CAJ | 학술논문

重症急性胰腺炎%多器官功能障碍综合征%多器官功能衰竭%急性呼吸窘迫综合征%C-反应蛋白%肿瘤坏死因子-α%白细胞介素-1%大黄附子汤重癥急性胰腺炎%多器官功能障礙綜閤徵%多器官功能衰竭%急性呼吸窘迫綜閤徵%C-反應蛋白%腫瘤壞死因子-α%白細胞介素-1%大黃附子湯
중증급성이선염%다기관공능장애종합정%다기관공능쇠갈%급성호흡군박종합정%C-반응단백%종류배사인자-α%백세포개소-1%대황부자탕
Severe acute pancreatitis%Multiple organ dysfunction syndrome%Multiple organ failure%Acute respiratory distress syndrome%C-reactive protein%Tumor necrosis Factor%Interleukin-1%Dahuang Fuzi decoction

目的观察大黄附子汤对重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者的治疗效果.方法采用前瞻性、多中心、随机对照临床实验.收集2011年7月至2012年8月大连地区3家三级甲等医院收住院的SAP合并ARDS的患者60例,分为健康对照组、大黄附子汤治疗组和大黄汤治疗组,每组20例.3组治疗均包括重症监护、禁食水、持续胃肠减压、机械通气、镇静解痉、抑制胰腺外分泌、营养支持、抗感染治疗.健康对照组用温皂水200 ml每日2次保留灌肠,每次保留时间为30 min.大黄附子汤组和大黄汤组分别用大黄附子汤和大黄汤,剂量、使用次数及保留时间均同健康对照组.观察三组患者治疗前、治疗后7d的APACHEⅡ评分、7d的病死率,以及治疗前、治疗1、3、7d肝肾功能、血淀粉酶、血钙、内毒素、血常规、血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素1(IL-1)、血气.结果与健康对照组和大黄汤组相比,大黄附子汤组患者治疗后3、7d血淀粉酶、血钙、PaO2和PaO2/FiO2、内毒素、以及APACHEⅡ评分、病死率均明显改善(P＜0.05或P＜0.01),同时患者血WBC、ALT、BUN及Cr、CRP、TNF-α、IL-1亦有不同程度好转(P＜0.05).结论大黄附子汤可降低SAP-ARDS患者体内炎性介质,改善氧合功能,降低病死率,明显改善SAP-ARDS患者的预后,且大黄附子汤的治疗效果明显优于单纯大黄汤的治疗效果.
목적 관찰대황부자탕대중증급성이선염(SAP)합병급성호흡군박종합정(ARDS)환자적치료효과.방법 채용전첨성、다중심、수궤대조림상실험.수집2011년7월지2012년8월대련지구3가삼급갑등의원수주원적SAP합병ARDS적환자60례,분위건강대조조、대황부자탕치료조화대황탕치료조,매조20례.3조치료균포괄중증감호、금식수、지속위장감압、궤계통기、진정해경、억제이선외분비、영양지지、항감염치료.건강대조조용온조수200 ml매일2차보류관장,매차보류시간위30 min.대황부자탕조화대황탕조분별용대황부자탕화대황탕,제량、사용차수급보류시간균동건강대조조.관찰삼조환자치료전、치료후7d적APACHEⅡ평분、7d적병사솔,이급치료전、치료1、3、7d간신공능、혈정분매、혈개、내독소、혈상규、혈청C-반응단백(CRP)、종류배사인자-α(TNF-α)、백세포개소1(IL-1)、혈기.결과 여건강대조조화대황탕조상비,대황부자탕조환자치료후3、7d혈정분매、혈개、PaO2화PaO2/FiO2、내독소、이급APACHEⅡ평분、병사솔균명현개선(P＜0.05혹P＜0.01),동시환자혈WBC、ALT、BUN급Cr、CRP、TNF-α、IL-1역유불동정도호전(P＜0.05).결론 대황부자탕가강저SAP-ARDS환자체내염성개질,개선양합공능,강저병사솔,명현개선SAP-ARDS환자적예후,차대황부자탕적치료효과명현우우단순대황탕적치료효과.
Objective To observe the therapeutic efficacy of Dahuang Fuzi Decoction (a Chinese herbal medicine preparation with Rheum officinale Baill and Aconitum carmichaeli Debx) in patients with acute respiratory distress syndrome (ARDS) and severe acute pancreatitis (SAP).Methods A prospective,multi-center,randomized controlled clinical trials were carried out in 60 patients with ARDS and SAP in three tertiary university teaching hospitals in Dalian from July 2011 to August 2012.These patients were divided into Dahuang Fuzi Decoction treatment group (n =20),Dahuang Decoction treatment group (n =20) and Control group (n =20).All patients of 3 groups were treated with comprehensive measures including intensive care,fasting,continuous gastrointestinal decompression,mechanical ventilation,sedative antispasmodics,suppression of pancreatic exocrine,nutritional support,and antiinfection measures.In patients of control group,retention enema with 200 ml warm soap water for 30 min twice a day.In addition to retention enema as given to patients of control group,the patients of Dahuang Fuzi Decotion group and Dahuang Decotion group were treated with Dahuang Fuzi Decoction and Dahuang Decoction respectively.The APACHE Ⅱ scores and mortalities in 3 groups of patients were observed before treatment and after treatment for 7 days.At the same time,the liver and renal functions,blood amylase,blood calcium,endotoxin,routine blood examination,C-reactive protein (CRP),TNF-α,IL-1,blood gas analysis were detected before and after treatment for 1 d,3 d and 7 days.Results Compared with the control group and Dahuang Decoction group,the blood amylase,blood calcium,PaO2 and PaO2/ FiO2,endotoxin,APACHE-Ⅱ score,and mortality in Dahuang Fuzi Decoction group were markedly improved after treatment for3d and7 days (P ＜ 0.05 or P ＜ 0.01),whereas the levels of WBC.ALT.BUN.Cr.CRP.TNF-α.And IL-1 in blood samples were more or less improved in certain extent (P ＜ 0.05).There was more improvement in above biomarkers found in Dahuang Fuzi Decotion treatment group than that in Dahuang Decoction treatment group (P ＜ 0.05).Conclusions Dahuang Fuzi Decoction showed therapeutic effects on SAP-ARDS patients evidenced by reduction in inflammatory mediators,improved oxygenation function,lowering mortality,and significantly improved the prognosis of SAP-ARDS patients,and the therapeutic effect of Dahuang Fuzi Decotion is significantly superior over that of Dahuang Decotion.