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目的:观察中药内服(胃管注入)、外敷配合西医综合疗法治疗重症急性胰腺炎(SAP)的临床疗效。方法:将80例SAP随机分为2组各40例。对照组给予禁食、胃肠减压、补充血容量、纠正水电解质酸碱失衡、生长抑素、奥美拉唑、抗生素治疗等综合救治措施;观察组在此基础上采用中药内服、外敷进行治疗。疗程均为10天,记录腹痛、腹胀缓解、肠鸣音恢复及通气排便时间;记急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)发生情况和手术中转情况;检测血清D-乳酸、血清二胺氧化酶(DAO)水平、肿瘤坏死因子-α(TNF-α),白细胞介素-6(IL-6)水平;记录第0、3、7和10天急性生理学和慢性健康状况评分(APACHEⅡ)。结果:观察组腹痛、腹胀缓解时间、肠鸣音恢复时间及首次排便时间均短于对照组(P<0.01)。观察组在第3、7、10天APACHEⅡ评分均低于对照组(P<0.01)。ARDS、MODS发生率观察组分别为15.0%、12.5%,对照组分别为37.5%、35.0%,2组比较,差异均有显著性意义(P<0.05);观察组手术中转率为10.0%,对照组为17.5%,2组比较,差异无显著性意义(P>0.05)。治疗后观察组血清D-乳酸、DAO、IL-6和TNF-α水平低于对照组(P<0.01)。结论:在西医常规综合治疗的基础上联合中药内服、外敷辅助治疗SAP,能保护肠道黏膜屏障功,减轻全身炎症反应,降低了ARDS和MODS的发生率,临床疗效显著。
Objective: To observe the clinical efficacy of orally taking traditional Chinese medicine (gastric tube injection) and external application in combination with western medicine in the treatment of severe acute pancreatitis (SAP). Methods: 80 cases of SAP were randomly divided into two groups of 40 cases. The control group was given fasting, gastrointestinal decompression, blood volume replacement, correct water and electrolyte acid-base imbalance, somatostatin, omeprazole, antibiotics and other comprehensive treatment measures; observation group on this basis, the use of traditional Chinese medicine orally, external application treatment. The course of treatment was 10 days. Abdominal pain, relief of abdominal distension, recovery of bowel sounds and ventilation and defecation time were recorded. Occurrence of acute respiratory distress syndrome (ARDS), multiple organ dysfunction syndrome (MODS) - Lactic acid, serum diamine oxidase (DAO), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) Health status score (APACHE II). Results: The abdominal pain, abdominal distension time, bowel sounds recovery time and defecation time in the observation group were shorter than those in the control group (P <0.01). APACHEⅡscore in the observation group on the 3rd, 7th and 10th days were lower than that of the control group (P <0.01). The incidence of ARDS and MODS in the observation group was 15.0% and 12.5% respectively, while the control group was 37.5% and 35.0% respectively. There was significant difference between the two groups (P <0.05). The operation rate in the observation group was 10.0% The control group was 17.5%. There was no significant difference between the two groups (P> 0.05). After treatment, the serum levels of D-lactate, DAO, IL-6 and TNF-α in the observation group were lower than those in the control group (P <0.01). Conclusion: Based on routine western medicine treatment combined with traditional Chinese medicine (TCM) and external application of adjuvant therapy (SAP), it can protect intestinal mucosal barrier function, reduce systemic inflammatory response and reduce the incidence of ARDS and MODS. The clinical effect is significant.