目的 觀察清胰利膽顆粒聯(lián)合注射用亞胺培南西司他丁鈉治療重癥急性胰腺炎的臨床療效。方法 選取2019年4月—2021年1月商丘市第一人民醫(yī)院收治的120例重癥急性胰腺炎患者，根據(jù)隨機(jī)數(shù)字表法將患者分為對照組和治療組，每組各60例。對照組患者靜脈滴注注射用亞胺培南西司他丁鈉，將1.0 g/次配伍0.9%氯化鈉注射液100 mL，8 h/次。治療組在對照組的基礎(chǔ)上溫水沖服清胰利膽顆粒，1袋/次，3次/d。兩組均治療14 d。觀察兩組臨床療效，比較兩組臨床癥狀改善情況、血清炎癥因子、生化指標(biāo)、腸道黏膜屏障功能指標(biāo)水平。結(jié)果 治療后，對照組的總有效率為68.33%，治療組的總有效率為88.33%，治療組高于對照組（P<0.05）。治療后，治療組的腸鳴音恢復(fù)時(shí)間、血清淀粉酶恢復(fù)時(shí)間、腹膜刺激征消失時(shí)間、腹痛腹脹消失時(shí)間、胃腸減壓時(shí)間均比對照組更短（P<0.05）。治療后，兩組患者的血清白細(xì)胞介素-6（IL-6）、白細(xì)胞介素-8（IL-8）、C反應(yīng)蛋白（CRP）、白細(xì)胞計(jì)數(shù)（WBC）水平均顯著下降，血清白細(xì)胞介素-35（IL-35）水平均升高（P<0.05），且治療組血清IL-6、IL-8、CRP、WBC水平明顯低于對照組，血清IL-35水平高于對照組（P<0.05）。治療后，兩組患者的血清淀粉酶、脂肪酶、尿淀粉酶水平均顯著下降（P<0.05），且治療組血清淀粉酶、脂肪酶、尿淀粉酶水平均明顯低于對照組（P<0.05）。治療后，兩組的血清內(nèi)霉素（PE）、D-乳酸、二胺氧化酶（DAO）水平均顯著下降（P<0.05），且治療組血清PE、D-乳酸、DAO水平低于對照組（P<0.05）。結(jié)論 清胰利膽顆粒聯(lián)合注射用亞胺培南西司他丁鈉治療重癥急性胰腺炎患者具有確切的臨床療效，能夠促進(jìn)臨床癥狀恢復(fù)，降低炎癥因子和生化指標(biāo)水平，改善患者的腸道黏膜屏障功能，安全性較好。

Objective To observe the clinical efficacy of Qingyi Lidan Granules combined with Imipenem and Cilastatin Sodium for injection in treatment of severe acute pancreatitis. Methods Patients (120 cases) with severe acute pancreatitis in Shangqiu First People's Hospital from April 2019 to January 2021 were randomly divided into control and treatment groups, and each group had 60 cases. Patients in the control group were iv administered with Imipenem and Cilastatin Sodium for injection, 1.0 g added into 0.9% sodium chloride injection 100 mL, 8 h/time. Patients in the treatment group were po administered with Qingyi Lidan Granules on the basis of the control group, 1 bag/time, three times daily. Patients in two groups were treated for 4 weeks. After treatment, the clinical efficacies were evaluated, and the improvements of clinical symptom, and the serum level of inflammatory factors, biochemical indexes, and intestinal mucosal barrier function indexes in two groups were compared. Results After treatment, the total effective rate was 68.33% in the control group, and 88.33% in the treatment group, which was higher than that in the control group (P < 0.05). After treatment, the recovery time of bowel sounds, the recovery time of serum amylase, the disappearance time of peritoneal stimulation sign, the disappearance time of abdominal pain, the disappearance time of abdominal distension, and the disappearance time of gastrointestinal decompression in the treatment group were shorter than those in the control group (P < 0.05). After treatment, the serum levels of IL-6, IL-8, CRP, and WBC in two groups were significantly decreased, but the serum levels of IL-35 in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of amylase, lipase, and urinary amylase in two groups were significantly decreased (P< 0.05), and the serum levels of amylase, lipase, and urinary amylase in the treatment group were significantly lower than those in the control group (P < 0.05). After treatment, the serum levels of PE, D-lactate, and DAO in two groups were significantly decreased (P < 0.05), and the serum levels of PE, D-lactate, and DAO in the treatment group were lower than those in the control group (P < 0.05). Conclusion Qingyi Lidan Granules combined with Imipenem and Cilastatin Sodium for injection has clinical curative effect in treatment of severe acute pancreatitis, can promote the recovery of clinical symptoms, reduce the levels of inflammatory factors and biochemical indicators, and improve the intestinal mucosal barrier function of patients, with good safety.

R975

河南省醫(yī)學(xué)科技攻關(guān)計(jì)劃聯(lián)合共建立項(xiàng)項(xiàng)目（LHGJ20201931）