清胰汤结合早期肠内营养治疗轻症急性胰腺炎疗效观察

发布时间：2018-06-02 12:32

本文选题：轻症急性胰腺炎 + 清胰汤　；参考：《青海大学》2014年硕士论文

【摘要】：目的：肠内营养与中西医结合目前常被用于重症急性胰腺炎的治疗，效果显著，死亡率明显降低。而临床则以轻症急性胰腺炎最常见，占急性胰腺炎发病率的80%；且病情较急性坏死性胰腺炎轻，经正规治疗后多能痊愈，但患者病程长、治疗费用高；偶有反复发作，更有转化为重症急性胰腺炎的可能。本文运用统计学的原理和方法，比较清胰汤加西医常规治疗结合早期肠内营养治疗轻症急性胰腺炎与西医常规治疗轻症急性胰腺炎的疗效差异，为临床治疗轻症急性急性胰腺炎选择更合理，更经济、更有效的方案提供临床依据。方法：搜集2012年4月--2013年12月期间我科收治的轻症急性胰腺炎患者60例，所有患者符合急性胰腺炎诊断标准，并通过相应检查排除有严重并发症的患者。其中男性41例,女性19例,年龄22～75岁,平均48.5岁，其中胆源性29例,酗酒暴饮暴食16例,其他原因15例。按随机分配原则分为治疗组(30例)与对照组(30例)。对照组给予西医常规治疗（禁食水；有效的胃肠减压；抑制胃酸及胰腺分泌；预防感染；镇痛；保持水电解质平衡及全胃肠外营养治疗）。治疗组在西医常规治疗的基础上，入院24h后再给予清胰汤结合肠内营养治疗。比较两组腹痛与腹胀消失的时间；腹部CT恢复正常时间；血淀粉酶、血清脂肪酶、尿淀粉酶及C反应蛋白恢复正常时间；观察患者完全禁食的天数；平均住院天数和治疗费用；患者经治疗后营养变化状况（血清白蛋白）。结果：与对照组相比较，治疗组腹胀与腹痛消失的时间、禁食的天数、平均住院天数都明显缩短；住院费用也减少；比较差异非常明显，差异有统计学意义（P0.05）。治疗组血淀粉酶、血清脂肪酶、尿淀粉酶；腹部CT、CRP恢复正常时间也明显短于对照组；比较差异有显著性，有统计学意义（P0.05）。结论：清胰汤能防止胃肠道黏膜进一步受损；快速促进胃肠道各种功能的恢复；减轻胰腺及胰周组织的损伤，促进胰腺的自我修复；减少C反应蛋白的过度产生，从而减轻急性炎症反应，缩短病程。肠内营养可改善患者营养状况，防止肠道发生废用性萎缩，减少因肠道细菌移位所引起的并发症，改善患者预后，，降低住院费用。
[Abstract]:Objective: enteral nutrition and combination of traditional Chinese and western medicine are often used in the treatment of severe acute pancreatitis. In clinical practice, mild acute pancreatitis is the most common, accounting for 80% of the incidence of acute pancreatitis; and the condition is lighter than that of acute necrotizing pancreatitis. After regular treatment, most of the patients can recover, but the course of disease is long and the cost of treatment is high. It is more likely to turn into severe acute pancreatitis. In this paper, the principle and method of statistics were used to compare the therapeutic effects of Qingyi decoction combined with early enteral nutrition in the treatment of mild acute pancreatitis and western medicine routine treatment of mild acute pancreatitis. To provide clinical basis for clinical treatment of mild acute pancreatitis more reasonable, more economical, more effective regimen. Methods: from April 2012 to December 2013, 60 patients with mild acute pancreatitis were collected from our department. All the patients met the diagnostic criteria of acute pancreatitis, and the patients with severe complications were excluded by corresponding examination. Among them, 41 cases were male, 19 cases were female, the age was 22 ~ 75 years old (mean 48.5 years), 29 cases of gallstone, 16 cases of excessive drinking and drinking, and 15 cases of other reasons. According to the principle of random distribution, 30 cases were divided into treatment group (n = 30) and control group (n = 30). The control group was given routine western medicine treatment (fasting water; effective gastrointestinal decompression; inhibition of gastric acid and pancreatic secretion; prevention of infection; analgesia; maintenance of water and electrolyte balance and total parenteral nutrition. The treatment group was treated with Qingyi decoction combined with enteral nutrition 24 hours after admission on the basis of routine western medicine. The time of disappearance of abdominal pain and abdominal distension, the time of abdominal CT returning to normal, the time of serum amylase, serum lipase, urine amylase and C-reactive protein returning to normal, the days of complete fasting, the average days of hospitalization and the cost of treatment were compared between the two groups. Nutritional status of patients after treatment (serum albumin). Results: compared with the control group, the time of disappearance of abdominal distension and abdominal pain, the days of fasting, the average days of hospitalization and the cost of hospitalization in the treatment group were significantly shortened, and the difference was very obvious (P 0.05). In the treatment group, serum amylase, serum lipase, urine amylase, abdominal CTU CRP return to normal time was also significantly shorter than the control group; the difference was significant (P 0.05). Conclusion: Qingyi decoction can prevent the further damage of gastrointestinal mucosa, accelerate the recovery of gastrointestinal function, reduce the injury of pancreas and peripancreatic tissue, promote the self-repair of pancreas, and reduce the excessive production of C-reactive protein. In order to alleviate the acute inflammatory reaction, shorten the course of disease. Enteral nutrition can improve the nutritional status of patients, prevent waste atrophy, reduce the complications caused by intestinal bacterial translocation, improve the prognosis of patients, and reduce the cost of hospitalization.
【学位授予单位】：青海大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R576

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