大承气汤联合连续性肾替代治疗对重症急性胰腺炎的影响

曾蜀春 马懿 张翠先

[摘要]目的 探討大承气汤联合连续性肾替代治疗（CRRT）对重症急性胰腺炎（SAP）的影响。方法 选取2017年1月～2019年9月于我院接受治疗的72例SAP患者为受试对象，采用随机数字表法将其分为研究组与对照组，每组各36例。对照组患者予以常规治疗，研究组患者在对照组的基础上给予大承气汤联合CRRT。比较两组患者治疗前及治疗72 h后炎症因子[肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）、血清降钙素原（PCT）、超敏C反应蛋白（hs-CRP）]、肾功能[血尿素氮（BUN）、血肌酐（SCr）]水平及急性生理与慢性健康评估（APACHEⅡ）评分;比较两组患者治疗后的临床症状消失时间（腹部不适消失时间、体温恢复时间、肠蠕动恢复时间、血淀粉酶恢复时间）。结果 治疗72 h后，两组患者的TNF-α、IL-6、PCT、hs-CRP、BUN、SCr水平及APACHE Ⅱ评分均低于治疗前，且研究组低于对照组，差异有统计学意义（P<0.05）。研究组患者的腹部不适消失时间、体温恢复时间、肠蠕动恢复时间、血淀粉酶恢复时间均短于对照组，差异有统计学意义（P<0.05）。结论 大承气汤联合CRRT用于SAP效果良好，能有效降低炎症因子水平，改善肾功能，促进患者胃肠功能恢复，利于患者预后。

[关键词]大承气汤联合连续性肾替代治疗;重症急性胰腺炎;炎症因子;临床症状消失;预后

[中图分类号] R576          [文献标识码] A          [文章编号] 1674-4721（2020）6（b）-0158-04

[Abstract] Objective To explore the effect of Dachengqi Decoction combined with continuous renal replacement therapy （CRRT） on severe acute pancreatitis （SAP）. Methods A total of 72 SAP patients who were treated in our hospital from January 2017 to September 2019 were selected as subjects， and they were divided into study group and control group according to the random number table method， 36 cases in each group. The control group was given routine treatment， and the study group was given Dachengqi Decoction combined with CRRT on the basis of the control group. The levels of inflammatory factors （tumor necrosis factor-α [TNF-α]， interleukin-6 [IL-6]， procalcitonin [PCT]， high-sensitivity C-reactive protein [hs-CRP]）， renal function （blood urea nitrogen [BUN]， serum creatinine [SCr]） and acute physiology and chronic health evaluation （APACHE Ⅱ） score before treatment and after 72 hours treatment were compared between the two groups. The disappearance time of clinical symptoms （abdominal discomfort disappearance time， body temperature recovery time， intestinal peristalsis recovery time， blood amylase recovery time） was compared between the two groups after treatment. Results After 72 hours of treatment， the levels of TNF-α， IL-6， PCT， hs-CRP， BUN， SCr and APACHE Ⅱ scores in the two groups were lower than those before treatment， and those in the study group were lower than those in the control group， with statistically significant differences （P<0.05）. The abdominal discomfort disappearance time， body temperature recovery time， intestinal peristalsis recovery time， blood amylase recovery time in the study group were shorter than those in the control group， and the differences were statistically significant （P<0.05）. Conclusion Dachengqi Decoction combined with CRRT has a good effect on SAP， which can effectively reduce the levels of inflammatory factors， improve renal function， promote the recovery of gastrointestinal function and benefit the prognosis of patients.

[Key words] Dachengqi Decoction combined with continuous renal replacement therapy; Severe acute pancreatitis; Inflammatory factors; Disappearance of clinical symptoms; Prognosis

重症急性胰腺炎（severe acute pancreatitis，SAP）是ICU常见的危重急症，常伴全身炎性反应综合征（systemic inflammatory response syndrome，SIRS）[1]。该病发病急、病情险恶且死亡率高，可在短时间内使患者出现免疫功能障碍、多器官功能障碍，破坏水电解质平衡，导致预后较差。尽管器官功能支持治疗水平不断提升，SAP死亡率仍高达20%[2]。……