中医辨证四联疗法对急性胰腺炎患者血管活性物质的影响  

Effects of traditional Chinese medicine syndrome differentiation quadruple therapy on serum vascular active substance in patients with acute pancreatitis

作　　者：杨国红[1] 张东玲 王晓[1] 曾震军[1] 李春颖[1] Yang Guohong Zhang Dongling Wang Xiao Zeng Zhenjun Li Chunying(Department of Digestology, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450000, Henan, China The First People＇s Hospital of Zhumadian, Zhumadian 463000, Henan, China)

机构地区：[1]河南中医药大学第一附属医院脾胃肝胆科,河南郑州450000 [2]驻马店市第一人民医院,河南驻马店463000

出　　处：《中国中西医结合急救杂志》2017年第5期502-507,共6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对急性胰腺炎（AP）患者血清血栓素A2（TXA2）、前列环素（PGI2）、血小板活化因子（PAF）水平的影响.方法 选择2016年1月至2017年3月河南中医药大学第一附属医院收治的90例AP患者,按计算机产生的随机数字将患者分为观察组和对照组,每组45例.对照组给予西医常规治疗;观察组在西医常规治疗基础上根据病情辨证给予中医四联疗法,即中药灌胃〔胃肠实热证（大黄、芒硝、麸炒枳实、姜厚朴等）、肝胆湿热证（柴胡、枳实、黄芩、生大黄等）,每剂煎药汁400 mL,每次取100 mL灌胃、每4 h 1次〕、中药保留灌肠〔大黄、姜厚朴、麸炒枳实、芒硝（冲）等,每剂煎药汁400 mL,每次取200 mL直肠滴注、6 h 1次〕、中药封包外敷（乳香、没药、蒲公英、黄连等临方粉碎,以蜂蜜调和外敷胰腺体表投影处及其周围,每次1剂,每次4 h、每日1次）、静脉滴注（静滴）活血化瘀药（灯盏花素注射液100 mg加入5%葡萄糖液250 mL静滴）.比较两组患者腹痛、腹胀消失和肠鸣音、血淀粉酶、脂肪酶、C-反应蛋白（CRP）、白细胞计数（WBC）恢复至正常时间的差异;观察两组治疗前后改良CT严重指数（MCTSI）评分和血清TXA2、PAF、PGI2水平的变化.结果 观察组腹痛、腹胀消失时间均短于对照组〔腹痛消失时间（d）：5.07±1.88比6.02±1.89、腹胀消失时间（d）：3.50±1.49比4.40±1.53、均P〈0.05〕,肠鸣音、WBC、CRP、血淀粉酶及脂肪酶恢复正常时间均短于对照组〔肠鸣音（d）：4.05±1.79比5.00±1.55,WBC（d）：3.93±1.49比5.98±2.90,CRP（d）：6.17±2.46比7.92±2.84、血淀粉酶（d）：3.5（3.0,5.0）比5.0（3.0,5.5）、脂肪酶（d）：5.0（3.0,7.0）比6.5（5.0,9.0）,均P〈0.05〕;两组疗后MCTSI评分均较疗前降低,且以观察组治疗后的降低程度较对照组更显著〔分：2（0,4）比4（0,6）,P〈0.05〕.两组疗后血清TXObjective To observe the effects of traditional Chinese medicine （TCM） syndrome differentiation quadruple therapy on serum thromboxane A2 （TXA2）, prostacyclin （PGI2） and platelet activating factor （PAF） levels in patients with acute pancreatitis （AP）. Methods Ninety patients with AP admitted to the First Affiliated Hospital of Henan University of TCM from January 2016 to March 2017, and they were divided into an observation group and a control group according to the random numbers generated by computer inpatients, 45 cases in each group. The control group was given routine treatment of western medicine, and the observation group was given TCM syndrome differentiation quadruple therapy according to the patient＆#39;s disease individual situation and on the basis of western medicine treatment. The TCM syndrome differentiation quadruple therapy included the following methods： intragastric administration of TCM decoction [gastrointestinal excess heat syndrome （rhubarb, sodium sulfate, aurantii fructus immaturus, magnolia bark, etc.）, damp heat syndrome of liver and gallbladder （radix bupleuri, aurantii fructus immaturus, baical skullcap root, rhubarb, etc.）, each group of above agents immersed in water and decocted to make juice 400 mL, once 100 mL taken orally, every 4 hours]; retention enema with TCM decoction [rhubarb, magnolia bark, aurantii fructus immaturus, sodium sulfate （dissolved） etc, each dose of agents forming decoction 400 mL, 200 mL taken for proctoclysis, once every 6 hours]; Chinese medicine package （boswellin, myrrha, dandelion, coptidis rhizoma and so on crushed and mixed with honey, then applied to the body surface of the pancreas and its periphery, 1 dose each time for 4 hours, once a day ）; intravenous drip of blood-activating and stasis-resolving TCM （Dengzhanhuasu injection 100 mg added to 5% glucose solution 250 mL for intravenous drip）. The times of disappearance of abdominal distension, abdominal pain, and the recovery times of bowel sound, blood a

关 键 词：中医辨证四联疗法 胰腺炎 急性 血栓素A2 前列环素 血小板活化因子 

分 类 号：R576[医药卫生—消化系统]