经鼻空肠管注入生大黄治疗重症急性胰腺炎的临床研究
发布时间:2018-06-09 23:36
本文选题:重症急性胰腺炎 + 大黄 ; 参考:《安徽医科大学》2013年硕士论文
【摘要】:目的比较经鼻空肠管和经胃管途径注入生大黄对SAP患者炎症反应、生化指标及临床指标影响的差异,探讨经鼻空肠途径注入生大黄治疗SAP的疗效。 方法选取安徽医科大学附属安庆医院2010年8月至2013年2月期间收治的45例SAP患者为研究对象。将45例患者随机分为实验组(N=23例)、对照组(N=22例),所有患者均在入院1h内放入胃管或鼻空肠导管,两组患者均给予SAP的一般基础治疗,包括吸氧、重症监护、禁食禁水、胃肠减压、抑酸、抑酶、补液扩容、纠正水电解质酸碱平衡紊乱、应用抗生素预防感染、芒硝持续外敷、解痉止痛、营养支持等综合治疗,实验组经鼻空肠管途径注入生大黄,对照组经胃管途径注入生大黄。观察比较两组患者入院1d,7d时急性生理学与慢性健康状况评分系统Ⅱ评分(APACHE-Ⅱ评分),Balthazar CT积分,血清IL-1,IL-6,细菌内毒素水平,外周血白细胞计数,血清CRP、血淀粉酶恢复正常时间,肛门恢复排气排便时间,并发症发生率的差异,分析经鼻空肠管注入生大黄治疗SAP的疗效。 结果(1)实验组血清CRP、血清淀粉酶恢复时间为[(6.74±1.42)d、(5.78±1.04)d],对照组为[(8.00±1.63)d、(6.82±1.22)d],实验组血清CRP、血淀粉酶恢复时间明显早于对照组(P0.05)。(2)实验组肛门恢复排气排便时间为(3.30±0.97)d,对照组为(4.68±0.89)d,实验组肛门恢复排气排便时间明显早于对照组(P0.05)。(3)治疗7d时实验组APACHE-Ⅱ评分为(4.48±1.44),对照组为(5.32±1.04),实验组的APACHE-Ⅱ评分明显低于对照组;实验组下降幅度为(6.26±2.86),对照组下降幅度为(4.77±1.77),实验组的下降幅度明显大于对照组。治疗7d时实验组Balthazar CT积分为(2.57±1.38),对照组为(2.95±1.05),两组比较无明显差异(P0.05),,实验组下降幅度为(3.04±2.10),对照组下降幅度为(2.36±1.50),实验组下降幅度和对照组相比无明显差异(P0.05),(4)治疗7d时实验组血清IL-1、IL-6、细菌内毒素为[(28.76±7.36)pg/ml、(33.56±8.13)pg/ml、(21.03±13.67)pg/ml],对照组为[(34.80±7.71)pg/ml、(38.33±6.42)pg/ml、(33.25±14.15)pg/ml](P0.05),实验组的IL-1、IL-6、细菌内毒素水平明显低于对照组(P0.05);且两组和入院时相比均明显降低(P0.05)。治疗组的IL-1、IL-6、细菌内毒素下降幅度分别为[(30.00±10.65)pg/ml、(38.30±9.41)pg/ml、(97.96±28.12)pg/ml],对照组为[(19.13±7.94)pg/ml、(28.58±11.19)pg/ml、(78.37±26.94)pg/ml](P0.05),实验组的下降幅度明显大于对照组(P0.05)。(5)治疗7d时实验组外周血白细胞计数为(12.28±2.28)×109/L,对照组为(16.53±2.48)×109/L,实验组白细胞计数明显低于对照组(P0.05)。(6)实验组并发症发生率为21.7%,对照组并发症发生率为50.0%,实验组的并发症发生率明显低于对照组(P0.05)。 结论(1)经鼻空肠管途径注入生大黄治疗SAP可使患者血清CRP、血淀粉酶酶较早恢复正常。(2)经鼻空肠管途径注入生大黄治疗SAP可早期消除肠麻痹、恢复肠道功能。(3)经鼻空肠管途径注入生大黄治疗SAP可降低患者APACHE-Ⅱ评分,但对降低Balthazar CT积分无明显优势。(4)经鼻空肠管途径注入生大黄治疗SAP可降低外周血白细胞计数。(5)经鼻空肠管途径注入生大黄治疗SAP可降低患者炎症反应,减少细菌肠道细菌和内毒素易位。(6)经鼻空肠管途径注入生大黄治疗SAP可减少并发症的发生率。因此,经鼻空肠途径注入生大黄治疗SAP是一种更有效的给药途径,值得临床推广。
[Abstract]:Objective to compare the effects of rhubarb on the inflammatory response, biochemical indexes and clinical indexes of SAP patients via nasal empty intestines and gastric tube into the treatment of SAP by injecting rhubarb via the jejunum via the jejunum.
Methods 45 SAP patients admitted to Anqing Hospital Affiliated to Medical University Of Anhui from August 2010 to February 2013 were selected as the research subjects. 45 patients were randomly divided into experimental group (N=23 cases), control group (N=22 cases), all patients were put into the stomach tube or the nasal jejunum catheter in the admission 1H, and the two groups were given the general basic treatment of SAP, including sucking. Oxygen, intensive care, fasting water prohibition, gastrointestinal decompression, inhibition of acid, enzyme inhibition, dilation of fluid and electrolyte, correcting the disturbance of water and electrolyte acid-base balance, using antibiotics to prevent infection, continuous external application of mirabilite, spasmodic analgesic and nutritional support, the experimental group injected the rhubarb through the nasal hollow tube pathway, and the control group injected the rhubarb through the gastric tube way. The two groups were observed and compared. Patients admitted to 1D, 7d, acute physiological and chronic health status score system II score (APACHE- II score), Balthazar CT score, serum IL-1, IL-6, bacterial endotoxin level, peripheral blood leukocyte count, serum CRP, blood amylase recovery time, anal recovery exhaust defecation time, the difference in the incidence of complications, and analysis of transnasal empty intestines The effect of rhubarb on SAP was injected.
Results (1) the serum CRP in the experimental group was (6.74 + 1.42) d, (5.78 + 1.04) d], the control group was [8 + 1.63) d, (6.82 + 1.22) d], the serum amylase recovery time of the experimental group was significantly earlier than that of the control group (P0.05). (2) the time of anus recovery and exhaust defecation in the experimental group was (3.30 + 0.97) d, the control group was (4.68 + 1.42) d, the experimental group anus The time of portal recovery and defecation was earlier than that of the control group (P0.05). (3) the APACHE- II score of the experimental group was (4.48 + 1.44) and the control group was (5.32 + 1.04), and the APACHE- II score of the experimental group was significantly lower than that of the control group; the decrease of the experimental group was (6.26 + 2.86) and the decrease of the group was (4.77 + 1.77), and the decrease of the experimental group was obviously greater than that of the experimental group. In the control group, the Balthazar CT score of the experimental group was (2.57 + 1.38), the control group was (2.95 + 1.05), the two groups had no significant difference (P0.05), the decrease of the experimental group was (3.04 + 2.10), the decrease of the control group was (2.36 + 1.50), and the decrease of the experimental group was not significantly different (P0.05), and (4) the serum IL-1 and IL-6 in the treatment group of the experimental group (4). The bacterial endotoxin was [(28.76 + 7.36) pg/ml, (33.56 + 8.13) pg/ml and (21.03 + 13.67)) pg/ml], the control group was [34.80 + 7.71) pg/ml, (38.33 + 6.42) pg/ml, (33.25 + 14.15) pg/ml] (P0.05). The level of IL-1, IL-6 and bacterial endotoxin in the experimental group was significantly lower than that of the control group (P0.05), and the two group and the admission period were significantly lower (P0.05). IL-1 of treatment group (P0.05) L-6, the decrease of bacterial endotoxin was [30 + 10.65) pg/ml, (38.30 + 9.41) pg/ml, (97.96 + 28.12) pg/ml], and the control group was [19.13 + 7.94) pg/ml, (28.58 + 11.19) pg/ml, (78.37 + 26.94) pg/ml] (P0.05). The decrease of the experimental group was significantly greater than that of the control group (P0.05). (5) the peripheral blood white blood cell count of the experimental group was (12.28 + +) * * * *. 109/L, the control group was (16.53 + 2.48) x 109/L, the white blood cell count of the experimental group was significantly lower than that of the control group (P0.05). (6) the incidence of complications in the experimental group was 21.7%, the incidence of complications in the control group was 50%, and the incidence of complications in the experimental group was significantly lower than that of the control group (P0.05).
Conclusion (1) the treatment of SAP by injection of rhubarb through nasal empty intestines can make patients' serum CRP and blood amylase back to normal early. (2) SAP can eliminate intestinal paralysis and restore intestinal function by injection of rhubarb through nasal empty intestinal canal in the early stage. (3) SAP can reduce the APACHE- II score of the patients via naso intestinal canal into yellowish yellow to reduce the APACHE- II score, but to reduce Balth Azar CT integral has no obvious advantages. (4) SAP can reduce peripheral blood leucocyte count by injection of rhubarb through nasal empty intestinal canal. (5) injection of rhubarb via nasal hollow tube into rhubarb can reduce the inflammatory response and reduce bacterial translocation of bacterial intestinal bacteria and endotoxin. (6) SAP can reduce complications by injection of rhubarb via the nasal Jejunum Tube Pathway. Therefore, intranasal injection of rhubarb via nasojejunal route is a more effective way to treat SAP, which is worthy of clinical promotion.
【学位授予单位】:安徽医科大学
【学位级别】:硕士
【学位授予年份】:2013
【分类号】:R657.51
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