摘要
目的分析瘀毒内结型重症急性胰腺炎(SAP)相关性急性肺损伤(ALI)患者接受龙血竭散灌肠辅助治疗的价值。方法选择60例瘀毒内结型SAP相关性ALI患者为研究对象,随机分为对照组(n=30,常规治疗)和观察组(n=30,常规治疗+龙血竭散灌肠辅助治疗)。比较两组的中医证候积分、实验室指标[肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、白细胞介素-1β(IL-1β)、血清淀粉酶(AMY)]、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))]、症状持续时间、疾病严重程度[急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分]和肺损伤程度(Murray肺损伤评分)、药物安全性指标[肌酐(CREA)、丙氨酸氨基转移酶(ALT)和天门冬氨酸氨基转移酶(AST)]。结果治疗后,两组腹痛、喘促气急、发热、面色晦暗积分均下降,且观察组低于对照组(P<0.05)。治疗后,两组TNF-α、IL-6、IL-1β、AMY水平均下降,且观察组TNF-α(125.53±20.17)pg/ml、IL-6(13.25±2.51)pg/ml、IL-1β(45.13±6.51)ng/L、AMY(61.51±10.53)U/L均低于对照组的(165.21±29.33)pg/ml、(19.29±3.21)pg/ml、(49.81±5.76)ng/L、(79.21±12.21)U/L(P<0.05)。治疗后,两组PaO_(2)和SaO_(2)水平均上升,且观察组PaO_(2)(83.83±6.60)mm Hg(1 mm Hg=0.133 kPa)和SaO_(2)(92.51±6.36)%均高于对照组的(71.73±5.83)mm Hg、(80.21±5.21)%,两组PaCO_(2)水平均下降,且观察组PaCO_(2)(41.36±3.21)mm Hg低于对照组的(44.39±2.47)mm Hg(P<0.05)。观察组体温恢复正常时间(3.17±1.59)d及机械通气时间(2.73±1.66)d均短于对照组的(5.15±1.63)、(4.23±1.39)d(P<0.05)。治疗后,两组APACHEⅡ评分和Murray肺损伤评分均降低,且观察组APACHEⅡ评分(10.87±1.57)分和Murray肺损伤评分(1.05±0.33)分均低于对照组的(14.21±2.21)、(1.61±0.55)分(P<0.05)。治疗后,两组ALT、AST和CREA水平比较均无差异性(P>0.05)。结论龙血竭散灌肠辅助治疗瘀毒内结型SAP相关性ALI,能够改善患者的临床症状,降低炎症水平和疾病严重程度,具有显著的临床应用价值。
Objective To analyze the value of adjuvant treatment with Resina Draconis Powder enema in patients with severe acute pancreatitis(SAP)-associated acute lung injury(ALI)of the stasis-toxin internal accumulation type.Methods A total of 60 patients with SAP-associated ALI of the stasis-toxin internal accumulation type were selected as research subjects,and randomly divided into a control group(n=30,conventional treatment)and an observation group(n=30,conventional treatment+adjuvant treatment with Resina Draconis Powder enema).Comparison was made on traditional Chinese medicine syndrome scores,laboratory indicators[tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),interleukin-1β(IL-1β),serum amylase(AMY)],blood gas indicators[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),oxygen saturation(SaO_(2))],symptom duration,disease severity[Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡscore)],lung injury degree(Murray score),and drug safety indicators[creatinine(CREA),alanine aminotrasferase(ALT)and aspartate transaminase(AST)]between the two groups.Results Following treatment,both groups exhibited decreased scores for abdominal pain,dyspnea,fever,and sallow complexion,and the observation group was lower thanthe control group(P<0.05).Following treatment,the levels of TNF-α,IL-6,IL-1βand AMY in both groups decreased.Moreover,the observation group had TNF-αof(125.53±20.17)pg/ml,IL-6 of(13.25±2.51)pg/ml,IL-1βof(45.13±6.51)ng/L,and AMY of(61.51±10.53)U/L,which were lower than those in the control group[(165.21±29.33)pg/ml,(19.29±3.21)pg/ml,(49.81±5.76)ng/L,and(79.21±12.21)U/L](P<0.05).Following treatment,the levels of PaO_(2)and SaO_(2)in both groups increased,and the observation group had PaO_(2)of(83.83±6.60)mm Hg(1 mm Hg=0.133 kPa)and SaO_(2)of(92.51±6.36)%,which were higher than those in the control group[(71.73±5.83)mm Hg and(80.21±5.21)%];PaCO_(2)levels in both groups decreased,and the observation group had a lower PaCO_(2)of(41.36±3.21)mm Hg than the control group's(44.39±2.47)mm Hg(P<0.05).The recovery time of body temperature in the observation group was(3.17±1.59)d and the duration of mechanical ventilation was(2.73±1.66)d,which were shorter than those in the control group[(5.15±1.63)and(4.23±1.39)d](P<0.05).Following treatment,the APACHEⅡscores and Murray scores in both groups decreased.Moreover,the observation group had APACHEⅡscore of(10.87±1.57)points and Murray score of(1.05±0.33)points,which were lower than those in the control group[(14.21±2.21)and(1.61±0.55)points](P<0.05).Following treatment,there was no difference in the levels of ALT,AST and CREA between the two groups(P>0.05).Conclusion Adjuvant treatment with Resina Draconis Powder enema for SAP-associated ALI of the stasis-toxin internal accumulation type can improve clinical symptoms,reduce inflammatory levels and disease severity,and has significant clinical application value.
作者
谭浩
张海涛
王磊
高家成
栾晓峰
TAN Hao;ZHANG Hai-tao;WANG Lei(Central Hospital of Dalian University of Technology(Dalian Municipal Central Hospital),Dalian 116033,China)
出处
《中国现代药物应用》
2026年第7期1-6,共6页
Chinese Journal of Modern Drug Application
基金
大连市中医药科学研究计划项目(项目编号:22Z12016)。
关键词
龙血竭散
灌肠
辅助治疗
瘀毒内结
重症急性胰腺炎
急性肺损伤
Resina Draconis Powder
Enema
Adjuvant therapy
Stasis-toxin internal accumulation type
Severe acute pancreatitis
Acute lung injury
