摘要目的 探讨大承气汤对SAP伴肠功能衰竭的治疗价值.方法 将48例SAP伴肠功能衰竭的患者按住院号奇偶数分为常规治疗组和大承气汤组.两组除常规治疗外,大承气汤组采用胃管内注入大承气汤(1帖/d,分2次注入),常规治疗组胃管内注入等量生理盐水.观察两组首次肛门排气时间及首次排便时间;检测血淀粉酶、CRP、TNF-α和IL-6水平;1周后并发症发生率和病死率.结果 大承气汤组首次肛门排气时间、首次排便时间分别为(12.3±5.7)h与(24.8±11.2)h,显著小于常规治疗组的(22.1±9.7)h和(46.2±17.4)h(P<0.05);治疗后1周,大承气汤组的血淀粉酶、CRP、TNF-α及IL-6水平分别为(120.3±35.8)U/L、(10.8±2.0)ng/ml、(36.3±5.8)U/L和(4.8±1.0)U/L,较治疗前明显下降,并较常规治疗组治疗1周后的(267.2±78.9)U/L、(19.5±2.7)ng/ml、(80.1±9.0)U/L和(10.5±1.2)U/L下降更明显(P<0.05).大承气汤组并发症发生率、病死率分别为12.5%和4.4%,显著低于常规治疗组的37.5%和25.0%(P<0.05).结论 大承气汤能迅速纠正SAP肠功能衰竭状况,降低并发症发生率、病死率,具有较好的治疗作用.

abstractsObjective To investigate the therapeutic effect of Da-Cheng-Qi Decoction on gut dysfunction in patients with severe acute pancreatitis (SAP). Methods Forty-eight SAP patients complicated with gut dysfunction were randomly divided into two groups according to the number of admission, which were treatment group and control group. The therapy in t reatment group was Da-Cheng-Qi Decoction infusion through gastric tube (one paste/day, b. i. d), however the therapy of control group was normal saline infusion through gastric tube (the amount was the same as the former, b. i. d), and other management in the two groups was similar. The first passage of gas by anus and defecation after treatment was observed. Serum amylase, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6 were examined before and one week after treatment;complications and mortality were compared between the two groups. Results The first passage of gas by anus and defecation in the treatment group was ( 12.3 ± 5.7 ) h and ( 24.8 ± 11.2 ) h, respectively, and shorter than ( 22. 1 ± 9.7 ) h and 46.2 ± 17.4) h of control group ( P <0.01) ;the numerical values of serum amylase, CRP, TNF-α and IL-6 one week after treatment were ( 120.3 ± 35.8 ) U/L, ( 10.8 ±2.0) ng/ml, (36.3 ± 5.8) U/L and (4.8 ± 1.0) U/L, which were significantly decreased when compared with the values before treatment, and these values were significantly lower than (267.2 ± 78.9 )U/L, ( 19.5 ± 2.7 ) ng/ml, (80.1 ± 9.0) U/L, ( 10.5 ± 1.2 ) U/L of the control group ( P < 0.05 ). The total complications and mortality of treatment group was 12.5% and 4.4%, respectively, which were significantly lower than those in the control group (37.5% and 25%, P <0.05). Conclusions Treatment with Da-Cheng-Qi Decoction in SAPpatients complicated with gut dysfunction was effective to reverse gut dysfunction and reduce total complications and mortality.