發(fā)布時間：2018-06-02 12:32

  本文選題：輕癥急性胰腺炎 + 清胰湯��； 參考：《青海大學》2014年碩士論文

【摘要】：目的：腸內營養(yǎng)與中西醫(yī)結合目前常被用于重癥急性胰腺炎的治療，效果顯著，死亡率明顯降低。而臨床則以輕癥急性胰腺炎最常見，占急性胰腺炎發(fā)病率的80%；且病情較急性壞死性胰腺炎輕，經正規(guī)治療后多能痊愈，但患者病程長、治療費用高；偶有反復發(fā)作，更有轉化為重癥急性胰腺炎的可能。本文運用統(tǒng)計學的原理和方法，比較清胰湯加西醫(yī)常規(guī)治療結合早期腸內營養(yǎng)治療輕癥急性胰腺炎與西醫(yī)常規(guī)治療輕癥急性胰腺炎的療效差異，為臨床治療輕癥急性急性胰腺炎選擇更合理，更經濟、更有效的方案提供臨床依據(jù)。 方法：搜集2012年4月--2013年12月期間我科收治的輕癥急性胰腺炎患者60例，所有患者符合急性胰腺炎診斷標準，并通過相應檢查排除有嚴重并發(fā)癥的患者。其中男性41例,女性19例,年齡22～75歲,平均48.5歲，其中膽源性29例,酗酒暴飲暴食16例,其他原因15例。按隨機分配原則分為治療組(30例)與對照組(30例)。對照組給予西醫(yī)常規(guī)治療（禁食水；有效的胃腸減壓；抑制胃酸及胰腺分泌；預防感染；鎮(zhèn)痛；保持水電解質平衡及全胃腸外營養(yǎng)治療）。治療組在西醫(yī)常規(guī)治療的基礎上，入院24h后再給予清胰湯結合腸內營養(yǎng)治療。比較兩組腹痛與腹脹消失的時間；腹部CT恢復正常時間；血淀粉酶、血清脂肪酶、尿淀粉酶及C反應蛋白恢復正常時間；觀察患者完全禁食的天數(shù)；平均住院天數(shù)和治療費用；患者經治療后營養(yǎng)變化狀況（血清白蛋白）。 結果：與對照組相比較，治療組腹脹與腹痛消失的時間、禁食的天數(shù)、平均住院天數(shù)都明顯縮短；住院費用也減少；比較差異非常明顯，差異有統(tǒng)計學意義（P0.05）。治療組血淀粉酶、血清脂肪酶、尿淀粉酶；腹部CT、CRP恢復正常時間也明顯短于對照組；比較差異有顯著性，有統(tǒng)計學意義（P0.05）。 結論：清胰湯能防止胃腸道黏膜進一步受損；快速促進胃腸道各種功能的恢復；減輕胰腺及胰周組織的損傷，促進胰腺的自我修復；減少C反應蛋白的過度產生，從而減輕急性炎癥反應，縮短病程。腸內營養(yǎng)可改善患者營養(yǎng)狀況，防止腸道發(fā)生廢用性萎縮，減少因腸道細菌移位所引起的并發(fā)癥，改善患者預后，，降低住院費用。
[Abstract]:Objective: enteral nutrition and combination of traditional Chinese and western medicine are often used in the treatment of severe acute pancreatitis. In clinical practice, mild acute pancreatitis is the most common, accounting for 80% of the incidence of acute pancreatitis; and the condition is lighter than that of acute necrotizing pancreatitis. After regular treatment, most of the patients can recover, but the course of disease is long and the cost of treatment is high. It is more likely to turn into severe acute pancreatitis. In this paper, the principle and method of statistics were used to compare the therapeutic effects of Qingyi decoction combined with early enteral nutrition in the treatment of mild acute pancreatitis and western medicine routine treatment of mild acute pancreatitis. To provide clinical basis for clinical treatment of mild acute pancreatitis more reasonable, more economical, more effective regimen. Methods: from April 2012 to December 2013, 60 patients with mild acute pancreatitis were collected from our department. All the patients met the diagnostic criteria of acute pancreatitis, and the patients with severe complications were excluded by corresponding examination. Among them, 41 cases were male, 19 cases were female, the age was 22 ~ 75 years old (mean 48.5 years), 29 cases of gallstone, 16 cases of excessive drinking and drinking, and 15 cases of other reasons. According to the principle of random distribution, 30 cases were divided into treatment group (n = 30) and control group (n = 30). The control group was given routine western medicine treatment (fasting water; effective gastrointestinal decompression; inhibition of gastric acid and pancreatic secretion; prevention of infection; analgesia; maintenance of water and electrolyte balance and total parenteral nutrition. The treatment group was treated with Qingyi decoction combined with enteral nutrition 24 hours after admission on the basis of routine western medicine. The time of disappearance of abdominal pain and abdominal distension, the time of abdominal CT returning to normal, the time of serum amylase, serum lipase, urine amylase and C-reactive protein returning to normal, the days of complete fasting, the average days of hospitalization and the cost of treatment were compared between the two groups. Nutritional status of patients after treatment (serum albumin). Results: compared with the control group, the time of disappearance of abdominal distension and abdominal pain, the days of fasting, the average days of hospitalization and the cost of hospitalization in the treatment group were significantly shortened, and the difference was very obvious (P 0.05). In the treatment group, serum amylase, serum lipase, urine amylase, abdominal CTU CRP return to normal time was also significantly shorter than the control group; the difference was significant (P 0.05). Conclusion: Qingyi decoction can prevent the further damage of gastrointestinal mucosa, accelerate the recovery of gastrointestinal function, reduce the injury of pancreas and peripancreatic tissue, promote the self-repair of pancreas, and reduce the excessive production of C-reactive protein. In order to alleviate the acute inflammatory reaction, shorten the course of disease. Enteral nutrition can improve the nutritional status of patients, prevent waste atrophy, reduce the complications caused by intestinal bacterial translocation, improve the prognosis of patients, and reduce the cost of hospitalization.
【學位授予單位】：青海大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R576

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