标题：单味大黄配合生长抑素对重症急性胰腺炎患者胃肠道功能及凝血功能的影响

      作者：许汝娟，任冬弓，武彦芳，高翠贤    陕西省第四人民医院消化内科，陕西 西安 710043

      卷次： 2019年30卷17期

      【摘要】 目的 探讨单味大黄配合生长抑素对重症急性胰腺炎患者胃肠道功能及凝血功能的影响。方法 选取2017年1月至2018年6月在陕西省第四人民医院消化内科治疗的90例重症急性胰腺炎患者作为研究对象，按照随机数表法将患者分为观察组和对照组，每组45例，对照组采用生长抑素治疗，观察组采用单味大黄配合生长抑素治疗，治疗疗程1周。比较两组患者治疗前、治疗后1周(治疗后)的临床疗效指标、胃肠道功能，治疗前与治疗后1 d、3 d、7 d的凝血功能指标。结果 治疗后，观察组和对照组患者的腹痛消除时间[(4.11±0.92) d vs (5.58±1.20) d]、胃肠减压时间[(5.65±1.78) d vs (8.68±1.99) d]、平均住院时间[(14.72±3.38) d vs (18.77±3.96) d ]比较，观察组均明显少于对照组，差异均有显著统计学意义(P?0.01)；治疗前，两组患者的胃动素(MTL)和血清胃泌素(GAS)水平比较差异无统计学意义(P>0.05)；治疗后，观察组患者的MTL水平为(90.27±9.85) ng/L，明显高于对照组的(71.57±8.89) ng/L，GAS水平为(52.12±5.16) ng/L，明显低于对照组的(72.35±8.28) ng/L，差异均有显著统计学意义(P?0.01)；治疗前和治疗后1d，观察组患者的血小板计数(PLT)、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)分别与对照组比较差异均无统计学意义(P>0.05)；治疗后3 d和7 d，观察组患者的的PLT明显高于对照组，PT、TT、APTT、FIB均明显低于对照组，差异均有显著统计学意义(P?0.01)。结论 单味大黄配合生长抑素治疗重症急性胰腺炎有助于提升患者的MTL水平，降低GAS水平，促进胃肠道功能的恢复，保护机体的凝血功能，最终达到控制重症急性胰腺炎患者病情的作用。
      【关键词】单味大黄；生长抑素；重症急性胰腺炎；胃肠道功能；凝血功能
      【中图分类号】 R657.5+1 【文献标识码】 A 【文章编号】 1003—6350（2019）17—2197—04

Effect of single rhubarb combined with somatostatin on gastrointestinal function and coagulation function inpatients with severe acute pancreatitis.
XU Ru-juan, REN Dong-gong, WU Yan-fang, GAO Cui-xian. Department ofGastroenterology, the Fourth People's Hospital of Shaanxi Province, Xi'an 710043, Shaanxi, CHINA
【Abstract】 Objective To investigate the effects of single rhubarb combined with somatostatin on gastrointesti-nal function and coagulation function in patients with severe acute pancreatitis. Methods A total of 90 patients with se-vere acute pancreatitis, who treated in the Department of Gastroenterology, the Fourth People's Hospital of Shaanxi Prov-ince from January 2017 to June 2018, were selected and divided into the observation group and control group accordingto random number table method, with 45 cases in each group. The control group was treated with somatostatin, and theobservation group was treated with single-flavored rhubarb combined with somatostatin for 1 week. For the two groups,the clinical efficacy indexes and gastrointestinal function before treatment and 1 week after treatment, and coagulationfunction indexes before treatment and 1 day, 3 days, and 7 days after treatment were compared. Results After treat-ment, the abdominal pain elimination time, gastrointestinal decompression time, average hospital stay of the observationgroup were (4.11±0.92) d, (5.65±1.78) d, (14.72±3.38) d, which were significantly lower than corresponding (5.58±1.20) d, (8.68±1.99) d, (18.77±3.96) d of the control group (all P?0.05). Before treatment, there was no significant dif-ference in the levels of motilin (MTL) and serum gastrin (GAS), P>0.05. After treatment, the MTL level of the observa-tion group was (90.27±9.85) ng/L, which was significantly higher than (71.57±8.89) ng/L of the control group; theGAS level was (52.12±5.16) ng/L, which was significantly lower than (72.35±8.28) ng/L of the control group (P?0.05). Before and after one day, there was no significant difference in treatment platelet count (PLT), prothrombin time(PT), thrombin time (TT), activated partial thromboplastin time (APTT) and fibrinogen (FIB) between the observationgroup and control group (P>0.05). At 3 days and 7 days after treatment, the PLT of the observation group was signifi-cantly higher than that of the control group; while PT, TT, APTT, FIB were significantly lower than those of the controlgroup (P?0.05). Conclusion In the treatment of severe acute pancreatitis, single rhubarb combined with somatostatincan improve the patient's MTL level, reduce GAS level, promote the recovery of gastrointestinal function, protect thebody's coagulation function, and finally achieve the control of patients with severe acute pancreatitis.
      【Key words】 Single rhubarb; Somatostatin; Severe acute pancreatitis; Gastrointestinal function; Coagulation