大承气汤联合大黄在重症急性胰腺炎治疗中的意义

周成莉

【摘要】 目的：探讨生大黄鼻饲和大承气汤灌肠治疗急性重症胰腺炎（severe acute pancreatitis， SAP）的临床疗效。方法 将我院SAP住院治疗的患者随机分为对照组和实验组，每组各68例。对照组给予西医常规保守治疗，实验组在对照组治疗的基础上，加用鼻饲生大黄和灌肠大承气汤，观察2组临床疗效、胃肠功能恢复时间，以及血清中TNF-α、IL-6、IL-10表达情况。结果1.实验组患者腹痛、腹胀缓解和排气、排便时间均显著短于对照组，组间比较差异均有统计学意义（P<0.05）。2.治疗实验组、对照组患者的TNF-a、IL-6水平均显著降低，IL-10水平明显升高，与治疗前比较差异均有统计学意义（P<0.01，P<0.05）；，治疗后实验组患者的血清TNF-α、IL-6水平显著低于对照组，而 IL-10的表达水平高于对照组，两组比较差异有统计学意义（P<0.05）。结论 生大黄鼻饲和大承气汤灌肠治疗急性重症胰腺炎能显著提高疗效，这可能与其拮抗血TNF-α、IL-6等炎症因子的释放同时促进IL-10的表达有关。

【关键词】 大承气汤；大黄；急性重症胰腺炎；治疗

【Abstract】 Objective To explore the clinical therapeutic effect of Rhubarb by nasal feeding and Dachengqitang by enema on acute severe pancreatitis（SAP）.Methods 136 cases of SAP patients were randomly divided into control group（68 cases） and experimental group（68 cases）.Control group were treated with conventional Western medicine， experimental group were treated based on the use of Rhubarb by nasal feeding and Dachengqitang by enema.Two groups were observed clinical curative effect， gastrointestinal function recovery time， and serum tumor necrosis factor （TNF alpha）， interleukin 6 （IL-6）， IL-10 levels.Results： The experimental group in clinical curative effect is significantly better than control group， patients with abdominal pain， abdominal distension relief and exhaust， defecation time were significantly shorter than the control group， the differences were statistically significant （P <0.05）.TNF-a， IL-6 levels were significantly lower， IL-10 level increased significantly after treatment in both groups， compared with before treatment differences were statistically significant （P<0.05 or P<0.01）； And after treatment the level of TNF α， IL-6 in the experimental group were significantly lower than the control group， while the expression of IL-10 levels was higher than the control group（P<0.05），the differences were statistically significant（P<0.05）.Conclusion：The SAP were significantly improve though Rhubarb by nasal feeding and Dachengqitang by enema.This could relevant to antagonism the release of inflammatory factors such as TNF-αand IL-6， at the same time promote the expression of IL-10.

【Key words】 Large Chengqi Decoction ； rhubarb；SAP；treatment

【中图分类号】R657.5+1 【文献标识码】A 【文章编号】1005-0019（2014）03-0011-02

SAP是临床上常见的消化系统的危急重疾病，病程发展快，短时间内极易出现局部并发症和多器官功能衰竭，从而导致患者死亡[1]。如何有效的减少并发症的发生，阻断器官衰竭在SAP病程中有重要的临床价值。大承气汤出自《伤寒论》，为寒下的重要方剂，在治疗SAP已备受临床的广泛关注。本研究选取我院从2009年6月至2013年6月收治的SAP，对其进行生大黄鼻饲和大承气汤灌肠，旨在探讨生大黄联合大承气汤在SAP中的治疗意义。

1 资料与方法

1.1 一般资料：选择2009年6月～2013年6月在我院收治的确诊SAP患者136例，所有患者经病史及影像学检查明确诊断，随机分为对照组与治疗组。对照组68例，男37例，女31例，年龄21～66岁，平均（47.31±6.17）岁；实验组68例，男35例，女33例，年龄22～67岁，平均（48.19±6.21）岁。两组患者年龄、性别、就诊时间及急性生理慢性健康评分（APACHEⅡ评分）经统计学处理，差异无统计学意义（P>0.05）

1.2 临床诊断标准： ①SAP诊断标准及APACHEⅡ评分均符合中华医学会消化病学分会胰腺疾病学组有关重症急性胰腺炎的临床诊断及分级标准[2]；……