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
2期
108-111
,共4页
何雷%任毅%陈春花%关春辉%张登鹏%陈波
何雷%任毅%陳春花%關春輝%張登鵬%陳波
하뢰%임의%진춘화%관춘휘%장등붕%진파
芒硝%大黄%脉冲式高容量血液滤过%急性胰腺炎,重症
芒硝%大黃%脈遲式高容量血液濾過%急性胰腺炎,重癥
망초%대황%맥충식고용량혈액려과%급성이선염,중증
Mirabilite%Rheum officinale%Pulse high-volume hemofiltration%Severe acute pancreatitis
目的:观察芒硝、大黄联合脉冲式高容量血液滤过(PHVHF)治疗重症急性胰腺炎(SAP)的临床疗效。方法选择贵州省黔南州中医院重症医学科收治的11例SAP患者,在接受常规西医治疗基础上给予生大黄水灌胃,芒硝外敷,并联合PHVHF治疗;观察治疗前后患者的腹部症状、生命体征、血气分析、血生化指标、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、Ranson评分等变化及预后。结果治疗后患者发热〔体温(℃):37.31±0.13比39.12±0.12〕、心动过速〔心率(次/min):106±17比123±22〕、呼吸窘迫〔呼吸频率(次/min):23±6比31±5〕等症状均有不同程度的缓解,APACHEⅡ评分(分:9.1±2.2比21.2±8.2)、Ranson评分(分:3.2±1.1比5.8±1.3)明显下降(均P<0.05)。存活的10例患者血流动力学稳定,心率(次/min:106±17比123±22)逐渐下降,平均动脉压〔MAP(mmHg,1 mmHg=0.133 kPa):73±6比41±5〕逐渐上升(均P<0.05)。治疗后血清淀粉酶〔AMY(U/L):367.3±102.3比923.5±351.7〕、丙氨酸转氨酶〔ALT(U/L):63.3±23.2比201.5±123.2〕、总胆红素〔TBil(μmol/L):22.1±20.1比56.1±63.2〕、血肌酐〔SCr(μmol/L):132.1±23.5比392.4±12.2〕、尿素氮〔BUN(mmol/L):9.5±4.9比19.2±5.9〕、血K+(mmol/L:4.2±0.2比5.6±2.1)均明显下降,动脉血二氧化碳分压〔PaCO2(mmHg):35.1±7.1比27.2±5.5〕、动脉血氧分压〔PaO2(mmHg):93.2±13.2比49.1±7.2〕和氧合指数(mmHg:187.1±28.5比148.2±32.7)、血Na+(mmol/L:132.1±19.1比127.1±42.1)明显升高,与治疗前比较差异均有统计学意义(P<0.05或P<0.01)。结论芒硝和大黄联合PHVHF治疗SAP效果显著,可作为SAP治疗的措施之一。
目的:觀察芒硝、大黃聯閤脈遲式高容量血液濾過(PHVHF)治療重癥急性胰腺炎(SAP)的臨床療效。方法選擇貴州省黔南州中醫院重癥醫學科收治的11例SAP患者,在接受常規西醫治療基礎上給予生大黃水灌胃,芒硝外敷,併聯閤PHVHF治療;觀察治療前後患者的腹部癥狀、生命體徵、血氣分析、血生化指標、急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分、Ranson評分等變化及預後。結果治療後患者髮熱〔體溫(℃):37.31±0.13比39.12±0.12〕、心動過速〔心率(次/min):106±17比123±22〕、呼吸窘迫〔呼吸頻率(次/min):23±6比31±5〕等癥狀均有不同程度的緩解,APACHEⅡ評分(分:9.1±2.2比21.2±8.2)、Ranson評分(分:3.2±1.1比5.8±1.3)明顯下降(均P<0.05)。存活的10例患者血流動力學穩定,心率(次/min:106±17比123±22)逐漸下降,平均動脈壓〔MAP(mmHg,1 mmHg=0.133 kPa):73±6比41±5〕逐漸上升(均P<0.05)。治療後血清澱粉酶〔AMY(U/L):367.3±102.3比923.5±351.7〕、丙氨痠轉氨酶〔ALT(U/L):63.3±23.2比201.5±123.2〕、總膽紅素〔TBil(μmol/L):22.1±20.1比56.1±63.2〕、血肌酐〔SCr(μmol/L):132.1±23.5比392.4±12.2〕、尿素氮〔BUN(mmol/L):9.5±4.9比19.2±5.9〕、血K+(mmol/L:4.2±0.2比5.6±2.1)均明顯下降,動脈血二氧化碳分壓〔PaCO2(mmHg):35.1±7.1比27.2±5.5〕、動脈血氧分壓〔PaO2(mmHg):93.2±13.2比49.1±7.2〕和氧閤指數(mmHg:187.1±28.5比148.2±32.7)、血Na+(mmol/L:132.1±19.1比127.1±42.1)明顯升高,與治療前比較差異均有統計學意義(P<0.05或P<0.01)。結論芒硝和大黃聯閤PHVHF治療SAP效果顯著,可作為SAP治療的措施之一。
목적:관찰망초、대황연합맥충식고용량혈액려과(PHVHF)치료중증급성이선염(SAP)적림상료효。방법선택귀주성검남주중의원중증의학과수치적11례SAP환자,재접수상규서의치료기출상급여생대황수관위,망초외부,병연합PHVHF치료;관찰치료전후환자적복부증상、생명체정、혈기분석、혈생화지표、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、Ranson평분등변화급예후。결과치료후환자발열〔체온(℃):37.31±0.13비39.12±0.12〕、심동과속〔심솔(차/min):106±17비123±22〕、호흡군박〔호흡빈솔(차/min):23±6비31±5〕등증상균유불동정도적완해,APACHEⅡ평분(분:9.1±2.2비21.2±8.2)、Ranson평분(분:3.2±1.1비5.8±1.3)명현하강(균P<0.05)。존활적10례환자혈류동역학은정,심솔(차/min:106±17비123±22)축점하강,평균동맥압〔MAP(mmHg,1 mmHg=0.133 kPa):73±6비41±5〕축점상승(균P<0.05)。치료후혈청정분매〔AMY(U/L):367.3±102.3비923.5±351.7〕、병안산전안매〔ALT(U/L):63.3±23.2비201.5±123.2〕、총담홍소〔TBil(μmol/L):22.1±20.1비56.1±63.2〕、혈기항〔SCr(μmol/L):132.1±23.5비392.4±12.2〕、뇨소담〔BUN(mmol/L):9.5±4.9비19.2±5.9〕、혈K+(mmol/L:4.2±0.2비5.6±2.1)균명현하강,동맥혈이양화탄분압〔PaCO2(mmHg):35.1±7.1비27.2±5.5〕、동맥혈양분압〔PaO2(mmHg):93.2±13.2비49.1±7.2〕화양합지수(mmHg:187.1±28.5비148.2±32.7)、혈Na+(mmol/L:132.1±19.1비127.1±42.1)명현승고,여치료전비교차이균유통계학의의(P<0.05혹P<0.01)。결론망초화대황연합PHVHF치료SAP효과현저,가작위SAP치료적조시지일。
Objective To observe the clinical efficacy of mirabilite and rheum officinale combined with pulse high-volume hemofiltration(PHVHF)in treatment of patients with severe acute pancreatitis(SAP). Methods A total of 11 patients with SAP in Department of Critical Care Medicine of Qiannan Traditional Chinese Medicine Hospital of Guizhou Province received the combined treatment of external application of mirabilite,gavage of rheum officinale decoction and PHVHF. The changes in abdominal symptoms,vital signs,blood gas analysis,blood biochemical indicators,and the acute physiology and chronic health evaluation(APACHEⅡ)score,Ranson score and prognosis were observed and compared before and after treatment. Results After treatment,the patients' fever〔body temperature(℃):37.31±0.13 vs. 39.12±0.12〕,tachycardia〔heart rate(beats/min):106±17 vs. 123±22〕, respiratory distress〔respiratory frequency(times/min):23±6 vs. 31±5〕and other symptoms were ameliorated in different degrees,and the APACHE Ⅱ score(9.1±2.2 vs. 21.2±8.2),Ranson score(3.2±1.1 vs. 5.8±1.3)were decreased significantly ,all the above indexes compared before and after treatment being of statistical significant differences(all P<0.05). The indexes of hemodynamics of 10 survival patients were stable,heart rate(beats/min:106±17 vs. 123±22)was decreased,and mean arterial pressure〔MAP,mmHg(1 mmHg=0.133 kPa):73±6 vs. 41±5〕was increased gradually(both P<0.05). After treatment,serum amylase〔AMY(U/L):367.3±102.3 vs. 923.5±351.7〕,alanine aminotransferase〔ALT(U/L):63.3±23.2 vs. 201.5±123.2〕,total bilirubin〔TBil (μmol/L):22.1±20.1 vs. 56.1±63.2〕,serum creatinine〔SCr(μmol/L):132.1±23.5 vs. 392.4±12.2〕,urea nitrogen〔BUN(mmol/L):9.5±4.9 vs. 19.2±5.9〕, K+(mmol/L:4.2±0.2 vs. 5.6±2.1) were significantly decreased,arterial partial pressure of carbon dioxide〔(PaCO2,mmHg):35.1±7.1 vs. 27.2±5.5〕,arterial partial pressure of oxygen〔PaO2(mmHg):93.2±13.2 vs. 49.1±7.2〕and oxygenation index(mmHg:187.1±28.5 vs. 148.2±32.7),Na+(mmol/L:132.1±19.1 vs. 127.1±42.1)were significantly increased compared with those before treatment, there were statistically significant differences(P<0.05 or P<0.01). Conclusion The combined treatment of mirabilite,rheum officinale and PHVHF has significant effects on the treatment of patients with SAP,and it can be one of the assistant therapies of SAP.