Objective To observe the therapeutic effect of rhubarb combined with Probiotics for treatment of patients with severe acute pancreatitis (SAP) accompanied by acute lung injury (ALI). Methods A prospective randomized controlled trial was conducted. Sixty patients with SAP and ALI were randomly divided into a rhubarb group and a combination of rhubarb and Probiotics group (combined group), 30 cases in each group. Both groups were treated with conventional therapy. On that therapeutic base, the patients in rhubarb group were treated with rhubarb 3 g·kg-1·d-1 (Raw rhubarb in boiling water 200 mL was cooked for 30 minutes, then the decoction was divided into two parts to be infused through nasal jejunal tube, retaining for 1 hour);while in the combined group, beside the above rhubarb therapy, the patients were additionally given Probiotics [Clostridium butyric acid:Chang Lekang capsule, once 1 grain (0.42 g), twice a day] through nasal jejunal tube. The therapeutic course was 14 days in the two groups. The plasma endotoxin levels, oxygenation index, and acute physiology and chronic health evaluationⅡ(APACHEⅡ) score were observed before and after treatment for 7 days and 14 days, respectively. After treatment for 30 days, the time of intestine functional recovery and mechanical ventilation, number of damaged organs, number of infectious sites, number of pancreatic pseudocysts, length of intensive care unit (ICU) stay and 30-day fatality rate were observed in the two groups. Results With the prolongation of treatment, the plasma level of endotoxin and APACHEⅡscore in the two groups were gradually reduced, and the oxygenation index was gradually increased after treatment for 7 days and 14 days in the two groups compared with those before treatment, and there were statistically significant differences in above indexes on the 14th day after treatment between combined group and rhubarb group [endotoxin (μg/L): 19.16±1.90 vs. 21.20±1.05, oxygenation index (mmHg, 1 mmHg = 0.133 kPa): 369.50±5.45 vs. 341.50±7.36, APACHE Ⅱscore:11.84±0.60 vs. 13.00±0.86, P<0.05 or P<0.01]. The length of intestine functional recovery in the combined group was longer than that in the rhubarb group (days: 5.63±1.75 vs. 5.02±1.54), the number of damaged organs (2.08±0.74 vs. 2.70±1.11), the number of infectious sites (1.93±0.64 vs. 2.23±0.83), the number of pancreatic pseudocysts (1.22±0.34 vs. 1.63±0.11) and the mortality rate [10.0%(3/30) vs. 13.3%(4/30)] in the combined group were lower than those of the rhubarb group, but there were no statistically significant differences between two groups (all P > 0.05). The times of mechanical ventilation (days: 13.40±1.76 vs. 15.60±1.28) and the length of ICU stay (days:16.13±1.25 vs. 17.63±1.30) were significantly shorter in combined group than those in rhubarb group (both P<0.05). Conclusion Rhubarb combined with Probiotics for treatment of patients with SAP and ALI can promote their recovery of lung function and shorten their length of ICU stay.%目的：观察生大黄联合微生态制剂对重症急性胰腺炎（SAP）伴急性肺损伤（ALI）患者的治疗作用。方法采用前瞻性随机对照研究方法，将60例SAP伴ALI患者按随机数字表法分为生大黄组和生大黄加微生态组，每组30例。两组均给予常规治疗，生大黄组加用生大黄3 g·kg-1·d-1（开水200 mL煎煮30 min，分2次经鼻空肠注入，保留1h）治疗；生大黄加微生态组在上述治疗基础上给予微生态制剂酪酸梭菌（常乐康胶囊，每粒0.42 g，每次1粒，每日2次）经鼻空肠管注入；两组疗程均为14 d。于治疗前及治疗后7 d、14 d检测两组患者血浆内毒素水平、氧合指数和急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，并观察两组治疗30 d后肠道功能恢复时间、机械通气时间、器官损害数、感染部位数、胰腺假性囊肿数、重症加强治疗病房（ICU）住院时间和病死率。结果随着治疗时间的延长，两组治疗后7 d、14 d血浆内毒素水平和APACHE Ⅱ评分均较治疗前逐渐降低，氧合指数较治疗前逐渐升高，14 d生大黄加微生态组和生大黄组上述指标比较差异有统计学意义〔内毒素（μg/L）：19.16±1.90比21.20±1.05，氧合指数（mmHg，1 mmHg＝0.133 kPa）：369.50±5.45比341.50±7.36，APACHEⅡ评分（分）：11.84±0.60比13.00±0.86，P＜0.05或P＜0.01〕。生大黄加微生态组治疗后肠道功能恢复时间较生大黄组延长（d：5.63±1.75比5.02±1.54），器官损害数（个：2.08±0.74比2.70±1.11）、感染部位数（个：1.93±0.64比2.23±0.83）、胰腺假性囊肿数（个：1.22±0.34比1.63±0.11）及病死率〔10.0%（3/30）比13.3%（4/30）〕均较生大黄组降低，但两组比较差异均无统计学意义（均P＞0.05）；生大黄加微生态组机械通气时间（d：13.40±1.76比15.60±1.28）及ICU住院时间（d：16.13±1.25比17.63±1.30）均较生大黄组明显缩短（均P＜0.05）。结论生大黄联合微生态制剂能够改善SAP伴ALI患者的肺功能，缩短患者在ICU的住院时间。
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