中医下法治疗重症急性胰腺炎的临床疗效观察
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摘要
目的：1．观察中医下法治疗脾胃实热证重症急性胰腺炎的临床疗效：2．综合评价中医下法治疗重症急性胰腺炎的作用。
方法：将脾胃实热证重症急性胰腺炎病人30例，随机分为治疗组16例和对照组14例。治疗组以中医下法，予内服中药汤剂大柴胡汤加减，每日2剂，同时予复方大黄灌肠液200ml，保留灌肠，每日2次，治疗7天。西药予以常规禁食、胃肠减压、液体支持、抑酸、抑酶、抗感染等综合治疗。对照组用生理盐水200ml，保留灌肠，每日2次，治疗7天。西药予以常规禁食、胃肠减压、液体支持、抑酸、抑酶、抗感染等综合治疗。观察两组患者主要症状疗效、白细胞数(WBC)、血淀粉酶(AIdS)、C反应蛋白(CRP)等生化指标，比较两组疗效。
结果：1．治疗组临床症状疗效总有效率93.8％(其中显效5例，有效10例，无效1例)，对照组总有效率71.4％(其中显效1例，好转9例，无效4例)，两组比较差异有显著性(p＜0.05)；治疗组中医证候总有效率87.5％(其中痊愈1例，显效5例，有效8例，无效2例)，对照组总有效率64.3％(其中痊愈0例，显效1例，好转8例，无效5例)，两组比较差异有显著性(p＜0.05)。2．治疗后两组患者WBC、AMS、CRP均较治疗前有所降低，与治疗前比较有统计学差异(p＜0.05)；而治疗组WBC、AMS、CRP改善优对照组，两组比较有统计学差异(p＜0.05)。
结论：中西医结合疗法在改善中医证候及临床症状方面优于西医疗法，中医下法可能通过减轻AP患者的炎症反应程度，减轻胰腺的损伤，从而更好的改善患者的临床症状及中医证候。说明中医下法治疗重症急性胰腺炎有效，其具体机理有待进一步探讨。
Objectives: 1. Chinese observation dismount stomach heat treatment of severeacute pancreatitis permit the clinical efficacy: 2. Purgation comprehensiveevaluation Chinese treatment of severe acute pancreatitis role.
Method: Heat stomach certification of severe acute pancreatitis 30 patientswere randomly divided into 16 cases of the treatment group and the controlgroup of 14 cases. Chinese group to dismount, the Chinese soups to Oral DachaihuDecoction daily 2. Rhubarb also to the compound enema fluid 200ml, retentionenema, 2 times a day for seven days. Conventional Western medicine to be fasting,gastrointestinal decompression, liquid support, suppression, the inhibitoryactivity, anti-infection treatment. Control group with normal saline 200ml,retention enema, 2 times a day for seven days. Conventional Western medicineto be fasting, gastrointestinal decompression, liquid support, suppression,the inhibitory activity, anti-infection treatment. Observation of the twogroups of patients with clinical symptoms, WBC (WBC), serum amylase (AMS),C-reactive protein (CRP), and other biochemical markers to compare the twogroups.
Results: 1. In the Treatment Group total effectiveness was 93.8%. Nil patientswere completely cured; five patients showed marked improvement, ten patientsshowed moderate improvement whilst one patients had no improvement. In theControl Group total effectiveness was 71.4%. Nil patients were completelycured; one patients showed marked improvement; nine patients showed moderateimprovement whilst four patients showed no improvement. Both groups post-treatment showed significant differences (p＜0.05).Clinical symptoms ofthe treatment group overall efficiency of 93.8% (8 patients recover and producefive cases, three cases effectively, invalid 1), the control group, the totalefficiency of 71.4% (3 patients recover and produce three cases, 4 cases, 4cases), the difference between the two groups was significant (p＜0.05). 2.After treatment, patients WBC, AMS, CAP than before treatment has been reduced,Compared with pre-treatment, a significant difference (p＜0.05); and thetreatment group WBC, AMS, You CAP to improve the control group, the two groupswas statistically different (p＜0.05).
Conclusion, Combination therapy in improving symptoms better than Chinesemedicine and Western medicine therapy, Chinese medicine may dismount APpatients by reducing the inflammatory response, the pancreas to alleviate theinjury, better with the improvement of clinical symptoms and TCM. Note dismountTCM treatment of severe acute pancreatitis effective, the specific mechanismto be further explored.
方法：将脾胃实热证重症急性胰腺炎病人30例，随机分为治疗组16例和对照组14例。治疗组以中医下法，予内服中药汤剂大柴胡汤加减，每日2剂，同时予复方大黄灌肠液200ml，保留灌肠，每日2次，治疗7天。西药予以常规禁食、胃肠减压、液体支持、抑酸、抑酶、抗感染等综合治疗。对照组用生理盐水200ml，保留灌肠，每日2次，治疗7天。西药予以常规禁食、胃肠减压、液体支持、抑酸、抑酶、抗感染等综合治疗。观察两组患者主要症状疗效、白细胞数(WBC)、血淀粉酶(AIdS)、C反应蛋白(CRP)等生化指标，比较两组疗效。
结果：1．治疗组临床症状疗效总有效率93.8％(其中显效5例，有效10例，无效1例)，对照组总有效率71.4％(其中显效1例，好转9例，无效4例)，两组比较差异有显著性(p＜0.05)；治疗组中医证候总有效率87.5％(其中痊愈1例，显效5例，有效8例，无效2例)，对照组总有效率64.3％(其中痊愈0例，显效1例，好转8例，无效5例)，两组比较差异有显著性(p＜0.05)。2．治疗后两组患者WBC、AMS、CRP均较治疗前有所降低，与治疗前比较有统计学差异(p＜0.05)；而治疗组WBC、AMS、CRP改善优对照组，两组比较有统计学差异(p＜0.05)。
结论：中西医结合疗法在改善中医证候及临床症状方面优于西医疗法，中医下法可能通过减轻AP患者的炎症反应程度，减轻胰腺的损伤，从而更好的改善患者的临床症状及中医证候。说明中医下法治疗重症急性胰腺炎有效，其具体机理有待进一步探讨。
Objectives: 1. Chinese observation dismount stomach heat treatment of severeacute pancreatitis permit the clinical efficacy: 2. Purgation comprehensiveevaluation Chinese treatment of severe acute pancreatitis role.
Method: Heat stomach certification of severe acute pancreatitis 30 patientswere randomly divided into 16 cases of the treatment group and the controlgroup of 14 cases. Chinese group to dismount, the Chinese soups to Oral DachaihuDecoction daily 2. Rhubarb also to the compound enema fluid 200ml, retentionenema, 2 times a day for seven days. Conventional Western medicine to be fasting,gastrointestinal decompression, liquid support, suppression, the inhibitoryactivity, anti-infection treatment. Control group with normal saline 200ml,retention enema, 2 times a day for seven days. Conventional Western medicineto be fasting, gastrointestinal decompression, liquid support, suppression,the inhibitory activity, anti-infection treatment. Observation of the twogroups of patients with clinical symptoms, WBC (WBC), serum amylase (AMS),C-reactive protein (CRP), and other biochemical markers to compare the twogroups.
Results: 1. In the Treatment Group total effectiveness was 93.8%. Nil patientswere completely cured; five patients showed marked improvement, ten patientsshowed moderate improvement whilst one patients had no improvement. In theControl Group total effectiveness was 71.4%. Nil patients were completelycured; one patients showed marked improvement; nine patients showed moderateimprovement whilst four patients showed no improvement. Both groups post-treatment showed significant differences (p＜0.05).Clinical symptoms ofthe treatment group overall efficiency of 93.8% (8 patients recover and producefive cases, three cases effectively, invalid 1), the control group, the totalefficiency of 71.4% (3 patients recover and produce three cases, 4 cases, 4cases), the difference between the two groups was significant (p＜0.05). 2.After treatment, patients WBC, AMS, CAP than before treatment has been reduced,Compared with pre-treatment, a significant difference (p＜0.05); and thetreatment group WBC, AMS, You CAP to improve the control group, the two groupswas statistically different (p＜0.05).
Conclusion, Combination therapy in improving symptoms better than Chinesemedicine and Western medicine therapy, Chinese medicine may dismount APpatients by reducing the inflammatory response, the pancreas to alleviate theinjury, better with the improvement of clinical symptoms and TCM. Note dismountTCM treatment of severe acute pancreatitis effective, the specific mechanismto be further explored.
引文
[1] Wilson C, Imrie CW. Changing patterms of incidence and mortality from acute pancreatitis in Scotland, 1961-1985. Br J Surg 1990; 77:731-734.
[2] Appelros S, Brogstrom B. Incidence, etiology and mortality rate of acute pancreatitis over 10 years in a defined population in Sweden. Br J Surg 1999; 86:465-470.
[3] Chris E. Forsmark(郭克建主译)．胰腺炎及其并发症，北京：人民卫生出版社，2006，第1版：6-7．
[4] Yadav D, pitchumoni CS. Issues in hypertriglyceridemic pancreatitis. J Clin Gastroenterol 2003; 36:54-62.
[5] Opie E. The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Johns Hopkins Hosp Bull 1901;12:19-21.
[6] Opie E. The etiology of acute hemorrhagic pancreatitis. Johns Hopkins Hosp Bull 1901; 12:182-188.
[7] Applebaum-Shapiro SE, Finch R, Pfutzer RH, et al. Hereditary pancreatitis in North America:the Pittsburgh-Midwest Multi-Center Pancreatic Study Group Study. Pancreatology 2001; 1:439-443.
[8] Steer ML, Meldolesi J. Pathogenesis of acute pancreatitis. Annu Rev Med 1988; 39:95-105.
[9] Grendell JH. Acute pancreatitis. Curr Opin Gastroenterol 1997; 13:381-385.
[10] Zielenski J, Tsui LC. Cystic fibrosis:genotypic and phenotypic variations. An Rev Genet 1995; 29:777-807.
[11] Mickle JE, Cutting GR. Genotype-phenotype relationships in cystic fibrosis. Med Clin North Am 2000; 84:597-607.
[12] Kristidis P, Bozon D, Corey M, et al. Genetic determination of exocrine pancreaticfunction in cystic fibrosis. AM J Hum Genet 1992; 50:1178-1182.
[13] Sten RC. The diagnosis of cystic fibrosis. N Engl J Med 1997; 336:487-491.
[14] Colomb E, Figarella C, Guy O.The two human trypsinogens. Evidence of complexfromation with basic pancreatic trypsin inhibitor-proteolytic activity. Biochim Biophys Acta 1979; 570:397-405.
[15] Rinderknecht H. Pancreatic Secretory Enzymes. In:Go VLW, DiMagno EP, Gardner JD, et al, ed. The pancreas:Biology, Pathobiology, and Disease, second edition. Raven Press, New York, 1993:219-251.
[16] Ogawa M. Pancreatic secretory trypsin inhibitor as an acute phase reactant. Chin Biochem 1988; 21; 19-25.
[17] Witt H, Luck W, Hennies HC, et al. Mutations in the gene encoding the serine protease inhibitor, kazal type 1 are associated with chronic pancreatitis. Nat Genet 2000;25:231-216.
[18] Pfutzer RH, Barmada MM, Brunskil APJ, et al. SPINK1/SPTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology 2000; 119:615-623.
[19] Whitcomb DC. How to think about SPINK and pancreatitis. AM J Gastroenterol 2002; 97:1085-1088.
[20] Kloppel G, Maillet B. Pathology of acute and chronic pancreatitis. Pancreas 1993：8：659-670．
[21] 张志宏，徐肇敏．胰腺疾病，辽宁：辽宁科学技术出版社，2005，第1版：167-179．
[22] 张肇达，严律南，刘续宝．急性胰腺炎，北京：人民卫生出版社，2004，第1版：123-124．
[23] 李洪波．中西医结合治疗急性胰腺炎86例．实用中医内科杂志，2005；19(5)：438．
[24] 吴晓华，张杨．中西医结合治疗急性胰腺炎临床观察．辽宁中医杂志，2005：32(8)：812-813．
[25] 毛盛名，蒋骞，李荣祥，等．中西医结合治疗重症急性胰腺炎．现代中西医结合杂志，2003；12(16)：1728-1729．
[26] 李娅琳，万苹，周雁．中西医结合治疗重症急性胰腺炎疗效分析．云南中医学院学报，2005；28(1)：58-59．
[27] 欧宏宇．中西医结合治疗重症急性胰腺炎临床观察．中华中医药杂志，2005：20(7)：408-409．
[28] 姚虹，姚开炳，于德洋．急性出血性胰腺炎92例诊治分析．中国中西医结合外科杂志，2001：7(3)：166-167．
[29] 吴河山．中西医结合分期辨证治疗重症急性胰腺炎Ⅱ型36例．中华实用中西医杂志，2004：4(17)：3404-3405．
[30] 尚文潘，黄穗平，余绍源，等．中西医结合治疗159急性胰腺炎临床观察．广州中医药大学学报，2005：22(6)：421-425．
[31] 余涛，黄宗文，于迎春，等．中西医结合治疗重症急性胰腺炎62例，新中医，2001：33(3)：40-41．
[32] 吕新生，张翼，李宜雄，等．甘遂治疗重症急性胰腺炎．中囡普外科杂志，2004：13(6)：401-404．
[33] 王绪华，徐瑞华．大黄对重症急性胰腺炎胃肠功能衰竭的防治作用．中国医师杂志，2004：6(2)：267-268．
[34] 邱冰峰．大黄治疗急性胰腺炎50例临床观察．福建中医药，2001：32(1)：8-9．
[35] 张建新，瞿建国，党胜春．丹参在重症急性胰腺炎非手术治疗中的作用．江苏大学学报，2004：14(5)：407-409．
[36] 胡如进，史火喜．生脉注射液治疗重症急性胰腺炎．时珍国医国药，2003：14(3)：157-158．
[37] 李燕，俞景奎，刘德全，等．川芎嗪对SAP的治疗作用．山东医药，2002：40(6)：30．
[38] 刘学民，潘承恩，刘青光，等．预防性治疗重症急性胰腺炎合并肺损伤．中国急救医学，2002：22(2)：109．
[39] 任茂才，宋林学，洪明，等．中西医结合治疗重症急性胰腺炎．肝胆胰外科杂志，2000：12(2)：78．
[40] 乔洪利，连永红．大黄牡丹汤灌肠治疗急性胰腺炎临床观察．中国中医急症，2003：12(4)：326．
[41] 林景松．大柴胡汤保留灌肠治疗急性水肿型胰腺炎23例．现代中西医结合杂志，2003：12(7)：698-699．
[42] 阴建兵，王永奇，杨坤．生大黄保留灌肠治疗急性胰腺炎34例临床观察．中国煤炭工业医学杂志，2005：8(2)：196-197．
[43] 宋文蔚，宋欣伟．参附注射液合中药灌肠对急性胰腺炎肠麻痹疗效观察．浙江中医学院学报。2005：29(3)：22-23．
[44] 朱文锋，何清湖．现代中医临床诊断学．．第1版．．北京：人民卫生出版社，2003：584．
[45] 黄华江，邹志森．大黄对急性胰腺炎炎症反应的影响．海南医学，2003：14(1)：67．
[2] Appelros S, Brogstrom B. Incidence, etiology and mortality rate of acute pancreatitis over 10 years in a defined population in Sweden. Br J Surg 1999; 86:465-470.
[3] Chris E. Forsmark(郭克建主译)．胰腺炎及其并发症，北京：人民卫生出版社，2006，第1版：6-7．
[4] Yadav D, pitchumoni CS. Issues in hypertriglyceridemic pancreatitis. J Clin Gastroenterol 2003; 36:54-62.
[5] Opie E. The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Johns Hopkins Hosp Bull 1901;12:19-21.
[6] Opie E. The etiology of acute hemorrhagic pancreatitis. Johns Hopkins Hosp Bull 1901; 12:182-188.
[7] Applebaum-Shapiro SE, Finch R, Pfutzer RH, et al. Hereditary pancreatitis in North America:the Pittsburgh-Midwest Multi-Center Pancreatic Study Group Study. Pancreatology 2001; 1:439-443.
[8] Steer ML, Meldolesi J. Pathogenesis of acute pancreatitis. Annu Rev Med 1988; 39:95-105.
[9] Grendell JH. Acute pancreatitis. Curr Opin Gastroenterol 1997; 13:381-385.
[10] Zielenski J, Tsui LC. Cystic fibrosis:genotypic and phenotypic variations. An Rev Genet 1995; 29:777-807.
[11] Mickle JE, Cutting GR. Genotype-phenotype relationships in cystic fibrosis. Med Clin North Am 2000; 84:597-607.
[12] Kristidis P, Bozon D, Corey M, et al. Genetic determination of exocrine pancreaticfunction in cystic fibrosis. AM J Hum Genet 1992; 50:1178-1182.
[13] Sten RC. The diagnosis of cystic fibrosis. N Engl J Med 1997; 336:487-491.
[14] Colomb E, Figarella C, Guy O.The two human trypsinogens. Evidence of complexfromation with basic pancreatic trypsin inhibitor-proteolytic activity. Biochim Biophys Acta 1979; 570:397-405.
[15] Rinderknecht H. Pancreatic Secretory Enzymes. In:Go VLW, DiMagno EP, Gardner JD, et al, ed. The pancreas:Biology, Pathobiology, and Disease, second edition. Raven Press, New York, 1993:219-251.
[16] Ogawa M. Pancreatic secretory trypsin inhibitor as an acute phase reactant. Chin Biochem 1988; 21; 19-25.
[17] Witt H, Luck W, Hennies HC, et al. Mutations in the gene encoding the serine protease inhibitor, kazal type 1 are associated with chronic pancreatitis. Nat Genet 2000;25:231-216.
[18] Pfutzer RH, Barmada MM, Brunskil APJ, et al. SPINK1/SPTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology 2000; 119:615-623.
[19] Whitcomb DC. How to think about SPINK and pancreatitis. AM J Gastroenterol 2002; 97:1085-1088.
[20] Kloppel G, Maillet B. Pathology of acute and chronic pancreatitis. Pancreas 1993：8：659-670．
[21] 张志宏，徐肇敏．胰腺疾病，辽宁：辽宁科学技术出版社，2005，第1版：167-179．
[22] 张肇达，严律南，刘续宝．急性胰腺炎，北京：人民卫生出版社，2004，第1版：123-124．
[23] 李洪波．中西医结合治疗急性胰腺炎86例．实用中医内科杂志，2005；19(5)：438．
[24] 吴晓华，张杨．中西医结合治疗急性胰腺炎临床观察．辽宁中医杂志，2005：32(8)：812-813．
[25] 毛盛名，蒋骞，李荣祥，等．中西医结合治疗重症急性胰腺炎．现代中西医结合杂志，2003；12(16)：1728-1729．
[26] 李娅琳，万苹，周雁．中西医结合治疗重症急性胰腺炎疗效分析．云南中医学院学报，2005；28(1)：58-59．
[27] 欧宏宇．中西医结合治疗重症急性胰腺炎临床观察．中华中医药杂志，2005：20(7)：408-409．
[28] 姚虹，姚开炳，于德洋．急性出血性胰腺炎92例诊治分析．中国中西医结合外科杂志，2001：7(3)：166-167．
[29] 吴河山．中西医结合分期辨证治疗重症急性胰腺炎Ⅱ型36例．中华实用中西医杂志，2004：4(17)：3404-3405．
[30] 尚文潘，黄穗平，余绍源，等．中西医结合治疗159急性胰腺炎临床观察．广州中医药大学学报，2005：22(6)：421-425．
[31] 余涛，黄宗文，于迎春，等．中西医结合治疗重症急性胰腺炎62例，新中医，2001：33(3)：40-41．
[32] 吕新生，张翼，李宜雄，等．甘遂治疗重症急性胰腺炎．中囡普外科杂志，2004：13(6)：401-404．
[33] 王绪华，徐瑞华．大黄对重症急性胰腺炎胃肠功能衰竭的防治作用．中国医师杂志，2004：6(2)：267-268．
[34] 邱冰峰．大黄治疗急性胰腺炎50例临床观察．福建中医药，2001：32(1)：8-9．
[35] 张建新，瞿建国，党胜春．丹参在重症急性胰腺炎非手术治疗中的作用．江苏大学学报，2004：14(5)：407-409．
[36] 胡如进，史火喜．生脉注射液治疗重症急性胰腺炎．时珍国医国药，2003：14(3)：157-158．
[37] 李燕，俞景奎，刘德全，等．川芎嗪对SAP的治疗作用．山东医药，2002：40(6)：30．
[38] 刘学民，潘承恩，刘青光，等．预防性治疗重症急性胰腺炎合并肺损伤．中国急救医学，2002：22(2)：109．
[39] 任茂才，宋林学，洪明，等．中西医结合治疗重症急性胰腺炎．肝胆胰外科杂志，2000：12(2)：78．
[40] 乔洪利，连永红．大黄牡丹汤灌肠治疗急性胰腺炎临床观察．中国中医急症，2003：12(4)：326．
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