摘要
目的探讨清胰通腑调肺饮联合序贯机械通气治疗重症急性胰腺炎致急性呼吸窘迫综合征的疗效及对血清C-反应蛋白(c-reactive protein,CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-1(interleukin-1,IL-1)水平影响。方法选取医院收治的重症急性胰腺炎致急性呼吸窘迫综合征患者124例,随机分为两组各62例。对照组给予序贯机械通气治疗,治疗组在对照组基础上给予清胰通腑调肺饮,对比两组临床疗效急性生理与慢性健康评分(acute physiology and chronic health evaluation II,APACHE-II)评分和全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)评分,中医证候评分,IL-1、TNF-α和CRP水平,血清P物质(substance p,SP)和神经激肽-1(neurokinin-1,NK-1)水平,尿淀粉酶(urineAmylase,UAMY)和血清淀粉酶(serum amylase,AMS)水平变化及预后情况。结果治疗后,治疗组总有效率明显较高(P<0.05);治疗组腹胀腹痛缓解时间、机械通气时间、首次排气或排便时间及ICU住院时间明显低于对照组(P<0.05);治疗前两组APACHEII评分和SIRS评分差异无统计学意义(P>0.05);治疗后两组APACHEII评分和SIRS评分显著降低(P<0.05);并且治疗组降低较多(P<0.05);两组治疗前中医证候评分差异无统计学意义(P>0.05);治疗后两组主症评分、次症评分和中医证候总评分明显降低(P<0.05);且治疗组降低较多(P<0.05);两组治疗前血清TNF-α、CRP和IL-1水平差异无统计学意义(P>0.05);治疗后两组血清TNF-α、CRP和IL-1水平明显降低(P<0.05);且治疗组降低较多(P<0.05);治疗前两组氧合指数、RR、PaO_(2)、PaCO_(2)水平无差异(P>0.05);治疗后两组RR、PaCO_(2)水平明显降低,氧合指数、PaO2水平显著升高(P<0.05);且治疗组改善较明显(P<0.05);治疗前两组UAMY和AMS水平差异无统计学意义(P>0.05);治疗后两组UAMY和AMS水平明显降低(P<0.05);且治疗组降低较多(P<0.05)。结论采用清胰通腑调肺饮联合序贯机械通气治疗重症急性胰腺炎致急性呼吸窘迫综合征具有较好的疗效,可降低血清CRP、TNF-α和IL-1水平。
Objective To investigate the efficacy of Qingyi Tongfu Tiaofei Yin(清胰通腑调肺饮)combined with sequential mechanical ventilation in the treatment of acute respiratory distress syndrome induced by severe acute pancreatitis and the effects on levels of serum C-reactive protein(CRP),tumor necrosis factor-α(TNF-α)and interleukin-1(IL-1).Methods A total of 124 cases of acute respiratory distress syndrome caused by severe acute pancreatitis in the hospital were selected and randomly divided into two groups,62 cases in each group.The control group was treated with sequential mechanical ventilation,and the treatment group was given Qingyi Tongfu Tiaofei Yin on the basis of the control group.The clinical efficacy,acute physiology and chronic health evaluation II(Apache II)score and systemic inflammatory response syndrome(SIRS)score,TCM syndrome score,levels of serum TNF-α,CRP and IL-1,levels of substance P(SP),neurokinin-1(NK-1),urine amylase(UAMY)and ser⁃um amylase(AMS)and the prognosis of the two groups were compared.Results After treatment,the total effective rate of thetreatment group was significantly higher(P<0.05).The relief time of abdominal distension and pain,mechanical ventilation time,first exhaust or defecation time and ICU hospitalization time in treatment group were significantly lower than those in control group(P<0.05).Apache II score and SIRS score had no difference between the two groups before treatment(P>0.05).A⁃pache II score and SIRS score in the two groups were significantly decreased after treatment(P<0.05)and significantly de⁃creased in the treatment group(P<0.05).There was no difference in TCM syndrome scores between the two groups before treat⁃ment(P>0.05).After treatment,the primary symptom score,secondary symptom score and TCM syndrome total score in two groups were significantly decreased(P<0.05)and significantly decreased in the treatment group(P<0.05).There were no sig⁃nificant differences in levels of serum TNF-α,CRP or IL-1 between the two groups before treatment(P>0.05).After treat⁃ment,the serum levels of TNF-α,CRP and IL-1 in two groups were significantly decreased(P<0.05)and significantly de⁃creased in the treatment group(P<0.05).Before treatment,there were no differences in oxygenation index,levels of respiratory rate(RR),PaO_(2) and PaCO2 between the two groups(P>0.05).After treatment,the levels of RR and PaCO2 were significantly decreased,while the oxygenation index and PaO_(2) were significantly increased(P<0.05).And those of the treatment group were significantly improved(P<0.05).There were no significant differences in the levels of UAMY or AMS between the two groups before treatment(P>0.05).After treatment,the levels of UAMY and AMS in the two groups were significantly decreased(P<0.05)and significantly decreased in the treatment group(P<0.05).Conclusions Qingyi Tongfu Tiaofei Yin combined with se⁃quential mechanical ventilation in the treatment of acute respiratory distress syndrome induced by severe acute pancreatitis has a good effect,and can reduce the levels of serum CRP,TNF-αand IL-1.
作者
邵兴
陈琨
SHAO Xing;CHEN Kun(Jinhua Hospital Affiliated to School of Medicine,Zhejiang University,Jinhua 321000,Zhejiang,China)
出处
《中华中医药学刊》
CAS
北大核心
2023年第2期196-200,共5页
Chinese Archives of Traditional Chinese Medicine
基金
浙江省医药卫生科技计划项目(2014KYB065)
金华市中医药科学科技研究计划项目(2019jzk015)。
