中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
1期
14-17
,共4页
夏亮%陈军贤%谢齐贵%莫耘松%张卫星
夏亮%陳軍賢%謝齊貴%莫耘鬆%張衛星
하량%진군현%사제귀%막운송%장위성
急性胰腺炎,重症%中药%早期肠内营养%疗效%中西医结合疗法
急性胰腺炎,重癥%中藥%早期腸內營養%療效%中西醫結閤療法
급성이선염,중증%중약%조기장내영양%료효%중서의결합요법
Severe acute pancreatitis%Traditional Chinese medicine%Early enteral nutrition%Curative effect%Integrated traditional Chinese and western medicine therapy
目的：分析中药联合肠内营养（EN）对重症急性胰腺炎（SAP）治疗的效果。方法将70例SAP患者按随机原则分为中药EN组和常规治疗组。常规治疗组（34例）接受常规治疗；中药EN组（36例）在常规治疗的基础上采用中药〔柴胡、白芍、黄芩、枳实、厚朴、生大黄（后下）及玄明粉（冲服）各10 g，浓煎150 mL，胃管内注入，夹管2.5～3 h，每日2次，4～7 d为1个疗程〕联合EN进行治疗。观察两组患者治疗后症状改善时间、肠道功能恢复情况、住院时间、医疗总费用、血清C-反应蛋白（CRP）、天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）、淀粉酶（AMY）、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分及并发症、重症监护病房（ICU）中转率、病死率。结果中药EN组治疗后腹部压痛（d：1.68±1.01比3.89±1.07）、腹胀（d：2.17±1.48比4.24±3.23）、腹痛（d：3.12±1.14比4.94±3.21）等症状改善时间及肠道恢复排气排便时间（d：3.48±0.92比5.32±3.30）、住院时间（d：15.50±1.75比19.35±1.69）均较常规治疗组明显缩短，住院总费用（万元：1.812±0.424比3.292±1.081）较常规治疗组明显减少（P＜0.05或P＜0.01）。治疗后中药EN组和常规治疗组血清CRP、AST、LDH、AMY、APACHEⅡ评分均较治疗前降低，且以中药EN组治疗10 d时降低更显著〔CRP（mg/L）：98.972±43.384比122.392±71.621，AST（U/L）：75.952±55.668比126.391±47.431，LDH （μmol?s-1?L-1）：1.48±0.21比2.61±1.46，AMY（U/L）：146.362±58.792比226.392±37.692，APACHEⅡ评分（分）：6.978±3.352比13.652±7.621，P＜0.05或P＜0.01〕。中药EN组无死亡病例，常规治疗组死亡1例；中药EN组ICU中转率少于常规治疗组（2.78%比11.76%），但两组比较差异无统计学意义（χ2＝0.99，P＞0.05）；70例SAP患者中，胆源性占55.72%，高脂血症性占37.14%，酒精性占4.28%，其他2.86%。结论使用中药联合EN治疗SAP，可以增强对SAP的治疗效果，减少SAP患者住院时间和医疗总费用，并减少并发症和病死率，有利于SAP患者尽快康复。
目的：分析中藥聯閤腸內營養（EN）對重癥急性胰腺炎（SAP）治療的效果。方法將70例SAP患者按隨機原則分為中藥EN組和常規治療組。常規治療組（34例）接受常規治療；中藥EN組（36例）在常規治療的基礎上採用中藥〔柴鬍、白芍、黃芩、枳實、厚樸、生大黃（後下）及玄明粉（遲服）各10 g，濃煎150 mL，胃管內註入，夾管2.5～3 h，每日2次，4～7 d為1箇療程〕聯閤EN進行治療。觀察兩組患者治療後癥狀改善時間、腸道功能恢複情況、住院時間、醫療總費用、血清C-反應蛋白（CRP）、天鼕氨痠轉氨酶（AST）、乳痠脫氫酶（LDH）、澱粉酶（AMY）、急性生理學與慢性健康狀況評分繫統Ⅱ（APACHEⅡ）評分及併髮癥、重癥鑑護病房（ICU）中轉率、病死率。結果中藥EN組治療後腹部壓痛（d：1.68±1.01比3.89±1.07）、腹脹（d：2.17±1.48比4.24±3.23）、腹痛（d：3.12±1.14比4.94±3.21）等癥狀改善時間及腸道恢複排氣排便時間（d：3.48±0.92比5.32±3.30）、住院時間（d：15.50±1.75比19.35±1.69）均較常規治療組明顯縮短，住院總費用（萬元：1.812±0.424比3.292±1.081）較常規治療組明顯減少（P＜0.05或P＜0.01）。治療後中藥EN組和常規治療組血清CRP、AST、LDH、AMY、APACHEⅡ評分均較治療前降低，且以中藥EN組治療10 d時降低更顯著〔CRP（mg/L）：98.972±43.384比122.392±71.621，AST（U/L）：75.952±55.668比126.391±47.431，LDH （μmol?s-1?L-1）：1.48±0.21比2.61±1.46，AMY（U/L）：146.362±58.792比226.392±37.692，APACHEⅡ評分（分）：6.978±3.352比13.652±7.621，P＜0.05或P＜0.01〕。中藥EN組無死亡病例，常規治療組死亡1例；中藥EN組ICU中轉率少于常規治療組（2.78%比11.76%），但兩組比較差異無統計學意義（χ2＝0.99，P＞0.05）；70例SAP患者中，膽源性佔55.72%，高脂血癥性佔37.14%，酒精性佔4.28%，其他2.86%。結論使用中藥聯閤EN治療SAP，可以增彊對SAP的治療效果，減少SAP患者住院時間和醫療總費用，併減少併髮癥和病死率，有利于SAP患者儘快康複。
목적：분석중약연합장내영양（EN）대중증급성이선염（SAP）치료적효과。방법장70례SAP환자안수궤원칙분위중약EN조화상규치료조。상규치료조（34례）접수상규치료；중약EN조（36례）재상규치료적기출상채용중약〔시호、백작、황금、지실、후박、생대황（후하）급현명분（충복）각10 g，농전150 mL，위관내주입，협관2.5～3 h，매일2차，4～7 d위1개료정〕연합EN진행치료。관찰량조환자치료후증상개선시간、장도공능회복정황、주원시간、의료총비용、혈청C-반응단백（CRP）、천동안산전안매（AST）、유산탈경매（LDH）、정분매（AMY）、급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분급병발증、중증감호병방（ICU）중전솔、병사솔。결과중약EN조치료후복부압통（d：1.68±1.01비3.89±1.07）、복창（d：2.17±1.48비4.24±3.23）、복통（d：3.12±1.14비4.94±3.21）등증상개선시간급장도회복배기배편시간（d：3.48±0.92비5.32±3.30）、주원시간（d：15.50±1.75비19.35±1.69）균교상규치료조명현축단，주원총비용（만원：1.812±0.424비3.292±1.081）교상규치료조명현감소（P＜0.05혹P＜0.01）。치료후중약EN조화상규치료조혈청CRP、AST、LDH、AMY、APACHEⅡ평분균교치료전강저，차이중약EN조치료10 d시강저경현저〔CRP（mg/L）：98.972±43.384비122.392±71.621，AST（U/L）：75.952±55.668비126.391±47.431，LDH （μmol?s-1?L-1）：1.48±0.21비2.61±1.46，AMY（U/L）：146.362±58.792비226.392±37.692，APACHEⅡ평분（분）：6.978±3.352비13.652±7.621，P＜0.05혹P＜0.01〕。중약EN조무사망병례，상규치료조사망1례；중약EN조ICU중전솔소우상규치료조（2.78%비11.76%），단량조비교차이무통계학의의（χ2＝0.99，P＞0.05）；70례SAP환자중，담원성점55.72%，고지혈증성점37.14%，주정성점4.28%，기타2.86%。결론사용중약연합EN치료SAP，가이증강대SAP적치료효과，감소SAP환자주원시간화의료총비용，병감소병발증화병사솔，유리우SAP환자진쾌강복。
Objective To analyze the curative effect of traditional Chinese medicine(TCM)combined with early enteral nutrition(EN)for treatment of patients with severe acute pancreatitis(SAP). Methods 70 SAP patients were randomly divided into TCM plus EN group(36 cases)and conventional therapy group(34 cases). Both groups received routine treatment. Additionally,TCM+EN group received early EN and TCM decoction treatment〔the ingredients of decoction including radix bupleuri,radix paeoniae alba,radix scutellariae,fructus aurantii immaturus, magnolia bark,raw rhubarb(rhubarb was added at last during cooking the decoction)and natrii sulfas exsiccatus (dissolved in water to be administered)each 10 g,the decoction was concentrated to 150 mL and then administered via a stomach tube to the patient,afterwards the tube was clipped for 2.5-3 hours,twice a day,4-7 days constituting a therapeutic course〕. After treatment,the time for patients' symptoms improvement,the situation of intestinal recovery, the length of stay in hospital,the total medical cost,serum C-reactive protein(CRP),aspartate aminotransferase (AST), lactate dehydrogenase (LDH), amylase (AMY), acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and complications,intensive care unit(ICU)transfer rate and case fatality rate in two groups were observed. Results The time for symptoms improvement of abdominal tenderness(day:1.68±1.01 vs. 3.89±1.07), abdominal distension(day:2.17±1.48 vs. 4.24±3.23),abdominal pain(day:3.12±1.14 vs. 4.94±3.21)and the intestinal recovery of exhaust defecation time(day:3.48±0.92 vs. 5.32±3.30)of SAP patients after treatment in the TCM+EN group were faster significantly than those in the conventional therapy group(all P<0.05). The length of stay in hospital(day:15.50±1.75 vs. 19.35±1.69)and total cost(wan yuan:1.812±0.424 vs. 3.292±1.081) of TCM+EN group were less than those of conventional therapy group(P<0.05 or P<0.01). After treatment,the levels of serum CRP,AST,LDH,AMY,APACHEⅡscore in TCM+EN group and conventional therapy group were all lower than those before treatment,and on day 10,the degree of descent was more prominent in TCM+EN group〔CRP(mg/L):98.972±43.384 vs. 122.392±71.621,AST(U/L):75.952±55.668 vs. 126.391±47.431, LDH (μmol?s-1?L-1):1.48±0.21 vs. 2.61±1.46,AMY(U/L):146.362±58.792 vs. 226.392±37.692,APACHE Ⅱscores:6.978±3.352 vs. 13.652±7.621,P<0.05 or P<0.01〕. There was no death in TCM+EN group,while in the conventional therapy group,there was 1 case dead. ICU transfer rate in TCM+EN group was less than that in the conventional therapy group(2.78% vs. 11.76%),but there was no statistical significant difference between the two groups(χ2=0.99,P>0.05). Among the 70 patients with SAP,the cause of the disease due to gallstone accounted for 55.72%,hyperlipidemia for 37.14%,alcoholic for 4.28%and other 2.86%. Conclusion The use of TCM combined with early EN for treatment of patients with SAP can enhance the curative effect of SAP,reduce the hospitalization time and the total cost of patients,and decrease complications and mortality,that is conducive to the faster recovery of patients.
