退黄合剂口服及保留灌肠联合大剂量丹参注射液治疗重型肝炎临床疗效观察  

A clinical observation on oral administration and retention enema of TuiHuang mixture （退黄合剂 ）combined with large doses of Danshen injection（丹参注射液） for treatment of patients with severe hepatitis

作　　者：刘光伟[1] 费景兰[1] 王春芳[1] 赵文霞[1] 

机构地区：[1]河南中医学院第一附属医院消化科,河南郑州450014

出　　处：《中国中西医结合急救杂志》2011年第4期206-208,共3页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：中国肝炎防治基金会人工肝及血液净化科技攻关项目

摘　　要：目的观察退黄合剂口服及保留灌肠联合大剂量丹参注射液治疗重型肝炎的临床疗效及可能机制。方法选择住院治疗的重型肝炎患者38例，按随机原则分为治疗组（18例）和对照组（20例）。对照组给予常规内科保肝、对症及单重血浆置换（PE）治疗；治疗组在对照组治疗基础上给予退黄合剂（茵陈蒿30g，金钱草30g，郁金20g，大黄10g）每日3次口服及每日1次保留灌肠，同时给予丹参注射液80m1每日2次静脉滴注；两组疗程均为28d。观察治疗后患者临床症状、体征的改善情况；取血测定血常规、肝功能、凝血功能、肠源性内毒素（ETM）的变化。结果治疗28d后，治疗组病死率明显低于对照组（10．0％比27．8％，P〈0．01）；脘腹胀满、倦怠乏力、口苦症状的比例明显低于对照组（50．0％、40．0％、30．00．4比94．40%、83．3％、94．4%，均P〈0．05）。两组治疗后白细胞计数（WBC）、红细胞计数（RBC）、血红蛋白（Hb）、血氨、总胆红素（TBil）、ETM均降低，凝血酶原活动度（PTA）升高；且治疗组与对照组治疗后WBC、RBC、TBil、ETM、PTA比较差异有统计学意义[WBC×10^9／L）：4．94±1．15比7．52±3．12，RBC（×10^12／L）：4．13±1．40比3．78±1．10，TBil（umol／L）：103．8±47．2比230．6±102．1，ETM（kEU／L）：0．041±0．011比0．212±0．014，PTA：（54．51±13．1）％比（44．1±12．1）％，均P〈0．05]。PLT（×10^9／L）在治疗组升高、对照组降低，两组间比较差异有统计学意义（87．9±45．4比66．9±37．4，P〈0．05）。结论退黄合剂口服及保留灌肠并联合大剂量丹参注射液可明显改善重型肝炎的高胆红素血症，缩短病程，降低病死率；其机制可能与减少内毒素吸收、促进内毒素及血氨代谢有关。Objective To observe the clinical therapeutic effect of oral administration and retention enema of Tuihuang mixture （退黄合剂） combined with large doses of Danshen injeetion（丹参注射液） for treatment of patients with severe hepatitis and its possible mechanism. Methods Thirty-eight patients with severe hepatitis from July 2008 to July 2010 hospitalized in the First Affiliated Hospital of Henan College of Traditional Chinese Medicine （TCM） were randomly divided into treatment group （18 cases） and control group （20 cases）. The patients in control group were treated with conventional medical treatment and single plasmapheresis （PE）, while the patients in treatment group were treated with Tuihuang mixture [Tarragon （茵陈蒿） 30 g, Money Grass （金钱草） 30 g, Turmeric（郁金） 20 g, Rhubarb （大黄） 10 g] 3 times per day orally and retention enema once a day, and Danshen injection （丹参注射液） 80 ml intravenous infusion twice daily on the basis of treatment in the control group. The therapeutic course was 28 days in both groups. The changes of clinical symptoms and signs, total bilirubin （TBil）, blood ammonia,blood coagulation function, intestinal endotoxemia （ETM） in both groups were observed after 28 days of treatment. Results The mortality in treatment group was significantly lower than that in the control group after 28 days of follow-up （10. 0% vs. 27.8%, P〈 0. 01）, the degrees of abdominal distention, fatigue, mouth bitterness improved obviously compared with those in the control group （50. 0%, 40. 0%, 30.0% vs. 94.0%, 83.0%, 94. 4%, all P〈0.05）. The white blood cell count （WBC）, red blood cell count （RBC） , hemoglobin （Hb）, blood ammonia, TBil, ETM in the two groups were markedly decreased and prothrombin activity （PTA） increased after treatment, there were statistical significant differences in WBC, RBC, TBil, ETM, PTA between the two groups [WBC（×10^9/L） ： 4. 94±1.15 vs. 7. 52±3.12, RBC （×10^12/L）：

关 键 词：退黄合剂 丹参注射液 重型肝炎 中药 中西医结合疗法 

分 类 号：R285.6[医药卫生—中药学] R575.1[医药卫生—中医学]