10水平比较筹异均有统计学意义(P均 < 0.05);C组患者经治疗后急性肺损伤、胸/腹腔积液、肠麻痹/梗阻、败血症等并发症与A、B组患者比较差异也有统计学意义(P < 0.05).结论间断短时静脉-静脉血液滤过能大量清除血浆炎症介质,大黄甘草汤能较好地改善胃肠功能,减少并发症,两者早期联合应用能提高其临床疗效.
목적 탐토대황감초탕연합간단단시정맥-정맥혈액려과대중증급성이선염치료작용급궤제.방법 103례환자안수궤수자표법분위3조.대황감초탕관위조(A조,25례),간단단시정맥-정맥혈액려과조(B조,35례)화간단단시정맥-정맥혈액려과연합대황감초탕조(C조,43례).재상규치료적기출상,A조가용대황감초탕관위;B조가용간단단시정맥-정맥혈액려과;C조가용간단단시정맥-정맥혈액려과연합대황감초탕관위.관찰3조환자적심솔、호흡、혈압、간、신공능,양합지수,혈양포화도,혈상규,혈장전해질,포도당급C반응단백병행A-PACHE Ⅱ평분;소유환자입원시분별우치료후24、48、96 h취혈측묘종류배사인자α,백세포개소10수평.결과 치료후24、48、96 h시,3조환자APACHE Ⅱ평분、종류배사인자α、백세포개소10수평비교주이균유통계학의의(P균 < 0.05);C조환자경치료후급성폐손상、흉/복강적액、장마비/경조、패혈증등병발증여A、B조환자비교차이야유통계학의의(P < 0.05).결론 간단단시정맥-정맥혈액려과능대량청제혈장염증개질,대황감초탕능교호지개선위장공능,감소병발증,량자조기연합응용능제고기림상료효.
Objective To approach the treatment effect and mechanism of action of intermittent short time veno-venuous hemofiltration(ISVVH)and Rheum Glycyrrhiza Decoction in patients with severe acute pancreatitis(SAP).Methods One hundred and three SAP patients were randomly divided into 3 groups.Rheum Glyeyrrhiza uraleusis fisch Decoction group(A,n=25),ISVVH group(B,n=35)and ISVVH CO-Rheum Glyeyrrhiza uralensis fisch decoction group(C,n=43).A,B and C groups were all treated with conventional therapy.However.the patients in group A were added Rheum Glycyrrhiza uralensis fisch Decoction,the patients in group B added ISVVH while group C were raised ISVVH co-Rheum Glycyrrhiza uralensis fiach Decoction.Finally,we observed three groups of patients with heart rate(HR),respiration(R),blood pressure(BP),liver and kidney function;oxygenation index(PaO2/FiO2),oxygen saturation(SaO2);blood routine,plasma electrolytes,glucose and C-reactive protein;parallel APACHE Ⅱ score;measure level of TNF-α,IL-10 in patients blood serum when they were admitted to hospital,24,48,96 h after treatment respectively.Results After treated 24,48,96 h,C group compared to B group,B group compared to A group,there were significantly improvements in APACHE Ⅱ score(P < 0.05);TNF-alevel decreased(P < 0.05);IL-10 level increased(P < 0.05);three groups after treatment of acute lung injury, thoracic/abdominal effusion,intestinal paralysis/obstruction,sepsis and other complications improved significantly(P < 0.05).Conclusions ISVVH and glycyrrhiza decoction can regulate the liver and renal dysfunctions that followed SAP,raise physical conditions,improve the complications of patients with SAP.