通腑解毒汤联合血液滤过对重症急性胰腺炎患者炎症介质及疗效的影响

Effect of Tongfu Jiedu Decoction with continuous venovenous hemofiltration on serum inflammation mediators in patients with severe pancreatitis

摘要:

目的  探讨通腑解毒汤联合连续性静-静脉血液滤过（CVVH）对急性重症胰腺炎（SAP）患者肿瘤坏死因子-α（TNF-α）、白介素-6（IL-6）的影响及临床疗效。方法  选择发病72 h的SAP患者40例，随机分为对照组和治疗组，每组20例。对照组予以西医常规治疗，治疗组在对照组的基础上加用中药通腑解毒汤联合CVVH治疗。比较两组治疗前及治疗72 h后IL-6和TNF-α的浓度；观察两组治疗前后生命体征、血气、生化指标、急性生理学与慢性健康状况评分系统Ⅱ（APACHE Ⅱ）评分、Ranson评分等指标，判断患者整体病情。结果  治疗72 h后，治疗组IL-6、TNF-α浓度较对照组降低（P <0.01），治疗组较对照组患者发热、呼吸窘迫等症状有不同程度的缓解，血清淀粉酶（AMY）、丙氨酸转氨酶（ALT）、总胆红素（TBIL）、血肌酐（SCr）、尿素氮（BUN）下降（P <0.05），平均动血压（MAP）逐渐上升，氧分压（PaO2）和氧合指数提高，肠麻痹时间、多器官功能障碍综合征发生率下降，平均住院日缩短（P <0.05）。治疗7 d后，治疗组较对照组APACHE Ⅱ评分、Ranson评分降低（P <0.01），住院费用比较差异无统计学意义（P >0.05）。结论  通腑解毒汤联合CVVH治疗SAP能清除部分促炎因子，减轻炎症反应，提高临床疗效，可作为SAP重要的辅助治疗措施之一。

Abstract:

Objective To investigate the effects of traditional Chinese medicine Tongfu Jiedu Decoction combined with continuous venovenous hemofiltration (CVVH) on tumor necrosis factor (TNF-α) and interleukin 6 (IL-6) in patients with severe acute pancreatitis (SAP). Methods Forty patients with SAP for 72 h were randomly divided into two groups, i.e. control group (n = 20) and treatment group (n = 20). In the control group, the patients were given a series of procedures including fasting, gastrointestinal decompression, fluid resuscitation, inhibition of pancreatic secretion, antibiotic prophylaxis, parenteral nutrition and symptomatic therapy. In the treatment group, the patients received additional traditional Chinese medicine Tongfu Jiedu Decoction combined with CVVH treatment (also called continuous renal replacement therapy, CRRT). The concentrations of TNF-α and IL-6 were compared between both groups before treatment and 72 hours after treatment. Vital signs, blood gas analysis, biochemical indexes, acute physiology and chronic health evaluation (APACHE Ⅱ) score, and Ranson's score were evaluated in both groups before and after treatment. Results After 72 hours of treatment, the concentrations of TNF-α and IL-6 in the treatment group declined more remarkably than those in the control group with statistical significance (P < 0.01); the related symptoms like fever, respiratory distress were alleviated more significantly in the treatment group. In both treatment group and control group after treatment, the related indicators like serum amylase, alanine aminotransferase, total bilirubin, serum creatinine and urea-nitrogen significantly decreased (P < 0.05); and the mean arterial pressure gradually increased, blood oxygen partial pressure (PaO2) and oxygenation index significantly increased. The intestinal paralysis time and the average time of hospitalization were shortened, the incidence of multiple organ dysfunction syndrome decreased (P < 0.05). After treatment for 7 days, the APACHE Ⅱ score (sub) and Ranson's score (sub) in the treatment group declined more remarkably than those in the control group with statistical significance (P < 0.01), but the differences in hospitalization costs had no statistical significance (P > 0.05). Conclusions Traditional Chinese medicine Tongfu Jiedu Decoction combined with CVVH could remove part of proinflammatory factors, alleviate the inflammatory reaction and improve the clinical efficacy in the treatment of SAP. It could be used as one of the important auxiliary treatments for SAP.