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Medicina

重症急性胰腺炎患者中药灌肠

Published: January 27, 2023
doi:
10.3791/64831
, , , , ,
1Department of Critical Care Medicine,Hospital of Chengdu University of Traditional Chinese Medicine, 2Clinical Medicine Department,Chengdu University of Traditional Chinese Medicine

Summary

灌肠是一种用于治疗严重急性胰腺炎 （SAP） 的传统中药 （TCM） 疗法。该疗法包括通过肛门将中药液体滴入直肠和结肠，以将液体保持在肠道中，并通过肠粘膜吸收。本研究旨在规范SAP患者的灌肠程序。

Abstract

严重急性胰腺炎（SAP）的特点是死亡率高，并发症多，治疗难度大。中药灌肠剂已广泛应用于SAP的临床和实验研究。它已被证明在保护胰腺功能和延缓疾病进展方面具有有益作用。中药灌肠的程序是灌注生大黄（大黄）的中药液。大黄）从肛门进入直肠和结肠。该程序的基本步骤包括提前煮沸草药溶液，使用一次性灌肠试剂盒帮助患者采取左躺姿势，将患者的臀部抬高10厘米，并小心地将灌肠剂插入肛门30-35厘米，滴速为60-80滴/分钟。药液温度应与患者的体温相当，通常在37-39°C之间。 灌肠手术的结束应该是缓慢的，拔管前应给予推拿（按摩疗法）。药液应在直肠中保存1小时以上。灌肠后，必须观察患者的粪便和腹部，并评估腹部体征和症状的缓解。

Introduction

急性胰腺炎（AP）是一种急性腹部疾病，其特征在于胰腺酶异常激活引起的局部胰腺炎症反应，胰酶对胰腺和周围器官具有消化作用1。作为美国住院最普遍的胃肠道原因之一，急性胰腺炎需要越来越多的关注，因为它在世界范围内继续增加2，3。在过去的十年中，对急性胰腺炎病理生理机制的认识取得了重大进展4，5，6。约5%-10%的急性胰腺炎病例与严重器官功能障碍有关;这种类型的胰腺炎被定义为严重急性胰腺炎（SAP）7。早期西医治疗AP一般包括液体治疗、镇痛、营养支持、病因治疗和早期并发症。然而，西医治疗现阶段仍缺乏针对AP的特效药物8，9，10。

在传统中医（TCM）中，AP被称为“腹痛”，“皮心通”和“胰热”。中医灌肠疗法是中医最常用的治疗方法之一，可以追溯到汉11世纪张仲京《感冒致病论》中的蜂蜜汤法。其临床疗效已被记录用于治疗溃疡性结肠炎12、高尿酸血症13、急性放射性直肠炎 14、急性肾损伤15 和肠道 SARS-CoV-216。

近年来，中药灌肠（大黄17，18，米拉比石19，以及青衣汤20和大成奇汤21等复方制剂）在SAP的临床和实验研究中得到了广泛的应用。它已被证明可以保护胰腺功能，减轻腹痛和腹胀，并延缓疾病进展22，23。2021 年中国 AP 诊断和治疗指南包括中药灌肠24.然而，目前尚不清楚中药灌肠应如何用于SAP患者。因此，我们提出了一种进行中药灌肠的方案，为研究民族药物在SAP患者治疗中的成分和机制提供了一种有效的方法25。

Protocol

临床方案已获得成都中医药大学附属医院重症医学科管委会批准（备案号：KY20221005）。实验程序按照成都中医药大学医院指南进行。手术需要签署知情同意书的患者的同意。在进行灌肠之前，操作员应了解直肠的解剖结构并查看解剖注释（见 图3）。 1.操作人员的治疗前准备 包括有主要症状（即持续性上腹部疼痛）的患者。 …

Representative Results

在这项研究中，患者因反复上腹部疼痛而入院。根据诊断标准30，患者被诊断为SAP。在患者接受该方案治疗后，有明显的治疗效果31。 患者A，女性，84岁，于2019年5月2日首次确诊。患者主诉反复上腹部腹胀和疼痛。临床检查显示，血清淀粉酶为509 U/L（参考值：35-135 U/L），尿淀粉酶为1，343 U/L（参考值：0-600 U/L）。体格检查显示腹部肿胀，全…

Discussion

AP是一种炎症性疾病，可以进展为SAP。根据大量研究，SAP是一种毁灭性疾病，死亡率从不到10%到高达85%不等，尽管近十年死亡率有所下降33。SAP严重影响患者的生活质量，如果不及时有效地治疗，甚至可能导致死亡。积极有效的早期治疗具有临床意义34。

中草药灌肠在治疗SAP方面有很多优点。灌肠通过直肠吸收，吸收完全，生物利用度高，?…

Declarações

The authors have nothing to disclose.

Acknowledgements

这项工作得到了四川省中医药管理局中医药专项研究项目（2021MS417）的支持。

Materials

Automatic decoction machine packaging machine Taizhou Guo pin Le Ji Machinery Co., Ltd GPJ13(1+1)
Care turning pillows Hengshui Binhu New Area Fubon Medical Equipment Factory 20220902R
Disposable enema device Yangzhou Yuankang Medical Equipment Co., Ltd. 20220502B
Disposable gloves Jiangxi Almei Medical Equipment Co., Ltd. AEM/ST-AZ
Disposable medical kit Zhende Medical Supplies Co., Ltd. 20211220
Disposable treatment sheet Xinxiang Huakang Eisai Co., Ltd HK-38
Medical gauzepad Xinxiang Huakang Eisai Co., Ltd HK-02B
Medical nursing pad Hefei Mattel Care Products Co., Ltd CND502
Non-woven Filter Package Chengdu New Medical and Health Products Factory 20192183#(C)
Paraffin oil Shandong Lierkang Medical Technology Co., Ltd. 180801
Raw rhubarb Sichuan Guoqiang traditional Chinese Medicine  Co., Ltd 21120104
Thermometer Shenzhen Chenzhou Technology Co., Ltd. TP300
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Tags

EnemaTraditional Chinese MedicineSevere Acute PancreatitisRectal AdministrationPancreatic FunctionAbdominal PainDisease ProgressionPatient PreparationTemperature RegulationLateral Decubitus PositionAnal LubricationLiquid Medication TemperatureDrip RateDisposable Enema Kit

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Wang, S., Zhou, T., Long, K., Chen, J., Zhou, X., Gao, P. Enema of Traditional Chinese Medicine for Patients with Severe Acute Pancreatitis. J. Vis. Exp. (191), e64831, doi:10.3791/64831 (2023).
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