大承气汤对合并腹内高压的重症急性胰腺炎临床疗效的研究

发布时间：2018-02-09 02:10

本文关键词： 重症急性胰腺炎腹内高压大承气汤鼻空肠管　出处：《山东中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:观察大承气汤对合并腹内高压的重症急性胰腺炎患者的临床疗效。方法:研究对象均来源于2015年2月14日至2016年2月27日山东省千佛山医院重症医学科住院病人,预设样本量40人,依据《急性胰腺炎诊治指南(2014)》筛选符合诊断的患者并将入选病人随机分为治疗组(n=20)和对照组(n=20),进行前瞻性研究。对照组给予综合治疗(一般治疗解痉镇痛、蛋白酶抑制剂、胰酶抑制剂等、液体复苏、器官功能维持、血液净化、营养支持等),治疗组在综合治疗的基础上于入院72小时后(符合纳入标准的患者)经鼻空肠管给予大承气汤(大黄12g、厚朴24g、枳实12g、芒硝6g,水煎服取汁200ml,每日1剂,等分早晚温服)鼻饲治疗,治疗周期为7d。观察(观察期为患者入院后至出院或死亡)两组患者相关指标(血清淀粉酶、脂肪酶、白细胞总数、肾功能)变化、改良的CT严重指数评分(MCTSI)变化、腹内压(intra-abdominal pressure,IAP)变化、平均住院时间。结果:治疗前,两组患者一般情况(年龄、性别、病因)、相关检验、合并症、严重程度(参考APACHE II评分)等无明显差异,有可比性。至观察期结束,治疗组患者相关指标恢复时间,腹内高压(intra-abdominal hypertension,IAH)患者IAP降至正常的时间以及平均住院时间明显少于对照组,且具有统计学意义(P0.05),MCTSI治疗组较对照组,无明显改善。结论:在给予西医综合治疗的同时,及时应用大承气汤治疗合并腹内高压的重症急性胰腺炎,能显著缩短患者相关指标恢复时间,使合并IAH患者的IAP更快的降至正常,缩短平均住院时间,使患者受益。
[Abstract]:Objective: to observe the clinical effect of Dachengqi decoction on severe acute pancreatitis complicated with intra-abdominal hypertension. Methods: all the patients were from February 14th 2015 to February 27th 2016 in the Department of intensive Medicine of Qianfushan Hospital of Shandong Province. A preset sample of 40 patients was selected according to the guidelines for the diagnosis and treatment of acute pancreatitis (2014) and selected patients were randomly divided into treatment group (n = 20) and control group (n = 20) for prospective study. The control group was given comprehensive treatment (general treatment for antispasmodic analgesia). Protease inhibitors, trypsin inhibitors, fluid resuscitation, organ function maintenance, blood purification, The treatment group was given Dachengqi decoction (rhubarb 12g, Magnolia officinalis 24g, Fructus Aurantii 12g, Glauber Glauber 6g, water decoction 200ml, daily 1 dose through naso-jejunal tube) on the basis of comprehensive treatment. The treatment period was 7 days. The changes of serum amylase, lipase, total leukocyte count and renal function were observed in two groups. The modified CT severity Index score (MCTSIA), intra-abdominal pressure pressure pressure (IAPs) and average length of stay were changed. Results: before treatment, the patients in the two groups were in general condition (age, sex, etiology, correlation test, complication). There was no significant difference in severity (referred to APACHE II score) and so on. At the end of the observation period, the recovery time of related indexes in the treatment group, the time of IAP reduction to normal and the average hospital stay in the treatment group were significantly less than those in the control group. There was no significant improvement in the MCTSI group compared with the control group. Conclusion: Dachengqi decoction was used to treat severe acute pancreatitis with intraabdominal high pressure while western medicine was given. It can shorten the recovery time of patients' related indexes, reduce the IAP of patients with IAH more quickly to normal, shorten the average hospitalization time, and benefit the patients.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

【相似文献】