| 摘要: |
| 目的:观察大黄联合高容量血液滤过早期应用对重症急性胰腺炎(SAP)的临床疗效。方法:回顾分析2005年6月至2007年12月我科收治的SAP患者31例,其中12例(对照组)行持续高容量血液滤过，19例(治疗组)在持续高容量血液滤过治疗的基础上，辅以大黄浸液胃管注入，治疗3 d。观察两组患者生命体征及胃肠功能恢复情况，并测定血浆TNF-α、IL-6及内毒素的含量。结果:治疗过程中所有患者生命体征平稳，两组治疗后APACHE Ⅱ评分、血浆细胞因子含量明显降低，治疗前后差异有统计学意义(P＜0.05)，组间差异不明显；治疗组胃肠功能恢复较早，有效率明显高于对照组(P＜0.05)；对照组内毒素的含量于治疗开始后逐渐升高，而治疗组内毒素的含量在治疗短时间内升高后逐渐降低，组间差异显著(P＜0.05)。结论:血液滤过能大量清除血浆炎症介质及细胞因子，大黄能较好地改善胃肠功能、降低血液内毒素含量，两者早期联合应用能提高临床疗效。 |
| 关键词: 重症急性胰腺炎 血液滤过 大黄 细胞因子类 炎症介质 内毒素类 |
| DOI：10.3724/SP.J.1008.2009.0428 |
| 投稿时间：2008-09-20修订日期：2008-12-05 |
| 基金项目:福建省自然科学基金(2006J0372). |
|
| Early treatment with high-volume hemofiltration combined with rhubarb for patients with severe acute pancreatitis |
| ZOU Zhong-dong1, WANG Lie1, JIANG Sheng-bo1,2, WANG Yu1* |
| (1.Research Institute of General Surgery，Fuzhou General Hospital, PLA Nanjing Military Area Command, Fuzhou 350025，China;2.Fujian College of Traditional Chinese Medicine, Fuzhou 350003) |
| Abstract: |
| Objective:To investigate the effect of early treatment with a combination of rhubarb and high volume hemofiltration for patients with severe acute pancreatitis(SAP).Methods: We retrospectively analyzed the 31 SAP patients, who were treated in our department between June 2005 and December 2007.Twelve patients (control group) received high-volume hemofiltration only and the other 19 patients(treatment group)received both hemofiltration and rhubarb-enchyma infused via a gastric tube for three days.The vital signs and recovery of gastrointestinal functions were observed in the two groups.The serum concentrations of tumor necrosis factor-α (TNF-α), interleukin-6 ( IL-6) and plasma endotoxin were measured in the two groups.Results: The vital signs of all the patients were stable during the treatment.The APACHEⅡscore and serum cytokine concentrations were significantly decreased in the two groups after treatment(P＜0.05), and there was no significant difference between the treatment group and the control group (P>0.05).Gastrointestinal function of the treatment group recovered earlier, with an effective rate significantly higher than that of the control group(P＜0.05).The plasma endotoxin of the control group were gradually elevated during the treatment; that of the treatment group increased first and then gradually decreased; and there was significant difference between the two groups(P＜0.05).Conclusion: High-volume hemofiltration can clear the plasma inflammatory mediators and cytokines.Rhubarb can improve the gastrointestinal function and decrease the plasma endotoxin level of SAP patients; early treatment with a combination of both can improve the clinical outcomes of patients. |
| Key words: severe acute pancreatitis hemofiltration rhubarb cytokines mediators of inflammation endotoxins |
