中文摘要：

目的 观察大黄附子汤治疗重症急性胰腺炎（SAP）患者的临床疗效,为中西医结合治疗SAP提供有价值的循证医学证据. 方法 采用前瞻性、多中心、随机对照临床试验.收集2007年1月至2010年2月大连地区3家三级甲等医院206例SAP患者的临床资料,采用随机数字表法分为温皂水灌肠对照组（101例）和大黄附子汤灌肠研究组（105例）.两组于治疗前及治疗2、4、7 d分别取血测定淀粉酶、白蛋白（Alb）、D-乳酸、内毒素、二胺氧化酶（DAO）、超敏C-反应蛋白（hs-CRP）、免疫球蛋白（IgG、IgA、IgM）、补体（C3、C4）及肿瘤坏死因子-α（TNF-α）、白细胞介素（IL-6和IL-8）水平;并观察患者肠鸣音、胃肠功能和急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分;记录28 d内患者机械通气时间、住重症监护病房（ICU）天数、病死率及平均住院费用. 结果 与对照组比较,研究组可降低淀粉酶、DAO、D-乳酸、内毒素水平,升高Alb,下调促炎因子TNF-α、IL-6、IL-8、hs-CRP,增强机体免疫功能,促进肠蠕动,改善胃肠功能及APACHEⅡ评分,缩短机械通气时间、住ICU天数,降低病死率,减少平均住院费用[4 d淀粉酶（U/L）：357.35±137.54比492.95±189.42,2 d DAO（kU/L）：5.20±0.59比5.45±0.72,4 d D-乳酸（mmol/L）：3.31±0.48比4.15±0.55,2 d内毒素（kEU/L）：0.29±0.11比0.34±0.14,4 d Alb（g/L）：34.75±3.56比32.53±3.44,2 d TNF-α（ng/L）：3.08±0.45比3.36±1.11,2 d IL-6（ng/L）：298.54±67.82比313.56±73.91,4 d IL-8（ng/L）：30.48±8.56比45.16±10.81,2 d hs-CRP（mg/L）：32.56±11.83比40.42±15.10,4 d IgG（g/L）：7.05±2.56比9.53±2.94,2 d IgA（mg/L）：1 600±170比1 400±140,4 d IgM（mg/L）：1 310±280比1 650±290,4 d C3（g/L）：1.11±0.09比1.50±0.15,4 d C4（g/L）：0.32±0.11比0.41±0.10,2 d肠鸣音（次/min）：1.26±0.45比1.15±0.41,2 d胃肠功能评分（分）：2.24±0.98比2.42±1.05,4 d APACHEⅡ评?

英文摘要：

Objective To observe the efficacy of Dahuang Fuzi decoction（大黄附子汤） in patients with severe acute pancreatitis（SAP）,and to provide valuable medical evidences for a treatment of SAP with combined traditional Chinese and western medicine. Methods A prospective,multi-center,randomized,controlled clinical trial was designed.Two hundred and six adult patients with SAP admitted to intensive care unit（ICU） in three tertiary university teaching hospitals in Dalian from January 2007 to February 2010 were randomly divided into two groups：soapsuds enema control group（control group,n=101） and Dahuang Fuzi decoction enema study group（study group,n=105）.The levels of serum amylase,albumin（Alb）,D-lactic acid,endotoxin and diamine oxidase（DAO）,high-sensitive C-reactive protein（hs-CRP）,immunoglobulin（IgG,IgA,IgM）,complements（C3,C4）,tumour necrosis factor-α（TNF-α）,interleukins（IL-6,IL-8） were determined before and after treatment for 2,4,7 days.The bowel sound,gastrointestinal function score,the acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score and the length of mechanical ventilation（MV）,the length of stay in ICU,the mortality rate and average hospital expenses within 28 days were compared. Results Compared with control group,in the study group the levels of serum amylase,DAO,D-lactic acid and endotoxin were lowered,the Alb was increased,the levels of TNF-α,IL-6,IL-8,hs-CRP were decreased,the function of body immunity was enhanced,intestinal peristalsis was enhanced,gastrointestinal function score and APACHEⅡ score were improved,the length of MV was reduced,the length of stay in ICU was diminished,the 28-day mortality and average hospital expenses were lowered[4 days amylase（U/L）：357.35±137.54 vs.492.95±189.42,2 days DAO（kU/L）：5.20±0.59 vs.5.45±0.72,4 days D-lactic acid（mmol/L）：3.31±0.48 vs.4.15±0.55,2 days endotoxin（kEU/L）：0.29±0.11 vs.0.34±0.14,4 days Alb（g/L）：34.75±3.56 vs.32.53±3.44,2 days TNF-α?