鼻饲清胰汤联合芒硝外敷治疗急性重症胰腺炎并发肠麻痹临床研究

摘要

目的 探讨应用清胰汤内服联合芒硝外敷治疗重症急性胰腺炎(Severe Acute Pancreatitis,SAP)并发肠麻痹的临床疗效.方法 将126例SAP患者随机分成治疗组和对照组,每组各63例.对照组采用常规西医治疗(包括禁食水、持续胃肠减压、应用生长抑素及质子泵抑制剂、抗感染、调节水电解质酸碱平衡等),治疗组在常规治疗基础上,给予复方清胰汤经鼻空肠管注入联合芒硝敷腹.结果 治疗组的腹痛腹胀缓解时间、肠鸣音恢复时间、肛门首次排便(排气)时间、腹腔内压力开始下降时间均明显优于对照组(P＜0.05).治疗组并发症发生率及住院天数明显低于对照组(P＜0.05).二组死亡率无统计学差异(P＞0.05).结论 清胰汤内服联合芒硝外敷治疗重症急性胰腺炎可以有效地改善胰腺和肠道微循环,保护胃肠道黏膜屏障,抑制肠道菌群和内毒素易位,促进肠蠕动,减少并发症的发生.%Objective To investigate the clinical effect of naso-jejunal tube feeding Qingyitang combined with external application Mirabilite for severe acute pancreatitis (SAP) complicated with enteroplegia.Methods 126 cases of SAP complicated with enteroplegia were randomized into treatment group and control group (n=63,respectively).Control group was treated with conventional protocol including fasting,continuous gastrointestinal decompression,somatostatin,proton pump inhibitors,anti-inflammatory,regulate water and electrolyte acid-base balance,etc.The treatment group used naso-jejunal tube feeding Qingyitang combined with external application Mirabilite and conventional protocol.Results Abdominal pain and distention remission time,bowel sounds recovery time,first defecation or anal exsufflation time,intra-abdominal pressure began to drop time superior than the control group significantly (P＜0.05).The incidence of complications and hospitalization days in the treatment group were significantly lower than the control group (P＜0.05).Mortality was no significant difference between 2 groups (P＞0.05).Conclusion Naso-jejunal tube feeding Qingyitang combined with topical Mirabilite can effectively improve the pancreas and intestinal microcirculation,protect the gastrointestinal tract mucosal barrier,inhibit intestinal microflora and endotoxin translocation,promote bowel movements,reduce the incidence of complications.