清解化攻汤结合西医常规疗法治疗重症急性胰腺炎早期合并胆石症(胆总管结石)临床研究  

Clinical observation of Qingjie Huagong Decoction combined with western medicine in the treatment of severe acute pancreatitis complicated with cholelithiasis(bile duct stones)

作　　者：郑日辉 陈国忠[2] 唐曦平 袁铁超 杨昕 秦百君 谢彩杏 Zheng Rihui;Chen Guozhong;Tang Xiping;Yuan Tiechao;Yang Xin;Qin Baijun;Xie Caixing(Master Degree Student of Grade 2019,Guangxi University of Chinese Medicine,Nanning 530001,China;Department of Spleen and Stomach Diseases,First Affiliated Hospital of Guangxi University of Chinese Medicine,Nanning 530023,China;Digestive Endoscopy Center,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西中医药大学,南宁530001 [2]广西中医药大学第一附属医院脾胃病科,南宁530023 [3]广西医科大学附属肿瘤医院内镜中心,南宁530021

出　　处：《国际中医中药杂志》2022年第2期145-149,共5页International Journal of Traditional Chinese Medicine

基　　金：广西自然科学基金(2020GXNSFAA238004);广西研究生教育创新计划资助项目(YCXJ2021033)。

摘　　要：目的评价清解化攻汤联合西医常规疗法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)早期合并胆石症(胆总管结石)的临床疗效。方法将符合入选标准的2017年1月-2020年1月广西中医药大学第一附属医院32例SAP早期合并胆石症住院患者,采用随机数字表法分为2组,每组16例。对照组予内镜逆行胰胆管造影术+西医常规疗法治疗,治疗组在对照组基础上加用清解化攻汤治疗。2组均治疗14 d。采用碘-淀粉比色法检测血清淀粉酶(serum amylase,AMS),连续监测法检测GOT、GPT,免疫透射比浊法检测CRP、IL-6、降钙素原(PCT);采用急性生理和慢性健康状况评分Ⅱ(APACHEⅡ)、CT严重指数评分(CTSI)及改良Marshall评分评价SAP严重程度;观察并记录体温恢复正常时间、腹胀痛缓解时间、肠鸣音恢复时间、总住院时间,评价临床疗效。结果治疗组总有效率为93.8%(15/16)、对照组为75.0%(12/16),2组比较差异有统计学意义(χ^(2)=8.19,P=0.042)。治疗组治疗后血清AMS、WBC、CRP、PCT、GOT、GPT、IL-6水平均低于对照组(t值分别为14.30、7.24、9.63、5.48、7.05、7.33、28.34,P值均<0.01);体温恢复至正常时间[(2.91±0.12)d比(3.78±0.38)d,t=8.76]、腹胀痛缓解时间[(4.77±0.68)d比(7.13±1.55)d,t=9.52]、肠鸣音恢复时间[(3.90±1.80)d比(4.89±1.38)d,t=2.98]、总住院时间[(22.60±2.80)d比(30.37±3.89)d,t=7.88]均较对照组缩短(P<0.01);APACHEⅡ、CTSI及改良Marshall评分均低于对照组(t值分别为11.82、12.72、7.71,P<0.01)。结论清解化攻汤结合内镜逆行胰胆管造影术+西医常规疗法可有效降低SAP早期合并胆石症患者的炎症水平,快速缓解症状,提高疗效。Objective To evaluate the clinical efficacy of TCM Qingjie Huagong Decoction combined with routine internal medicine in the treatment of severe acute pancreatitis with cholelithiasis(bile duct stones)in the early stage.Methods Thirty-two patients with severe acute pancreatitis combined with cholelithiasis in the first affiliated Hospital of GuangXi University of Traditional Chinese Medicine were selected and randomly divided into two groups with 16 in each,both groups were treated for 14 days.Serum amylase(AMS)was detected by iodine-starch colorimetry,GOT and GPT were detected by continuous monitoring method,and CRP,IL-6 and procalcitonin(PCT)were detected by immune transmission turbidimetry.Acute Physiological and Chronic Health ScoreⅡ(APACHEⅡ),CT Severity Index Score(CTSI)and Modified Marshall Score were used to evaluate the severity of SAP.The recovery time of body temperature,the relief time of abdominal distension pain,the recovery time of bowel sounds and the total hospital stay were observed and recorded to evaluate the clinical effect.Results The total effective rate was 93.8%(15/16)in the treatment group and 75.0%(12/16)in the control group.There was significant difference between the two groups(χ^(2)=8.19,P=0.042).After treatment,the level of AMS,WBC,CRP,PCT,AST,ALT and IL-6 in the treatment group were lower than those in the control group(t values were 14.3,7.24,9.63,5.48,7.05,7.33,28.34,respectively,all Ps<0.05);After treatment,the time for body temperature to return to normal[(2.91±0.12)d vs.(3.78±0.38)d,t=8.76],the time for relief of abdominal distension pain[(4.77±0.68)d vs.(7.13±1.55)d,t=9.52],the time for recovery of bowel sounds[(3.90±1.80)d vs.(4.89±1.38)d,t=2.98]and the total hospital stay[(22.60±2.80)d vs.(30.37±3.89)d,t=7.88]in the treatment group were all significantly shorter than those in the control group(P<0.01);APACHEⅡ,CTSI and the Modified Marshall Score in the treatment group were lower than those in the control group(t values were 11.82,12.72,7.71,respectively,all Ps<

关 键 词：胰腺炎 重症急性胰腺炎 胆石症 清解化攻汤 中西医结合疗法 

分 类 号：R576[医药卫生—消化系统] R575.62[医药卫生—内科学]