| Acute pancreatitis(ap)is a digestive disease in which pancreatic enzymes are activated by a variety of pathogenic factors,causing the pancreatic tissue to undergo self-digestion,thereby causing a series of inflammatory responses.Clinically,AP patients were classified as mild AP based on acute physiological function and chronic health status scoring system II(acute physiology and chronic health evalution,Apache II).)and moderately severe AP(moderately severe acute pancreatitis,MSAP)and severe AP(severeacute pancreatis,SAP).whereas 40% to 60% of the ap is biliary pancreatitis(ABP),which is mainly caused by cholelithiasis,biliary tract infection,biliary stricture,biliary ascarid,congenital abnormal pancreatic duct reflux and so on.ABP patients with biliary system infection,clinical routine Apply broad-spectrum antibiotic treatment for intestinal flora(e.g.,Escherichia coli),thus affecting the normal intestinal flora.severe ABP patients often cause intestinal mucosal barrier dysfunction in the later stage,resulting in bacterial translocation,serious imbalance of the intestinal flora,causing infection,aggravating the patient's condition,increasing the mortality of patients,and prolonging the hospitalization time of patients,so severe ABP patients are particularly important in improving intestinal microecology.But most of the prebiotics that improve the intestinal mucosal barrier and regulate the dysbacteriosis are bacteria,and their efficacy will be greatly compromised by the use of these broad-spectrum antibiotics.As a fungus,yeast Bracelet is resistant to broad-spectrum resistance the effect of antibiotics,theoretically in the regulation of intestinal flora,improve the intestinal mucosal barrier has a unique advantage,but yeast brastella in the treatment of severe ABP patients,the current application is relatively few,its safety needs to be explored.in this study,the effect of yeast brastella on intestinal mucosal barrier and prognosis in severe ABP patients was analyzed by clinical observation.Objective: 1?The effect of yeast on intestinal mucosal barrier recovery in severe ABP patients was analyzed by clinical observation and analysis.2?The effect of yeast on the improvement and prognosis of severe ABP patients was analyzed by clinical observation and analysisMethods: This paper is a prospective study.Between 2017-10-01 and 2019-10-31,78 severe ABP patients were enrolled in the first central hospital of baoding(in accordance with the diagnostic criteria of china ap diagnosis and treatment guidelines for 2013).it was randomly divided into two groups,in which 40 patients with severe ABP in the control group were treated only routinely(including fasting water,gastrointestinal decompression,rehydration,anti-infection,inhibition of trypsin secretion,early enteral nutrition,analgesia,maintenance of electrolyte balance,etc.).in the experimental group of 38 patients with severe abp,on the basis of the control group,combined application of yeast brah.Treatment of patients The fasting venous blood of the patient was extracted in the morning before and 7 days after treatment,and the serum D-lactic acid,DAO concentration was detected by ELISA.Records:(1)Apache II score,ct severity index(ctsi)score,Marshall score,gastrointestinal function score,Ranson score,serum D-lactic acid concentration,serum DAO concentration,and Ranson score after 48 h in two groups of patients before treatment;(2)patients with Apache ii score,CTSI score,Marshall score,gastrointestinal function score,serum D-lactic acid concentration,serum DAO concentration after 7 days of treatment.(3)The incidence of MODS,secondary infection rate of pancreas and living in two groupsResults: 1 ? Analysis of the general condition of the two groups before treatment : the age,sex and onset time of the two groups were compared,the difference was not statistically significant(P >0.05),and there was comparability between the two groups.2?Analysis of the patients' condition in the two groups before treatment : before treatment,the APACHE II score,CTSI score,Marshall score,gastrointestinal function score,Ranson score,48 hours Ranson score of experimental group [11.00(10.75,11.00)?5.00(4.00,6.00)?3.00(2.25,4.00)?2.00(2.00,3.00)?4.00(3.00,4.00)?2.50(2.00,3.00)]compared with those in the control group [11.00(10.00,11.00)?4.00(4.00,6.00)?3.00(2.00,4.25)?2.50(2.00,3.00)?3.50(3.00,4.00)?3.00(2.00,3.00)],the difference was not statistically significant(P <0.05).3 ? Analysis of intestinal mucosal barrier in two groups before treatment and 7 days after treatment :before treatment,the concentrations of serum DAO and D-lactic acid in the experimental group were 17.64(15.30,19.79),23.14±1.86)compared with those in the control group [16.72(14.77,20.64),22.52 ± 2.33]the difference was not statistically significant(P >0.05).After 7 days of treatment,the serum D-lactic acid concentrations in the experimental group[7.18(6.42,9.17),4.98±1.75] were significantly lower than those in the control group [8.23(7.21,9.90)?9.18±1.75],the difference was statistically significant(P <0.05).4?After 7 days of treatment,the scores of Apache II,CTSI,Marshall and gastrointestinal function in the experimental group were[5.00(4.00,6.00)? 2.00(2.00,2.00)? 1.50(1.00,2.00)? 1.00(1.00,1.75)]significantly lower than those in the control group [5.00(5.00,6.00)?2.00(2.00,4.00)?2.00(2.00,3.00)?2.00(1.50,2.00)]The difference was statistically significant(P <0.05).5?Analysis of the incidence of mods,pancreatic-inspired infection rate,hospitalization days and hospitalization expenses in the two groups: the incidence of mods,pancreatic-inspired infection rate,hospitalization days and hospitalization expenses in the experimental group[15(39)?6(16)?26.76±1.26?4.33(3.52,5.19)]were significantly lower than those in the control group[24(60)?15(37.5)?35.45±1.60?5.93(4.82,7.03)]The difference was statistically significant(P <0.05).Conclusion: 1 ? Yeast bras significantly improved intestinal mucosal barrier function in severe ABP patients.2?As an adjuvant drug for the treatment of severe ABP,yeast Bura can significantly reduce the improvement of the patient's condition,thus reducing the incidence of MODS,the rate of pancreatic infection,the total number of days in hospital,the total cost of hospitalization,and improve the social and economic benefits,which provides a new direction for the treatment and prognosis of the patient. |
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