摘要
目的探究大承气汤联合奥曲肽治疗急性重症胰腺炎的临床疗效。方法选取80例2020年12月—2021年12月期间医院收治的急性重症胰腺炎的患者,随机分为对照组(40例)与联合治疗组(40例)。两组急性重症胰腺炎患者均接受基础治疗,对照组给予奥曲肽治疗,联合治疗组在对照组基础上联合大承气汤治疗。治疗1个疗程后进行治疗有效率、免疫功能、血清炎症因子水平、肝功能、序贯器官衰竭评分(sequential organ failure assessment,SOFA)、不良反应和病死率的评价。结果(1)治疗有效率:与对照组总有效率(62.50%,25/40)相比,联合治疗组的治疗总有效率(85.00%,34/40)显著升高,差异具有统计学意义(P<0.05)。(2)免疫功能:与对照组相比,联合治疗组患者血清CD+4、CD+8、免疫球蛋白(immunoglobulin,Ig)G、IgM治疗前后差值均显著升高,差异均有统计学意义(均P<0.05)。(3)炎症因子:与治疗前相比,对照组和联合治疗组患者治疗后血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、白细胞介素-6(interleukin-6,IL-6)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平均显著降低;与对照组相比,联合治疗组患者治疗后血清TNF-α、IL-6、hs-CRP水平均显著降低,差异均有统计学意义(均P<0.05)。(4)肝功能:与治疗前相比,对照组和联合治疗组患者治疗后血清谷丙转氨酶(alanine aminotransferase,ALT)、谷草转氨酶(aspartate aminotransferase,AST)、尿素氮(blood urea nitrogen,BUN)、总胆红素(total bilirubin,TBIL)水平均显著降低;与对照组相比,联合治疗组患者治疗后血清ALT、AST、BUN、TBIL水平均显著降低,差异均有统计学意义(均P<0.05)。(5)SOFA评分:与治疗前相比,对照组和联合治疗组患者治疗后SOFA评分均显著降低;与对照组相比,联合治疗组患者治疗后SOFA评分显著降低,差异均有统计学意义(均P<0.05)。(6)不良反应情况:对照组和联合治疗组急性重症胰腺炎患者治疗后的不良反应发生率比较,差异无统计学意义(P>0.05)。(7)28 d病死率:对照组和联合治疗组患者的28 d病死率比较,差异无统计学意义(P>0.05)。结论大承气汤联合奥曲肽治疗急性重症胰腺炎,可以显著提高治疗总有效率,提高患者免疫功能和肝功能,降低炎症反应,改善脏器状态,但不良反应发生率和28 d病死率无显著影响。
Objective To explore the clinical efficacy of Dachengqi Decoction(大承气汤)combined with octreotide in the treatment of severe acute pancreatitis.Methods A total of 80 patients with severe acute pancreatitis admitted to the hospital from December 2020 to December 2021 were selected and randomly divided into the control group(40 cases)and the combined treat⁃ment group(40 cases).Both groups received basic treatment.The control group was treated with octreotide,and the combined treatment group was treated with Dachengqi Decoction on the basis of the control group.After 1 course of treatment,the treatment response rate,immune function,serum inflammatory factor levels,liver function,sequential organ failure assessment(SOFA),ad⁃verse reactions and mortality were evaluated.RESULTS(1)The effective rate of treatment:Compared with that of the control group(62.50%,25/40),the total effective rate(85.00%,34/40)of the combined treatment group was significantly higher,and the difference was statistically significant(P<0.05).(2)Immune function:Compared with those of the control group,the serum CD+4,CD+8,immunoglobulin(Ig)G and IgM in the combined treatment group were significantly increased before and after treat⁃ment,and the differences were statistically significant(all P<0.05).(3)Inflammatory factors:Compared with those before treatment,serum levels of tumor necrosis factor-α(TNF-α)and interleukin-6(IL-6)of patients in control group and com⁃bined treatment group after treatment,the levels of hypersensitive C-reactive protein(hs-CRP)were significantly decreased.Compared with those of the control group,the serum levels of TNF-α,IL-6 and hs-CRP in the combined treatment group after treatment were significantly decreased,and the differences were statistically significant(all P<0.05).(4)Liver function:Com⁃pared with those before treatment,serum levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),blood urea nitrogen(BUN)and total bilirubin(TBIL)in the control group and combined treatment group after treatment were significantly decreased.Compared with those of the control group,the serum levels of ALT,AST,BUN and TBIL in the combined treatment group were significantly decreased after treatment,and the differences were statistically significant(all P<0.05).(5)SOFA score:Compared with those before treatment,the SOFA scores of the patients in the control group and the combined treatment group were significantly decreased after treatment(all P<0.05).(6)Adverse reactions:There was no significant difference in the incidence of adverse reactions between the control group and the combined treatment group in patients with acute severe pan⁃creatitis after treatment(P>0.05).(7)28-day fatality rate:There was no significant difference in the 28-day fatality rate be⁃tween the control group and the combined treatment group(P>0.05).Conclusion Dachengqi Decoction combined with octreoti⁃de in the treatment of severe acute pancreatitis can significantly improve the total effective rate of treatment,the patients'immune function and liver function,reduce inflammatory response and improve the state of organs,but the incidence of adverse reactions and 28-day mortality have no significant influences.
作者
高翔
刘梅梅
姚琪琪
李芸婕
李振
张培荣
GAO Xiang;LIU Meimei;YAO Qiqi;LI Yunjie;LI Zhen;ZHANG Peirong(Affiliated Hospital of Weifang Medical University,Weifang 261000,Shandong,China)
出处
《中华中医药学刊》
CAS
北大核心
2023年第2期238-242,共5页
Chinese Archives of Traditional Chinese Medicine
基金
山东省中医药科技发展计划项目(2019-0438)。
关键词
大承气汤
奥曲肽
急性重症胰腺炎
免疫功能
炎症反应
Dachengqi Decoction(大承气汤)
octreotide
severe acute pancreatitis
immune function
inflammatory response
