【摘要】 目的 探究生大黄联合亚胺培南西司他丁钠对急性胰腺炎患者胃肠功能障碍、免疫功能的影响。方法 前瞻性选取从2022年1月至2023年3月在安庆市立医院收治的急性胰腺炎患者92例，将所有患者按随机数字表法分为对照组(n=46)、观察组(n=46)。所有患者进行基础治疗，对照组在此基础上采用亚胺培南西司他丁钠进行治疗，观察组在对照组的基础上联合生大黄灌肠进行治疗。比较两组患者的疗效，治疗前后胃肠功能的恢复情况、T淋巴细胞亚群(CD4~+、CD8~+、CD4~+/CD8~+)、免疫球蛋白(IgA、IgM、IgG)、血清淀粉酶、炎症因子[白细胞介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)]水平的变化情况。结果 治疗后，观察组患者总有效率为91.30%,显著高于对照组(73.91%),差异有统计学意义(P<0.05)。观察组患者的肠鸣音恢复时间、术后首次排气和排便的时间以及腹胀腹痛缓解时间分别为(2.26±0.67)、(2.72±0.67)、(3.57±1.01)、(3.66±0.93) d,均显著短于对照组[(3.49±0.80)、(3.85±0.83)、(5.03±1.24)、(5.31±1.18) d],差异均有统计学意义(P<0.05)。治疗后，两组的CD4~+、CD4~+/CD8~+、IgA、IgM、IgG水平均较治疗前显著升高，CD8~+、血清淀粉酶、IL-6、TNF-α水平均较治疗前显著降低，且观察组的CD4~+、CD4~+/CD8~+、IgA、IgM、IgG水平分别为(35.93±6.49)%、1.85±0.32、(1.46±0.31) g/L、(1.56±0.31) g/L、(9.86±1.41) g/L,均显著高于对照组[(32.47±6.83)%、1.51±0.28、(1.19±0.29) g/L、(1.07±0.24) g/L、(8.24±1.25) g/L],CD8~+、血清淀粉酶、IL-6、TNF-α水平分别为(19.39±4.25)%、(130.76±15.68) U/L、(50.08±5.61) ng/L、(35.25±5.84)μg/L,均显著低于对照组[(21.54±4.63)%、(143.45±12.83) U/L、(61.34±6.42) ng/L、(51.93±7.19)μg/L],差异均有统计学意义(P<0.05)。结论 生大黄联合亚胺培南西司他丁钠治疗急性胰腺炎患者的效果显著，可以改善患者的临床症状，促进胃肠功能的恢复，提高免疫功能，抑制炎症反应。更多还原

【Abstract】 Objective To investigate the effects of raw rhubarb combined with imipenem cilastatin sodium on gastrointestinal dysfunction and immune function in patients with acute pancreatitis. Methods From January 2022 to March 2023, 92 patients with acute pancreatitis accepted by Anqing Municipal Hospital were collected. All patients were assigned to the control group(n=46) and the observation group(n=46) according to the random number table method. All patients received basic treatment. On this basis, the control group was treated with imipenem cilastatin sodium, and the observation group was treated with raw rhubarb enema based on the control group. The curative effects of the two groups were compared, including the recovery of gastrointestinal function, changes of T lymphocyte subsets(CD4~+, CD8~+, CD4~+/CD8~+), immunoglobulin(IgA, IgM, IgG), serum amylase and inflammatory factors[interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α)] levels before and after treatment. Results After treatment, the total effective rate of patients in the observation group was 91.30%, which was significantly higher than that in the control group(73.91%), the difference was statistically significant(P<0.05). The recovery time of bowel sounds, the time of first postoperative exhaust and defecation, relief time for abdominal distension and pain in the observation group were(2.26±0.67),(2.72±0.67),(3.57±1.01), and(3.66±0.93) d, respectively, which were significantly shorter than those in the control group [(3.49±0.80),(3.85±0.83),(5.03±1.24), and(5.31±1.18) d], the differences were statistically significant(P<0.05). After treatment, the levels of CD4~+, CD4~+/CD8~+, IgA, IgM and IgG in the two group were higher than those before treatment, and the levels of CD8~+, serum amylase, IL-6 and TNF-α were lower than those before treatment, and the levels of CD4~+, CD4~+/CD8~+, IgA, IgM and IgG in the observation group were(35.93±6.49)%, 1.85±0.32,(1.46±0.31) g/L,(1.56±0.31) g/L,(9.86±1.41) g/L, respectively, which were higher than those in the control group[(32.47±6.83)%, 1.51±0.28,(1.19±0.29) g/L,(1.07±0.24) g/L,(8.24±1.25) g/L],and the levels of CD8~+, serum amylase, IL-6 and TNF-α in the observation group were(19.39±4.25)%,(130.76±15.68) U/L,(50.08±5.61) ng/L,(35.25±5.84) μg/L, respectively, which were lower than those in the control group [(21.54±4.63)%,(143.45±12.83) U/L,(61.34±6.42) ng/L,(51.93±7.19) μg/L], the differences were statistically significant(P<0.05). Conclusion Raw rhubarb combined with imipenem cilastatin sodium has a obvious effect for acute pancreatitis, which can improve the clinical symptoms, promote the recovery of gastrointestinal function, enhance immune function and inhibit inflammatory reaction.更多还原