目的 观察清胰利胆颗粒联合注射用亚胺培南西司他丁钠治疗重症急性胰腺炎的临床疗效。方法 选取2019年4月—2021年1月商丘市第一人民医院收治的120例重症急性胰腺炎患者，根据随机数字表法将患者分为对照组和治疗组，每组各60例。对照组患者静脉滴注注射用亚胺培南西司他丁钠，将1.0 g/次配伍0.9%氯化钠注射液100 mL，8 h/次。治疗组在对照组的基础上温水冲服清胰利胆颗粒，1袋/次，3次/d。两组均治疗14 d。观察两组临床疗效，比较两组临床症状改善情况、血清炎症因子、生化指标、肠道黏膜屏障功能指标水平。结果 治疗后，对照组的总有效率为68.33%，治疗组的总有效率为88.33%，治疗组高于对照组（P<0.05）。治疗后，治疗组的肠鸣音恢复时间、血清淀粉酶恢复时间、腹膜刺激征消失时间、腹痛腹胀消失时间、胃肠减压时间均比对照组更短（P<0.05）。治疗后，两组患者的血清白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、C反应蛋白（CRP）、白细胞计数（WBC）水平均显著下降，血清白细胞介素-35（IL-35）水平均升高（P<0.05），且治疗组血清IL-6、IL-8、CRP、WBC水平明显低于对照组，血清IL-35水平高于对照组（P<0.05）。治疗后，两组患者的血清淀粉酶、脂肪酶、尿淀粉酶水平均显著下降（P<0.05），且治疗组血清淀粉酶、脂肪酶、尿淀粉酶水平均明显低于对照组（P<0.05）。治疗后，两组的血清内霉素（PE）、D-乳酸、二胺氧化酶（DAO）水平均显著下降（P<0.05），且治疗组血清PE、D-乳酸、DAO水平低于对照组（P<0.05）。结论 清胰利胆颗粒联合注射用亚胺培南西司他丁钠治疗重症急性胰腺炎患者具有确切的临床疗效，能够促进临床症状恢复，降低炎症因子和生化指标水平，改善患者的肠道黏膜屏障功能，安全性较好。

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

河南省医学科技攻关计划联合共建立项项目（LHGJ20201931）