ERCP联合清疏通下加减方治疗急性胆源性胰腺炎临床效果  

Clinical Effect of ERCP Combined with Qingshutong Plus or Minus Prescription in the Treatment of Acute Biliary Pancreatitis

作　　者：商倩[1] 廖振林[1] 卓振山[1] 苗园园 吴静 宋泓敏[1] 牛建海[2] SHANG Qian;LIAO Zhen-lin;ZHUO Zhen-shan;MIAO Yuan-yuan;WU Jing;SONG Hong-min;NIU Jian-hai(Department of Gastroenterology,the First Hospital of Baoding City,Baoding,Hebei 071000,China;Department of Spleen and Stomach,Baoding First Hospital of Traditional Chinese Medicine,Baoding,Hebei 071000,China)

机构地区：[1]保定市第一医院消化内科,河北保定071000 [2]保定市第一中医院脾胃科,河北保定071000

出　　处：《临床误诊误治》2022年第11期27-30,46,共5页Clinical Misdiagnosis & Mistherapy

基　　金：保定市科学技术局基金项目(1941ZF028)。

摘　　要：目的探讨内镜逆行胰胆管造影(ERCP)联合清疏通下加减方治疗急性胆源性胰腺炎(ABP)的临床效果。方法选取2019年4月—2020年7月收治的156例ABP为研究对象,按照治疗方法不同分为联合组和ERCP组,每组78例。联合组给予ERCP联合清疏通下加减方治疗,ERCP组给予ERCP治疗。比较2组治疗前及ERCP后12、24、72 h血清淀粉酶变化,比较2组康复指标、住院费用及安全性,比较2组治疗前及ERCP后3、7 d炎症指标[C反应蛋白(CRP)、降钙素原(PCT)、白细胞计数(WBC)]与肝功能指标[丙氨酸转氨酶(ALT)、直接胆红素(DBil)、γ-谷氨酰转肽酶(GGT)、天冬氨酸转氨酶(AST)]。结果ERCP后12、24、72 h,2组血清淀粉酶较治疗前呈显著降低趋势,且联合组低于ERCP组(P<0.05)。联合组腹痛缓解时间、淀粉酶恢复正常时间及住院时间均短于ERCP组(P<0.01);联合组住院费用及不同时间PCT与ERCP组比较差异无统计学意义(P>0.05)。ERCP后3、7 d,2组CRP、WBC、ALT、DBil、GGT、AST均低于治疗前,且联合组低于ERCP组(P<0.05)。联合组与ERCP组并发症发生率比较差异无统计学意义(P>0.05)。结论ERCP联合清疏通下加减方治疗ABP效果显著,可抑制炎症反应,促进肝功能恢复,加快患者康复进程,安全可靠,且不增加患者经济负担。Objective To investigate the clinical effect of endoscopic retrograde cholangiopancreatography(ERCP)combined with Qingshutong plus or minus prescription in the treatment of acute biliary pancreatitis(ABP).Methods A total of 156 cases of ABP treated from April 2019 to July 2020 were selected as the research subjects and divided into combination group(n=78)and ERCP group(n=78)according to different treatment methods.The combination group was treated with ERCP combined with Qingshutong plus or minus prescription,and the ERCP group was treated with ERCP.The changes of serum amylase before treatment and at 12,24 and 72 h after ERCP were compared between the two groups.The rehabilitation indexes,hospitalization costs and safety of the two groups were compared.The inflammatory indexes[C-reactive protein(CRP),procalcitonin(PCT),white blood cell(WBC)]and liver function indexes[alanine aminotransferase(ALT),direct bilirubin(DBil),γ-glutamyl transpeptide(GGT),aspartate aminotransferase(AST)]were compared between the two groups before treatment and at 3 and 7 d after ERCP.Results At 12,24 and 72 h after ERCP,serum amylase in the two groups was significantly decreased compared with that before treatment,which was lower in the combination group than in ERCP group(P<0.05).The time of abdominal pain relief,amylase recovery and length of hospital stay in combination group were shorter than those in ERCP group(P<0.01).There was no significant difference in hospitalization cost and PCT at different time points between the combination group and the ERCP group(P>0.05).At 3 and 7 d after ERCP,CRP,WBC,ALT,DBil,GGT and AST in the two groups were lower than those before treatment,and lower in the combination group than in the ERCP group(P<0.05).There was no significant difference in the incidence of complications between combination group and ERCP group(P>0.05).Conclusion ERCP combined with Qingshutong plus or minus prescription has a significant effect in the treatment of ABP,which can inhibit inflammatory reaction,promote the recovery

关 键 词：胰腺炎 内镜逆行胰胆管造影 清疏通下加减方 C反应蛋白 降钙素原 丙氨酸转氨酶 直接胆红素 

分 类 号：R576[医药卫生—消化系统]