清解化攻法合并高强度综合治疗在重症急性胰腺炎早期的作用
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摘要
目的:观察中医清解化攻法中胰解通腑汤联合西医早期高强度治疗重症胰腺炎的临床疗效。方法:选择本院收治的60例重症胰腺炎患者,随机数字表分法分为联合组和对照组,每组分别30例,对照组根据重症胰腺炎指南给予早期高强度的西医治疗,联合组除了早期高强度西医治疗,并予以自拟清解化攻法中胰解通腑汤联合治疗。观察指标包括:(1)血生化炎症因子指标水平:血清AMS、WBC、CRP、PCT、TNF-α、IL-6、内毒素;(2) APACHEⅡ评分、CT评分、改良Marshall评分;(3)临床体征症状:体温正常时间、腹胀痛消失时间、肠鸣音正常时间、住院时间;(4)并发症:MOFS、胰腺脓肿、假性囊肿、脓毒血症、死亡情况。结果:联合组治疗后血清AMS、WBC、CRP、PCT、TNF-α、IL-6、内毒素较对照组指标水平下降更显著(P <0. 05);联合组较对照组体温正常时间、腹胀痛消失时间、肠鸣音正常时间等临床体征症状较对照组明显更快(P <0. 05)、住院时间更短(P <0. 05);联合组并发症发生率与对照组相比显著降低(P <0. 05)。结论:采用自拟清解化攻法中胰解通腑汤联合早期高强度西医治疗治疗重症急性胰腺炎,患者症状体征、相关血生化及评分明显改善,临床疗效可,值得肯定及推广。
Objective: To observe the clinical curative effect of Yijie Tongfu Decoction which can clear and resolve and purge combined with western early high strength of severe acute pancreatitis. Methods: In our hospital 60 cases of patients with severe acute pancreatitis,according to the random number table method,were divided into the combination group and the control group,each group 30 cases respectively. In the control group,according to the early stage severe acute pancreatitis guidelines,were given western high strength treatment. The combination group were additionally given Yijie Tongfu Decoction. We observed the indicators included levels of inflammatory markers:( 1) Blood biochemical indexes: AMS,the WBC,CRP and PCT,serum TNF alpha,IL-6,endotoxin.( 2) The APACHE Ⅱ score and computed tomography( CT) score and modified Marshall score.( 3) Clinical signs symptoms: time,abdominal distension,pain disappeared time,the temperature returning to normal bowel sounds normal time and length of hospital stay.( 4) Complications: MOFS,pancreas abscess,pseudocyst,sepsis and death. Results: The combination group'sAMS,WBC,CRP and PCT,serum TNF alpha,IL-6,endotoxin levels decreased more significantly than those of the control group( P < 0. 05). The combination group' s normal time,abdominal distension,pain disappeared time normal bowel sounds,such as clinical signs and symptoms were significantly faster than those of the control group( P < 0. 05) and the hospital stay was signficantly shorter( P < 0. 05). The combination group' s complications significantly reduced compared with that of the control group( P < 0. 05). Conclusion: Yijie Tongfu Decoction combined with early high strength therapy in the treatment of severe acute pancreatitis patients' symptoms and signs can make blood biochemical and score improve significantly and the clinical curative effect is positive,worty of promotion.
Objective: To observe the clinical curative effect of Yijie Tongfu Decoction which can clear and resolve and purge combined with western early high strength of severe acute pancreatitis. Methods: In our hospital 60 cases of patients with severe acute pancreatitis,according to the random number table method,were divided into the combination group and the control group,each group 30 cases respectively. In the control group,according to the early stage severe acute pancreatitis guidelines,were given western high strength treatment. The combination group were additionally given Yijie Tongfu Decoction. We observed the indicators included levels of inflammatory markers:( 1) Blood biochemical indexes: AMS,the WBC,CRP and PCT,serum TNF alpha,IL-6,endotoxin.( 2) The APACHE Ⅱ score and computed tomography( CT) score and modified Marshall score.( 3) Clinical signs symptoms: time,abdominal distension,pain disappeared time,the temperature returning to normal bowel sounds normal time and length of hospital stay.( 4) Complications: MOFS,pancreas abscess,pseudocyst,sepsis and death. Results: The combination group'sAMS,WBC,CRP and PCT,serum TNF alpha,IL-6,endotoxin levels decreased more significantly than those of the control group( P < 0. 05). The combination group' s normal time,abdominal distension,pain disappeared time normal bowel sounds,such as clinical signs and symptoms were significantly faster than those of the control group( P < 0. 05) and the hospital stay was signficantly shorter( P < 0. 05). The combination group' s complications significantly reduced compared with that of the control group( P < 0. 05). Conclusion: Yijie Tongfu Decoction combined with early high strength therapy in the treatment of severe acute pancreatitis patients' symptoms and signs can make blood biochemical and score improve significantly and the clinical curative effect is positive,worty of promotion.
引文
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[11]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[12]Italian Association for the Study of the Pancreas(AISP),Pezzilli R,Zerbi A,et al.Consensus guidelines on severe acute pancreatitis[J].Dig Liver Dis,2015,47(7):532-543.
[13]Scott Tenner,John Baillie,John De Witt,et al.American College of Gastroenterology Guideline:Management of Acute Pancreatitis[J].Am J Gastroenterol,2013,108(9):1415-1416.
[14]唐历,刘施材,王政强,等.重症急性胰腺炎早期保守治疗的关键点[J].同济大学学报(医学版),2015,36(4):101-103.
[15]李非,陈宏,杨磊,等.重症急性胰腺炎早期脏器功能不全持续时间与治疗对策[J].中华外科杂志,2007,45(11):736-739.
[16]王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013年,上海)[J].胃肠病学,2013,18(7):428-433.
[17]Mao EQ,Tang YQ,Fei J,et al.Fluid therapy for severe acute pancreatitis in acute response stage[J].Chin Med J(Engl),2009,122:169-173.
[18]张声生,李慧臻.急性胰腺炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(9):4085-4088.
[19]苗彬,崔乃强,李忠廉,等.早期通里攻下法对重症急性胰腺炎结局影响的系统评价[J].世界华人消化杂志,2009,17(10):1042-1047.
[20]王昊峰.大柴胡汤加减联合西药治疗重症急性胰腺炎临床观察[J].新中医,2016,55(10):71-72.
[21]舒建胜.生大黄辅助治疗重症急性胰腺炎临床疗效研究[J].辽宁中医杂志,2013,40(6):1137-1138.
[22]方怡,叶静,黎贵湘.芒硝外敷腹部治疗重症急性胰腺炎疼痛及腹腔积液的疗效观察[J].华西医学,2015,30(3):510-511.
[23]王友帆,罗良坚.丹参注射液对重症急性胰腺炎患者的治疗作用及对血黏度的影响[J].中国中西医结合消化杂志,2013,21(6):296-298.
[24]王林,余亮科,王原,等.大黄素对重症急性胰腺炎大鼠肠黏膜屏障的分子保护机制[J].中国老年学杂志,2012,32(11):2319-2320.
[2]崔云峰,屈振亮,齐清会,等.重症急性胰腺炎中西医结合诊治指南(2014年,天津)[J].中国中西医结合外科杂志,2014,20(4):460-464.
[3]中华医学会外科学分会胰腺外科学组.重症急性胰腺炎诊治指南[J].中华外科杂志,2007,45(11):727-729.
[4]中国中西医结合普通外科专业委员会.重症急性胰腺炎中西医结合诊治常规(草案)[J].中国中西医结合外科杂志,2007,13(3):232-237.
[5]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis-2012:revision of the Atlanta classification and definitions by international consensus[J].Gut,2013,62(1):102-111.
[6]Banks PA,Bollen TL,Dervenis C,et al.Classification of acute pancreatitis-2012:revision of Atlanta classification and definitions by international consensus[J].Gut,2013,62:102-111.
[7]李萌芳,任晓蕊,支绍册,等.老年重症急性胰腺炎患者的临床特点及预后分析[J].医学研究杂志,2017,46(1):84-87.
[8]Tenner S,Baillie J,Dewitt J,et al.American college of gastroenterology guideline:Management of acute pancreatitis[J].Am J Gastroenterol,2013(9):1400-1415.
[9]Working Group IAP/APA Acute Pancreatitis Guidelines.IAP/APAevidence-based guidelines for the management of acute pancreatitis[J].Pancreatology,2013,13(4 Suppl 2):e1-15.
[10]Yokoe M,Takada T,Mayumi T,et al.Japanese guidelines for the management of acute pancreatitis:Japanese Guidelines 2015[J].JHepatobiliary Pancreat Sci,2015,22(6):405-432.
[11]中华医学会外科学分会胰腺外科学组.急性胰腺炎诊治指南(2014)[J].中国实用外科杂志,2015,35(1):4-7.
[12]Italian Association for the Study of the Pancreas(AISP),Pezzilli R,Zerbi A,et al.Consensus guidelines on severe acute pancreatitis[J].Dig Liver Dis,2015,47(7):532-543.
[13]Scott Tenner,John Baillie,John De Witt,et al.American College of Gastroenterology Guideline:Management of Acute Pancreatitis[J].Am J Gastroenterol,2013,108(9):1415-1416.
[14]唐历,刘施材,王政强,等.重症急性胰腺炎早期保守治疗的关键点[J].同济大学学报(医学版),2015,36(4):101-103.
[15]李非,陈宏,杨磊,等.重症急性胰腺炎早期脏器功能不全持续时间与治疗对策[J].中华外科杂志,2007,45(11):736-739.
[16]王兴鹏,李兆申,袁耀宗,等.中国急性胰腺炎诊治指南(2013年,上海)[J].胃肠病学,2013,18(7):428-433.
[17]Mao EQ,Tang YQ,Fei J,et al.Fluid therapy for severe acute pancreatitis in acute response stage[J].Chin Med J(Engl),2009,122:169-173.
[18]张声生,李慧臻.急性胰腺炎中医诊疗专家共识意见(2017)[J].中华中医药杂志,2017,32(9):4085-4088.
[19]苗彬,崔乃强,李忠廉,等.早期通里攻下法对重症急性胰腺炎结局影响的系统评价[J].世界华人消化杂志,2009,17(10):1042-1047.
[20]王昊峰.大柴胡汤加减联合西药治疗重症急性胰腺炎临床观察[J].新中医,2016,55(10):71-72.
[21]舒建胜.生大黄辅助治疗重症急性胰腺炎临床疗效研究[J].辽宁中医杂志,2013,40(6):1137-1138.
[22]方怡,叶静,黎贵湘.芒硝外敷腹部治疗重症急性胰腺炎疼痛及腹腔积液的疗效观察[J].华西医学,2015,30(3):510-511.
[23]王友帆,罗良坚.丹参注射液对重症急性胰腺炎患者的治疗作用及对血黏度的影响[J].中国中西医结合消化杂志,2013,21(6):296-298.
[24]王林,余亮科,王原,等.大黄素对重症急性胰腺炎大鼠肠黏膜屏障的分子保护机制[J].中国老年学杂志,2012,32(11):2319-2320.