摘要目的 观察大黄附子汤对重症急性胰腺炎(SAP)合并急性呼吸窘迫综合征(ARDS)患者的治疗效果.方法 采用前瞻性、多中心、随机对照临床实验.收集2011年7月至2012年8月大连地区3家三级甲等医院收住院的SAP合并ARDS的患者60例,分为健康对照组、大黄附子汤治疗组和大黄汤治疗组,每组20例.3组治疗均包括重症监护、禁食水、持续胃肠减压、机械通气、镇静解痉、抑制胰腺外分泌、营养支持、抗感染治疗.健康对照组用温皂水200 ml每日2次保留灌肠,每次保留时间为30 min.大黄附子汤组和大黄汤组分别用大黄附子汤和大黄汤,剂量、使用次数及保留时间均同健康对照组.观察三组患者治疗前、治疗后7d的APACHEⅡ评分、7d的病死率,以及治疗前、治疗1、3、7d肝肾功能、血淀粉酶、血钙、内毒素、血常规、血清C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素1(IL-1)、血气.结果 与健康对照组和大黄汤组相比,大黄附子汤组患者治疗后3、7d血淀粉酶、血钙、PaO2和PaO2/FiO2、内毒素、以及APACHEⅡ评分、病死率均明显改善(P＜0.05或P＜0.01),同时患者血WBC、ALT、BUN及Cr、CRP、TNF-α、IL-1亦有不同程度好转(P＜0.05).结论 大黄附子汤可降低SAP-ARDS患者体内炎性介质,改善氧合功能,降低病死率,明显改善SAP-ARDS患者的预后,且大黄附子汤的治疗效果明显优于单纯大黄汤的治疗效果.

abstractsObjective To observe the therapeutic efficacy of Dahuang Fuzi Decoction (a Chinese herbal medicine preparation with Rheum officinale Baill and Aconitum carmichaeli Debx) in patients with acute respiratory distress syndrome (ARDS) and severe acute pancreatitis (SAP).Methods A prospective,multi-center,randomized controlled clinical trials were carried out in 60 patients with ARDS and SAP in three tertiary university teaching hospitals in Dalian from July 2011 to August 2012.These patients were divided into Dahuang Fuzi Decoction treatment group (n =20),Dahuang Decoction treatment group (n =20) and Control group (n =20).All patients of 3 groups were treated with comprehensive measures including intensive care,fasting,continuous gastrointestinal decompression,mechanical ventilation,sedative antispasmodics,suppression of pancreatic exocrine,nutritional support,and antiinfection measures.In patients of control group,retention enema with 200 ml warm soap water for 30 min twice a day.In addition to retention enema as given to patients of control group,the patients of Dahuang Fuzi Decotion group and Dahuang Decotion group were treated with Dahuang Fuzi Decoction and Dahuang Decoction respectively.The APACHE Ⅱ scores and mortalities in 3 groups of patients were observed before treatment and after treatment for 7 days.At the same time,the liver and renal functions,blood amylase,blood calcium,endotoxin,routine blood examination,C-reactive protein (CRP),TNF-α,IL-1,blood gas analysis were detected before and after treatment for 1 d,3 d and 7 days.Results Compared with the control group and Dahuang Decoction group,the blood amylase,blood calcium,PaO2 and PaO2/ FiO2,endotoxin,APACHE-Ⅱ score,and mortality in Dahuang Fuzi Decoction group were markedly improved after treatment for3d and7 days (P ＜ 0.05 or P ＜ 0.01),whereas the levels of WBC.ALT.BUN.Cr.CRP.TNF-α.And IL-1 in blood samples were more or less improved in certain extent (P ＜ 0.05).There was more improvement in above biomarkers found in Dahuang Fuzi Decotion treatment group than that in Dahuang Decoction treatment group (P ＜ 0.05).Conclusions Dahuang Fuzi Decoction showed therapeutic effects on SAP-ARDS patients evidenced by reduction in inflammatory mediators,improved oxygenation function,lowering mortality,and significantly improved the prognosis of SAP-ARDS patients,and the therapeutic effect of Dahuang Fuzi Decotion is significantly superior over that of Dahuang Decotion.