郑要初　祝志太　吴细明　涂新颖

江西省鹰潭市人民医院消化内科，江西鹰潭335000

大承气汤在重症急性胰腺炎治疗中的作用

郑要初祝志太吴细明涂新颖

江西省鹰潭市人民医院消化内科，江西鹰潭335000

目的观察大承气汤治疗重症急性胰腺炎（SAP）的疗效。方法将我院收治的42例重症急性胰腺炎（SAP）患者，随机分为对照组和实验组各21例。对照组采用一般治疗，如禁食禁水、持续胃肠减压、补充血容量、维持电解质平衡、抗生素治疗、抑制胰腺分泌以及营养支持等，实验组除以上治疗外加用大承气汤治疗。分析两组间腹痛缓解时间、肠鸣音恢复时间；血淀粉酶、白细胞数量、C反应蛋白恢复正常时间；器官损害数、感染部位数及住院时间。结果与对照组比较，实验组腹痛缓解时间明显缩短，肠鸣音恢复明显加快，其他器官损害数减少，感染部位数显著减少，住院时间明显缩短，差异有统计学意义（P＜0.05）。实验组血淀粉酶、白细胞数量、C反应蛋白恢复正常的时间均短于对照组，差异有统计学意义（P＜0.05）。结论在常规治疗基础上加用大承气汤能保护肠道屏障功能，减轻全身炎症反应，改善临床治疗效果。

重症急性胰腺炎；大承气汤；肠道屏障功能；腹内高压；中西医结合

［Abstract］Objective To observe clinical effects of the Dachengqi decoction on severe acute pancreatitis（SAP）. Methods Forty-two patients with SAP were randomly divided into two groups，21 patients for each.The control group used conventional treatments which contained fasting，gastrointestinal decompression，expansion of blood volume，maintain the electrolyte balance，anti-infective therapy，inhibition of pancreatic secretion，nutritional support，etc.However，the treatment group used Dachengqi decoction based on conventional treatments.Clinical effects were analyzed including the recovery time of abdominal pain，bowel sounds，the time of blood amylase，white blood cell count，C-reactive protein returned to normal，injuried organs，infection positions and hospitalization time.Results The time of abdominal pain relief，bowel sound recovery，abdominal tenderness disappear and hospitalization were significantly shorter than those in the control group.Compared with control group，treatment group had statistically less injuried important organs and fewer infective positions（P＜0.05）.In the treatment group，the time of serum amylase，the leukocyte count and creactive protein returned to normal，which were significantly shorter than those in the control group（P＜0.05）.Conclusion Dachengqi decoction combined with conventional treatment can obviously protect intestinal mucosal barrier function，relieve systemic inflammatory response and improve clinical effects in patients with severe acute pancreatitis（SAP）.

［Key words］Severe acute pancreatitis（SAP）；Dachengqi decoction；Intestinal mucosal barrier function；Intra abdominal hypertention；Integrated Chinese-western medicine therapy

急性胰腺炎（acute pancreatitis）是指多种病因导致胰酶在胰腺内被激活后引起胰腺组织自身消化、水肿、出血甚至坏死的炎症反应，伴或不伴其他脏器功能障碍。根据2012年美国亚特兰大国际胰腺炎研讨会最新修订的急性胰腺炎分级和分类系统。……