中医辨证四联疗法治疗急性胰腺炎的临床疗效及对血清炎性因子的影响  

The clinical therapeutic effect of quadruple therapy of traditional Chinese medicine syndrome differentiation for treatment of patients with acute pancreatitis and its influence on serum inflammatory cytokines

作　　者：杨国红[1] 朱沛文 王晓[1] 曾震军[1] 李春颖[1] 李合国[1] 

机构地区：[1]河南中医学院第一附属医院脾胃肝胆科,河南郑州450000 [2]河南省中医院肝胆脾胃科,河南郑州450002

出　　处：《中国中西医结合急救杂志》2015年第5期499-503,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：河南省中医药科研专项课题（2014ZY02099）

摘　　要：目的 观察中医辨证四联疗法治疗急性胰腺炎（AP）的临床疗效及对患者血清炎性因子的影响.方法 采用前瞻性研究方法.将2014年4月至2015年4月河南中医学院第一附属医院脾胃肝胆科收治的83例AP患者按随机数字表法分为中西医结合治疗组（43例）和西医对照组（40例）.两组均予常规西医对症支持治疗,中西医结合治疗组同时加用中医辨证四联疗法.① 中药灌胃：肝胆湿热证方药采用柴胡、生大黄、枳实、黄芩、清半夏、白芍等;胃肠实热证方药采用大承气汤（大黄、枳实、厚朴、芒硝）,辨证后制备成中药煎剂100 mL,每4 h经胃管注入1次,夹闭1 h后开放.② 灌肠：方药采用大承气汤加桃仁、莱菔子等,煎剂200 mL,每6 h高位（距肛门20 cm）保留灌肠1次.③ 外敷：方药采用乳香、没药、黄柏、黄芩、黄连、蒲公英等研末,凡士林调和外敷胰腺体表投影处,荷叶外覆包扎,每日1次.④ 静脉滴注（静滴）灯盏花素注射液40 mL/d;伴有气阴两虚、心悸、休克者静滴生脉注射液40 mL/d;阳气欲脱者用参附注射液40 mL/d 静滴;瘀毒互结者用血必净注射液100 mL/d静滴.观察两组患者腹胀、腹痛消失时间,肠鸣音、血淀粉酶（AMS）、脂肪酶、C-反应蛋白（CRP）、白细胞计数（WBC）恢复正常时间,治疗前后修正的CT严重指数（MCTSI）评分的变化,以及治疗前和治疗后7 d、14 d血清肿瘤坏死因子-α（TNF-α）、白细胞介素-8（IL-8）、细胞间黏附分子-1（ICAM-1）水平.结果 中西医结合治疗组腹胀消失时间（d：3.79±1.93比5.12±2.41）、腹痛消失时间（d：3.81±1.94比5.45±2.27）、肠鸣音恢复时间（d：3.67±1.86比5.15±2.17）、AMS恢复正常时间（d：3.78±1.92比5.27±2.63）、脂肪酶恢复正常时间（d：5.13±2.47比6.23±2.87）、CRP恢复正常时间（d：7.07±2.89比8.91±2.75）、WBC恢复正常时间（d：4.14±2.18比5.94±2.78）均较西医�Objective To observe the clinical effect of quadruple therapy of traditional Chinese medicine （TCM） syndrome differentiation for treatment of patients with acute pancreatitis （AP） and its influence on serum inflammatory cytokines.Methods A prospective study was conducted, and 83 patients with AP in Department of Digestology of the First Affiliated Hospital of Henan University of TCM from April 2014 to April 2015 were divided into combined TCM and western medicine treatment group （43 cases） and western medicine control group （40 cases） by random number table method. Conventional western medicine treatment was given to both groups, and the combined treatment group was additionally treated by the quadruple therapy of the TCM syndrome differentiation, including： ① Intra-gastric administration of TCM decoction： in cases with liver and gallbladder damp heat syndrome, the formula of radix bupleuri, radix et rhizoma rhei, Aurantii Fructus Immaturus, scutellaria, pinellia, radix paeoniae alba, etc was used, and in cases with gastrointestinal repletion heat syndromes, Dachengqi decoction was applied （ingredients： rhubarb, Aurantii Fructus Immaturus, magnolia bark, glauber＆#39;s salt）. After differentiation of syndromes, the TCM decoction 100 mL was prepared for corresponding patients. The decoction was injected through a stomach tube, once every 4 hours, after once injection the tube was closed by a clip for 1 hour and then opened. ② Enema： 200 mL Dachengqi decoction with addition of peach seed, radish seed, etc. was used for high retention enema （20 cm from the anus）, once every 6 hours. ③ External application： the external applied agent was prepared by vaseline evenly mixed with powders of following ingredients： frankincense, myrrh, phellodendron bark, scutellaria, coptis, dandelion, and dressed on the body surface of pancreatic region, covered with lotus leaf once a day. ④ Intravenous drip （IV） of Breviscapine injection 40 mL/d; in cases with Qi and Yin deficiency, heart

关 键 词：中医辨证四联疗法 胰腺炎 急性 肿瘤坏死因子-Α 白细胞介素-8 细胞间黏附分子-1 

分 类 号：R765.21[医药卫生—耳鼻咽喉科]