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[目的]探讨大黄联合连续血液净化治疗重症急性胰腺炎合并肝损害的临床疗效。[方法]将2013年1月~2015年12月符合要求的重症急性胰腺炎合并肝损害患者76例按入院先后顺序采用随机数字表法分为研究组和对照组(各组38例),对照组予禁食、胃肠减压、制酸抑酶、抑制胰腺分泌、解痉止痛、液体复苏、氧疗(必要时机械通气)、护肝退黄、纠正电解质、酸碱紊乱、存在胆系等部位感染者抗感染、早期适时经鼻肠管肠内营养;研究组在此基础上采用连续性血液净化联合5g生大黄粉泡开水取上清液鼻饲,一天2~3次,保持患者每天2~3次大便。每天监测生命体征、血气分析,干预前及干预7天检测肝肾能指标、血淀粉酶、血红蛋白、白蛋白、前白蛋白等营养指标,T细胞亚群等免疫情况。同时观察记录首次肛门排气时间,肠内营养达目标剂量时间、机械通气撤机时间、总住院时间。[结果]研究组有1人退出,对照组有5人退出。研究组SAP的改良Marshall评分、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、谷氨酰胺转肽酶、碱性磷酸酶等肝功能指标,白蛋白、前白蛋白等营养指标,CD~(4+)T细胞、CD~(4+)/CD~(8+)等免疫情况干预前后变化比较均较对照组改善明显,差异有统计学意义,P<0.05。研究组首次肛门排气时间、肠内营养达目标剂量时间、机械通气撤机时间早于对照组,总住院时间均较对照组短,差异有统计学意义,P<0.05。[结论]生大黄粉鼻饲联合连续性血液净化能够明显促进SAP患者胃肠功能恢复,改善患者肝功能、营养与免疫状况,缩短住院时间,并且安全性高,值得在临床上推广应用。
[Objective] To investigate the clinical efficacy of rhubarb combined with continuous blood purification in the treatment of severe acute pancreatitis complicated with liver damage. [Methods] From January 2013 to December 2015, 76 patients with severe acute pancreatitis and liver damage who met the requirements were randomly divided into study group and control group (38 in each group) Group was given fasting, gastrointestinal decompression, acid suppression and inhibition of pancreatic secretion, antispasmodic and analgesic, fluid resuscitation, oxygen therapy (if necessary, mechanical ventilation), liver detoxification, correct electrolyte, acid-base disorders, Infection of other parts of the infected and early nasogastric enteral nutrition early; on the basis of the study group using continuous blood purification combined with rhubarb 5g rhubarb powder water to take supernatant nasal feeding, 2 or 3 times a day to maintain the patient 2 ~ 3 times the stool. Daily monitoring of vital signs, blood gas analysis, 7 days before intervention and intervention, liver and kidney index, serum amylase, hemoglobin, albumin, prealbumin and other nutritional indicators, T cell subsets and other immune status. At the same time, the time of the first anal exhaust, the target dose of enteral nutrition, the time of mechanical ventilation withdrawal and the total length of stay were recorded and recorded. [Results] One of the study group quit and the control group of five quit. In the study group, the improved Marshall score, liver function indexes such as alanine aminotransferase, aspartate aminotransferase, glutamine transpeptidase and alkaline phosphatase, nutritional indexes such as albumin and prealbumin, Compared with the control group, the immune status of ~ (4+) T cells, CD 4+ / CD 8+, etc. were significantly improved before and after the intervention, the difference was statistically significant, P <0.05. In the study group, the time of the first anus exhaust, the target dose of enteral nutrition, the time of mechanical ventilation withdrawal were earlier than the control group, and the total length of hospital stay was shorter than that of the control group (P <0.05). [Conclusion] The rhubarb powder nasal feeding combined with continuous blood purification can obviously promote the recovery of gastrointestinal function, improve the liver function, nutrition and immune status, shorten the length of hospital stay in patients with SAP, and it is safe and worthy of popularization and application in clinic.