中药三联疗法联合西医常规治疗重症急性胰腺炎瘀毒互结证患者41例临床观察  

Forty-one Cases of Severe Acute Pancreatitis with Binding of Blood Stasis and Toxins Pattern Treated by Chinese Herbal Medicine-based Triple Therapy in Combination with Western Medicine

作　　者：李梦阁 党志博 张广玉[1] 王宇亮[1] 钤培国 党中勤[1] LI Mengge;DANG Zhibo;ZHANG Guangyu;WANG Yuliang;QIAN Peiguo;DANG Zhongqin(Henan Province Hospital of Traditional Chinese Medicine,Zhengzhou,450002;Dongzhimen Hospital,Beijing University of Chinese Medicine)

机构地区：[1]河南省中医院,河南省郑州市450002 [2]北京中医药大学东直门医院

出　　处：《中医杂志》2021年第11期961-965,共5页Journal of Traditional Chinese Medicine

基　　金：2018年度河南省中医药科学研究专项(2018ZY2004);国家中医药管理局中医药循证能力建设项目(2019XZZX-XH005)。

摘　　要：目的观察中药三联疗法联合西医常规治疗重症急性胰腺炎(SAP)瘀毒互结证的临床疗效并探讨其可能机制。方法将88例SAP瘀毒互结证患者随机分为观察组和对照组各44例。对照组给予西医常规治疗,观察组在对照组治疗基础上给予中药三联疗法(鼻饲或口服清胰利胆方汤、清腑灌肠方中药保留灌肠、硝黄塌渍方外敷),连续治疗7天。治疗前后比较两组患者中医症状及体征(包括发热、腹痛腹胀、压痛、反跳痛、大便不通)评分,并评价中医证候疗效;分别于治疗前及治疗第3天、第7天测定生化指标[包括血淀粉酶(AMS)、尿淀粉酶(UAMY)、丙氨酸氨基转移酶(ALT)、门冬氨酸氨基转移酶(AST)、总胆红素(TBiL)]、炎症指标[包括C反应蛋白(CRP)、核因子κB p65(NF-κB p65)、肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)]水平。结果治疗期间两组均有3例患者脱落。与治疗前比较,治疗后两组患者发热、腹痛腹胀、压痛、反跳痛、大便不通评分均显著降低(P<0.05),且治疗后观察组均低于对照组(P<0.05)。观察组中医证候疗效总有效率为97.56%,对照组为70.73%,观察组优于对照组(P<0.01);与本组治疗前比较,两组治疗第3天AMS、UAMY、ALT、AST、TBiL、NF-κB p65、CRP、TNF-α、IL-6水平均明显降低,且治疗第7天较治疗第3天亦显著降低(P<0.05);治疗第3天、7天观察组生化指标及炎症指标改善情况均优于对照组(P<0.05)。结论中药三联疗法联合西医常规治疗SAP瘀毒互结证患者可提高临床疗效,明显改善肝功能及临床症状,且优于单用西医常规治疗,其机制可能与抑制炎症因子有关。Objective To observe the clinical effect of Chinese herbal medicine(CHM)-based triple therapy combined with western medicine in treatment of severe acute pancreatitis(SAP) with binding of blood stasis and toxins pattern as well as the underlying possible mechanism. Methods Eighty-eight SAP patients with binding of blood stasis and toxins pattern were randomized into treatment group and control group with 44 patients in each group. The control group was treated with conventional western medicine, and the treatment group additionally received CHM-based triple therapy including nasal feeding or oral administration of Qingyi Lidan Formula(清胰利胆方), enema with Qingfu Guanchang Formula(清腑灌肠方) and external application of Xiaohuag Tazi Formula(硝黄塌渍方), administered for seven days. The scores of traditional Chinese medicine(TCM) symptoms and signs including fever, abdominal pain and distension, tenderness, rebound tenderness, and constipation were compared between groups before and after treatment, and the syndrome-related clinical effectiveness was evaluated;biochemistry indicators including serum amylase(AMS), urine amylase(UAMY), alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TBiL) and inflammation indicators including C-reactive protein(CRP), nuclear factor κB p65(NF-κB p65), tumor necrosis factor α(TNF-α), interleukin 6(IL-6) were assessed before treatment and at the 3 rd and 7 th day after treatment. Results There were three cases of drop-outs in each group. The scores of fever, abdominal pain and distension, tenderness, rebound tenderness, and constipation of both groups significantly decreased after treatment(P<0.05), and more changes were seen in treatment group(P<0.05). The syndrome-related total effectiveness rate of treatment group was 97.56%, significantly higher than 70.73% of control group(P<0.01). The levels of AMS, UAMY, ALT, AST, TBiL, NF-κB p65, CRP, TNF-α and IL-6 measured on the 3 rd day after treatment significantly decreased in both g

关 键 词：重症急性胰腺炎 肝损伤 瘀毒互结证 中药三联疗法 清胰利胆方 清腑灌肠方 硝黄塌渍方 

分 类 号：R576[医药卫生—消化系统]