清下化瘀方联合西医常规疗法对中重度急性胰腺炎患者胃肠道功能及预后评分系统的影响  

Effect of Qingxia Huayu decoction combined with western medicine therapy on gastrointestinal function and prognosis scoring system in patients with moderate and severe acute pancreatitis

作　　者：孔婧[1] 王晓素[1] 杜奕奇 周秉舵[1] 方盛泉[1] 熊光苏 李英[1] 唐义爽 程传奇 何聪 KONG Jing;WANG Xiaosu;DU Yiqi;ZHOU Bingduo;FANG Shengquan;XIONG Guangsu;LI Ying;TANG Yishuang;CHENG Chuanqi;HE Cong(Department of Gastroenterology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China;Department of Gastroenterology,Changhai Hospital Affiliated to Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院消化内科,上海200437 [2]海军军医大学附属长海医院消化内科,上海200433

出　　处：《上海中医药杂志》2020年第9期55-59,共5页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金面上项目(81973809);上海市卫健委进一步加快中医药事业发展三年行动计划项目[ZY(2018-2020)-FWTX-1004]。

摘　　要：目的观察清下化瘀方联合西医常规疗法对中重度急性胰腺炎患者胃肠道功能及预后评分系统的影响。方法将66例中重度急性胰腺炎患者随机分为治疗组、对照组,每组33例,对照组予西药常规治疗,治疗组在对照组治疗措施的基础上加服清下化瘀方。治疗7 d后,观察两组临床疗效及胃肠道功能恢复情况,比较中医证候积分、急性胃肠道损伤(AGI)分级评分、急性胰腺炎严重程度床边指数(BISAP)评分、急性生理和慢性健康评价指标II(APACHEⅡ)评分、CT严重指数(MCTSI)评分的变化情况。结果①试验过程中,治疗组、对照组各脱落3例,最终完成试验者60例,治疗组、对照组各30例。②治疗组、对照组总有效率分别为96.7%、83.3%,治疗组临床疗效优于对照组(P<0.05)。③治疗前后组内比较,两组中医证候积分均减少(P<0.05);组间治疗后比较,中医证候积分差值有统计学意义(P<0.05)。④随着治疗时间的延长,两组AGI分级评分逐步降低(P<0.05);治疗第3天、第7天、第14天组间比较,治疗组AGI分级评分均低于对照组(P<0.05)。⑤治疗组患者肠内营养达标时间,腹痛、腹胀、恶心呕吐、便秘消失时间早于对照组(P<0.05)。⑥治疗前后组内比较,两组BISAP评分、APACHEⅡ评分、MCTSI评分降低,差异有统计学意义(P<0.05);组间治疗后比较,治疗组BISAP评分、APACHEⅡ评分、MCTSI评分低于对照组(P<0.05)。结论与单纯采用西医常规疗法相比,加用清下化瘀方治疗中重度急性胰腺炎疗效满意,可更好地促进胃肠道功能恢复,进而改善患者的临床症状及预后。Objective To observe the effect of Qingxia Huayu decoction combined with conventional western medicine therapy on gastrointestinal function and prognosis scoring system in patients with moderate and severe acute pancreatitis.Methods Sixty-six patients with moderate and severe acute pancreatitis were randomly divided into treatment group and control group,33 cases in each group.The control group was treated with conventional western medicine,and the treatment group was treated with Qingxia Huayu decoction besides treatment measures of the control group.After 7 days of treatment,the clinical efficacy and gastrointestinal function recovery of the two groups were observed,and the changes of TCM syndrome score,acute gastrointestinal injury(AGI)score,bedside index for severity in acute pancreatitis(BISAP)score,acute physiological and chronic health evaluation II(APACHE II)score and modified computed tomography severity index(MCTSI)score were compared.Results(1)In the course of the trial,the treatment group and the control group lost 3 cases respectively,and 60 cases finally completed the trail with 30 cases in the treatment group and 30 cases in the control group.(2)The total effective rates of the treatment group andthe control group were 96.7%and 83.3%respectively,and the clinical efficacy of the treatment group was better than that of the control group(P<0.05).(3)TCM syndrome scores in both groups decreased when compared before and after treatment(P<0.05).After treatment,the difference in TCM syndrome scores between two groups was statistically significant(P<0.05).(4)With the prolongation of treatment time,AGI scores of the two groups gradually decreased(P<0.05).The AGI score of the treatment group was lower than that of the control group on the 3 rd,7 th and 14 th day of treatment(P<0.05).(5)The time of enteral nutrition reaching the standard and the elapsed time of abdominal pain,abdominal distension,nausea,vomiting and constipation in the treatment group was shorter than that in the control group(P<0.05).(6)The s

关 键 词：急性胰腺炎 重症急性胰腺炎 清下化瘀方 急性胃肠道损伤 胃畅道功能 预后 

分 类 号：R576[医药卫生—消化系统]