【作者】 毛峥嵘； 冯博； 张少雷； 夏晗； 朱智琦；

【Author】 Mao Zhengrong;Feng Bo;Zhang Shaolei;Xia Han;Zhu Zhiqi;Department of critical care medicine,The First Affiliated Hospital of Henan University of Traditional Chinese Medicine;

【机构】 河南中医学院第一附属医院重症医学科；

【摘要】 目的探讨宣白承气汤、芒硝联合脉冲式高容量血液滤过(pulse high-volume hemofiltration,PHVHF)治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的疗效,为临床治疗SAP提供参考。方法选择2015年1月—2015年10月于医院重症医学科收治的13例SAP患者为研究对象,在接受常规西医治疗基础上,给予芒硝外敷,宣白承气汤灌肠,并联合PHVHF治疗。观察治疗前后患者的生命体征、腹部症状、血生化指标、血气分析、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分及Ranson评分的变化情况及预后,采用SPSS 19.0统计学软件进行分析。结果患者治疗前后,体温分别为(39.10±0.23)和(37.24±0.11)℃、心率(122±20)和(105±13)次/min、呼吸频率(31±9)和(24±5)次/min,较治疗前均明显缓解,差异具有统计学意义(P<0.05);治疗前后,APACHE II评分(21.5±8.0)和(9.4±1.9)分、Ranson评分(5.9±1.2)和(3.4±0.9)分较治疗前均明显下降(P<0.05)。存活12例患者,血流动力学均稳定,平均动脉压(42±3)和(74±7)mmHg较治疗前明显上升(P<0.05)。患者治疗前后,丙氨酸转氨酶分别为(203.4±121.1)和(65.6±22.8)U/L、血清淀粉酶(931.6±348.7)和(358.1±101.6)U/L、总胆红素(55.7±62.4)和(23.6±17.4)μmol/L、尿素氮(19.1±4.3)和(9.7±5.2)mmol/L、血肌酐(390.5±12.6)和(133.5±24.6)μmol/L、血K~+(5.7±2.0)和(4.4±0.5)mmol/L,较治疗前均明显下降,差异有统计学意义(P<0.05);治疗前后,动脉血氧分压(49.7±6.1)和(94.4±15.7)mmHg、动脉血二氧化碳分压(26.7±3.6)和(36.2±6.4)mmHg、氧合指数(147.1±33.5)和(189.2±26.5)mmHg、血Na~+(128.3±42.3)和(134.5±12.3)mmol/L较治疗前均明显升高,差异有统计学意义(P<0.05)。结论宣白承气汤与芒硝联合PHVHF治疗重症急性胰腺炎临床效果显著,可作为SAP治疗的方法之一。更多还原

【Abstract】 OBJECTIVE To investigate curative effect of xuan bai cheng qi tan g and mirabilite combined pulse high-volume hemofiltration in treatment of sev ere acute pancreatitist,in order to provide reference for clinical treatment of SA P.METHODS A total of 13 SAP cases were selected from January 2015 to October 2015 in Hospital intensive medicine department on the basis of conven tional western medicine treatment,give xuan bai cheng qi tang and mirabilite,en ema and external,then combined with PHVHF therapy.The changes of(APAC HEII) score and Ranson score were observed before and after the treatment of patients with life signs,abdominal symptoms,blood biochemical index,blood gas analysis,acute physiology and chronic health conditions,was analyzed with SPSS 19.0 software.RESULTS Before and after treatment,patients with body te mperature was(39.10±0.23) and(37.24±0.11)℃,heart rate was(122±20)and(105±13)times per minute,respiratory rate was(31±9) and(24±5)times per minute,the se symptoms were significantly relieved than before treatment,the difference wa s statistically significant(P<0.05);APACHE II score was(21.5±8.0)and(9.4±1.9)sco res,Ranson score was(5.9±1.2)and(3.4±0.9)scores,were significantly decreased(P<0.05).The survival of 12 patients,hemodynamics were stable,the average arterial pressure was(42±3)and(74±7)mmHg,was significantly increased than before treat ment(P<0.05);Before and after treatment,the serum levels of alanine aminotransf erasewas(203.4±121.1)and(65.6±22.8)U/L,serum amylase was(931.6±348.7)and(358.1±101.6)U/L,total bilirubinwas(55.7±62.4)and(23.6±17.4)μmol/L,urea nitrogen w as(19.1±4.3)and(9.7±5.2)mmol/L,serum creatinine was(390.5±12.6)and(133.5±24.6)umol/L,blood K+ was(5.7±2.0)and(4.4±0.5)mmol/L,were significantly decreased,th e difference was statistically significant(P<0.05);Arterial oxygen partial pressure was(49.7±6.1)and(94.4±15.7)mmHg,arterialcarbon dioxide partial pressure was(26.7±3.6)and(36.2±6.4)mmHg,oxygenation index was(147.1±33.5)and(189.2±26.5)mm Hg,blood Na+ was(128.3±42.3)and(134.5±12.3) mmol/L,were significantly higher than before treatment,the difference was statistically significant(P<0.05).CONC LUSION The clinical effect of xuan bai cheng qi tang and mirabilite combine d with PHVHF intreatment of severe acute pancreatitis was significantly,which can be used one of the methods in treatment of SAP.更多还原