通腑法治疗急性胰腺炎的临床疗效观察及对炎症因子的影响  

Clinical Observation on Therapy of Unblocking Bowels for the Treatment of Acute Pancreatitis and Its Effect on Inflammatory Factors

作　　者：吴佩珊 肖菁菁 杨丽清 周正[1] 黄广文 WU Pei-Shan;XIAO Jing-Jing;YANG Li-Qing;ZHOU Zheng;HUANG Guang-Wen(Dongguan Hospital of Guangzhou University of Chinese Medicine,Dongguan 523000 Guangdong,China)

机构地区：[1]广州中医药大学东莞医院,广东东莞523000

出　　处：《广州中医药大学学报》2023年第11期2756-2763,共8页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：东莞市科技计划医疗卫生类科研项目(编号:2011021500261);东莞市社会发展科技项目(编号:20221800900032);东莞市卫健局“周正东莞市名中医药专家传承工作室”建设项目(东卫函[2020]136号)。

摘　　要：【目的】观察基于通腑法运用大黄玄明粉泡服液联合加减大柴胡汤治疗急性胰腺炎(acute pancreatitis,AP)的临床疗效及对炎症因子的影响。【方法】将86例AP少阳阳明合病之腑实热结证患者随机分为对照组和观察组,每组各43例。对照组给予常规西医对症治疗,观察组在对照组的基础上给予服用大黄玄明粉泡服液联合加减大柴胡汤煎剂治疗。治疗1周后,评估2组患者的临床疗效、肛门排便恢复时间、腹痛缓解时间、腹胀消失时间、恶心呕吐消失时间以及总住院时间,观察2组患者治疗前后血清胰腺酶学指标[血清淀粉酶、血清脂肪酶]、炎症指标[白细胞计数(WBC)、C反应蛋白(CRP)、降钙素原(PCT)]、血清炎症因子[白细胞介素6(IL-6)、白细胞介素8(IL-8)、白细胞介素10(IL-10)和肿瘤坏死因子α(TNF-α)]水平的变化情况。【结果】(1)脱落情况:研究过程中,观察组和对照组各有2例患者脱落,最终2组各有41例患者纳入疗效统计。(2)疗效情况:治疗1周后,观察组的总有效率为85.37%(35/41),对照组为65.85%(27/41),组间比较,观察组的疗效明显优于对照组(P<0.05)。(3)临床症状体征改善情况:观察组患者的肛门排便恢复时间、腹痛缓解时间、腹胀消失时间、恶心呕吐消失时间和总住院时间均较对照组明显缩短(P<0.05)。(4)血清胰腺酶学指标情况:治疗后,2组患者的血清淀粉酶和脂肪酶水平均较治疗前明显下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.05)。(5)炎症指标情况:治疗后,2组患者的WBC、CRP、PCT水平均较治疗前明显下降(P<0.05),且观察组的下降幅度均明显优于对照组(P<0.05)。(6)血清炎症因子情况:治疗后,2组患者的血清IL-6、IL-8、TNF-α水平均较治疗前降低(P<0.05),血清IL-10水平均较治疗前升高(P<0.05),且观察组对血清IL-6、IL-8、TNF-α水平的降低幅度及对血清IL-10水平的升高幅度均明显优于对�Objective To investigate the clinical efficacy of Rhei Radix et Rhizoma and Natrii Sulfas Exsiccatus Soaking Solution combined with modified Da Chaihu Decoction following the therapy of unblocking bowels for the treatment of acute pancreatitis(AP)and to observe its effect on inflammatory factors.Methods Eighty-six AP patients with shaoyang-yangming combined syndrome of fu-organ excess and heat accumulation were randomly divided into the control group and the observation group,with 43 cases in each group.The control group was given conventional symptomatic treatment with western medicine,and the observation group was given Rhei Radix et Rhizoma and Natrii Sulfas Exsiccatus Soaking Solution combined with modified Da Chaihu Decoction on the basis of treatment for the control group.After one week of treatment,the clinical efficacy,anal defecation recovery time,abdominal pain relief time,abdominal distension disappearance time,nausea and vomiting disappearance time and total hospitalization time of the two groups were assessed,and the serum pancreatic enzymology indexes of amylase and lipase,inflammation indicators of white blood cell(WBC)count,C-reactive protein(CRP),and procalcitoninogen(PCT),serum levels of inflammatory factors of interleukin 6(IL-6),interleukin 8(IL-8),and interleukin 10(IL-10),and tumor necrosis factor alpha(TNF-α)were observed.Results(1)During the trial,2 patients in the observation group and 2 patients in the control group fell off,and finally 41 patients in each group were included for the statistics of clincal efficacy.(2)After one week of treatment,the total effective rate of the observation group was 85.37%(35/41)and that of the control group was 65.85%(27/41),and the efficacy of the observation group was significantly superior to that of the control group when compared between the two groups(P<0.05).(3)The recovery time of anal defecation,the relief time of abdominal pain,the disappearance time of abdominal distension,the disappearance time of nausea and vomiting,and the total hospitaliza

关 键 词：急性胰腺炎 少阳阳明合病之腑实热结证 通腑法 大黄玄明粉泡服液 加减大柴胡汤 临床疗效 炎症因子 

分 类 号：R269[医药卫生—中西医结合] R657.51[医药卫生—中医外科学]