大柴胡汤口服联合芒硝外敷治疗ERCP术后胰腺炎的临床疗效研究  

Clinical Effect of Dachaihu Decoction Oral Administration Combined with Mirabilite External Application on Post-ERCP Pancreatitis

作　　者：陈萌[1] 吕婵[1] 蔡淦[1] 王娴娴 李甫[1] 吴静怡 李涛[1] 刘畅[1] CHEN Meng;LYU Chan;CAI Gan;WANG Xianxian;LI Fu;WU Jingyi;LI Tao;LIU Chang(Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China)

机构地区：[1]上海中医药大学附属曙光医院,上海201203 [2]上海中医药大学附属普陀医院,上海200062

出　　处：《中药新药与临床药理》2022年第10期1415-1421,共7页Traditional Chinese Drug Research and Clinical Pharmacology

基　　金：蔡淦全国名中医传承工作室项目(MZYGZS-2017003);国家自然科学基金项目(81904017);上海市科学技术委员会科研计划项目(19401972400);上海市进一步加快中医药事业发展三年行动计划[ZY(2018-2020)-FWTX-1105]。

摘　　要：目的 探讨大柴胡汤口服联合芒硝外敷治疗内镜逆行胰胆管造影术(ERCP)术后胰腺炎(腑实热结证)的临床疗效。方法 将102例ERCP术后胰腺炎(腑实热结证)患者随机分为对照组(51例)和治疗组(51例)。两组患者均进行常规治疗,治疗组加用大柴胡汤口服,并联合芒硝外敷治疗,疗程为7 d。观察两组患者的临床疗效、腹痛视觉模拟量表(VAS)评分、临床转归情况、炎症指标水平变化,并评估2组患者改良计算机断层扫描的严重指数(MCTSI)评分、急性生理学与慢性健康状况评分II(APACHE II)。结果 (1)对照组脱落3例,完成研究48例;治疗组脱落1例,完成研究50例。(2)治疗组的总有效率94.00%(47/50),高于对照组的81.25%(39/48),差异有统计学意义(P<0.05)。(3)治疗后,两组患者的VAS评分在治疗第3天、治疗第7天较治疗前均明显下降(P<0.05),且治疗组患者治疗第3天VAS评分低于对照组(P<0.05)。(4)治疗组腹痛消失时间、首次排便时间以及肠鸣音、血清淀粉酶、白细胞的复常时间均短于对照组(P<0.05)。(5)治疗后两组患者的血清C-反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)、白细胞介素(IL)-1、IL-6、IL-8含量较治疗前均明显下降(P<0.05),IL-10水平较术后均明显上升(P<0.05);治疗第3天,治疗组患者的血清CRP、TNF-α、IL-1、IL-6水平均明显低于对照组(P<0.05),IL-10水平明显高于对照组(P<0.05);治疗第7天,治疗组患者血清CRP、TNF-α、IL-1、IL-6水平均明显低于对照组(P<0.05)。(6)治疗第7天,治疗组MCTSI评分以及ApacheⅡ评分均明显低于对照组(P<0.05)。(7)治疗期间两组均未发现与治疗相关的明显不良反应。结论 大柴胡汤口服联合芒硝外敷治疗ERCP术后胰腺炎,能快速缓解临床症状,减轻炎症反应,降低ERCP术后胰腺炎严重程度,改善预后,且安全性较好。Objective To investigate the clinical efficacy of Dachaihu Decoction oral administration combined with mirabilite external application on post-ERCP pancreatitis(PEP). Methods A total of 102 patients with PEP with viscera-excess and heat accumulation syndrome were randomly divided into control group(51 cases)and treatment group(51 cases). Both groups received conventional treatment, and the treatment group was additionally treated with oral administration of Dachaihu Decoction and external application of mirabilite, with a course of 7days. Clinical efficacy,VAS score,clinical outcome and the levels of inflammatory markers(IL-1,IL-6,IL-8,IL-10),MCTSI score,APACHE II score were evaluated in two groups. Results(1)In the control group,3 cases fell off and 48 cases completed the study. In the treatment group, 1 case fell off and 50 cases completed the study.(2)The total effective rate of the treatment group was 94.00%(47/50),which was higher than that of the control group(81.25%,39/48),and the difference was statistically significant(P<0.05).(3)VAS score of two groups on the 3rd and 7th day of treatment were significantly lower than those before treatment(P<0.05),and VAS score of treatment group on the 3rd day of treatment was lower than that of control group(P<0.05).(4) The disappearance time of abdominal pain,first defecation time,and borborygmus,serum amylase and white blood cell recovery time in the treatment group were shorter than those in the control group(P<0.05).(5)After treatment,CRP,TNF-α,IL-1,IL-6 and IL-8 in two groups were significantly decreased compared with those before treatment(P<0.05),while IL-10 was significantly increased compared with that before treatment(P<0.05). On the 3rd day of treatment,the levels of CRP,TNF-α,IL-1 and IL-6 in the treatment group were significantly lower than those in the control group(P<0.05),and the level of IL-10 was significantly higher than that in the control group(P<0.05). On 7th day of treatment, the levels of CRP, TNF-α, IL-1 and IL-6 in the treatment group were

关 键 词：大柴胡汤 芒硝 内镜下逆行胰胆管造影术 胰腺炎 疗效分析 

分 类 号：R285.6[医药卫生—中药学]