利胆排石汤保守治疗慢性胆囊炎的临床分析  

Clinical Analysis of Lidan Paishi Tang in Expectant Treatment of Chronic Cholecystitis

作　　者：张洁靖[1] 李汉智[1] 

机构地区：[1]南阳医学高等专科学校第一附属医院,河南南阳473058

出　　处：《中国实验方剂学杂志》2016年第7期187-190,共4页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：河南省科技攻关计划项目(132102310175)

摘　　要：目的:探讨利胆排石汤保守治疗慢性胆囊炎肝胆气滞证的临床疗效以及对血清瘦素(LEP)和肿瘤坏死因子-α(TNF-α)水平的影响。方法:选择慢性胆囊炎患者120例,随机按数字表法分为对照组和治疗组各60例,剔除脱落和遗失病例,对照组实际完成病例59例,治疗组实际完成58例;对照组参照《中国慢性胆囊炎、胆囊结石内科诊疗共识意见》治疗,急性发作期采用硝酸甘油片,0.5 mg舌下含服,1次/4 h;盐酸异丙嗪片口服,2片/次,2次/d;消化不良者应用复方阿嗪米特肠溶片,2片/次,3次/d;抗感染采用注射用哌拉西林钠他唑巴坦钠,4.5 g/次,用250 m L 5%葡萄糖注射液稀释,静脉滴注,2次/d;甲硝唑片,3片/次,3次/d,口服。治疗组在对照组治疗的基础上加用利胆排石汤治疗,1剂/d,常规水煎煮2次,分早晚2次内服;两组患者均给予4周治疗。比较两组治疗前后中医临床症状评分、胆囊壁厚度以及胆囊收缩功能;检测两组LEP和TNF-α水平。结果:治疗组治疗后中医临床症状积分均明显低于对照组(P<0.01);治疗组临床总有效率为93.1%,对照组为76.27%,治疗组优于对照组(P<0.05);治疗组治疗后胆囊收缩功能显著高于对照组,而胆囊壁厚度明显低于对照组(P<0.01);治疗后治疗组血清LEP和TNF-α水平均明显低于对照组,比较差异均有统计学意义(P<0.01)。结论:利胆排石汤联合保守治疗慢性胆囊炎肝胆气滞证可明显改善中医临床症状积分,增强胆囊收缩功能,减少胆囊壁厚度,提高临床治疗效果,降低患者血清LEP和TNF-α水平。Objective： To investigate the efficacy of Lidan Paishi Tang in expectant treatment of chronic cholecystitis（ liver and qi stagnation syndrome type） and observe its effect on levels of leptin（ LEP） and tumor necrosis factor-α（ TNF-α）. Method： One hundred and twenty chronic cholecystitis patients in our hospital were randomly divided into control group（ 60 cases） and treatment group（ 60 cases） according to random number table.By subtracting the shedding and exclusion cases,actually 59 patients in control group and 58 patients in treatment group completed this study. By referring to Chinese consensus on the medical diagnosis and treatment of chronic cholecystitis and gallstones,patients of control group in acute attack period were treated with nitroglycerin tablets（ 0. 5 mg sublingually,1 time /4 hours）,promethazine hydrochloride tablets orally（ 2 tablets/time,bid）.Patients with poor digestion were treated with compound azintamide enteric-coated tablets（ 2 tablets / time,tid）.Those with infection were treated with intravenous drip of piperacillin sodium and tazobactam sodium（ 4. 5 g /time）,diluted by 5% glucose,bid. Metronidazole tablets orally（ 3 tablets / d,tid）. Patients in treatment group were also treated with Lidan Paishi Tang（ 1 dose / d,bid） based on the treatment in control group. The treatment course was 4 weeks for both groups. The traditional Chinese medicine（ TCM） symptom scores,gallbladder wall thickness and gallbladder contract function in two groups were compared before and after treatment. The levels of LEP and TNF-α in serum were detected in two groups. Result： The TCM symptom scores in treatment group were significantly lower than those in control group after treatment（ P〈 0. 01）. The total efficacy of treatment group was93. 1%,higher than 76. 27% in control group（ P〈 0. 05）. Compared with control group,gallbladder contract function was significantly higher and gallbladder wall thickness was significantly lower in treatment group

关 键 词：利胆排石汤 慢性胆囊炎 肝胆气滞证 瘦素 肿瘤坏死因子-α 

分 类 号：R287[医药卫生—中药学]