茵陈蒿汤治疗热重于湿证阻塞性黄疸患者的临床疗效研究  

Observation on clinical efficacy of Yinchenhao decoction combined with conventional treatment in patients with obstructive jaundice of heat heavier than dampness syndrome

作　　者：刘军舰 袁红霞[2] 张井虹 陈帅 张德林 李鸿侠 李忠廉 张西波 LIU Jun-jian;YUAN Hongxia;ZHANG Jing-hong(Tianjin Hospital of Integrated Traditional Chinese and Western Medicine,Tianjin(300100),China)

机构地区：[1]天津市中西医结合医院,天津300100 [2]天津中医药大学,天津301617 [3]南昌大学第一附属医院,南昌330052 [4]徐州市中医院,徐州221003

出　　处：《中国中西医结合外科杂志》2024年第1期90-94,共5页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：国家自然科学基金面上项目(81273952);天津市应用基础研究多元投入基金(21JCZDJC01150);天津市卫生健康委员会中医中西医结合科研课题(2021042);天津市教委科研计划项目(2022KJ271);天津市卫生健康委员会中医药重点领域科研项目(2019003);袁红霞天津市名中医传承工作室建设项目;天津市“131”创新型第一层次人才培养工程(张西波)。

摘　　要：目的:探讨茵陈蒿汤联合常规治疗对热重于湿证阻塞性黄疸患者的临床疗效。方法:选取2020年6月-2021年12月天津市南开医院收治的热重于湿证阻塞性黄疸(良、恶性胆道梗阻均可)96例,随机分为对照组和治疗组,每组48例,所有患者行手术、内镜取石或置入胆道支架等操作解除梗阻。术后,对照组给予常规治疗(丁二磺酸腺苷蛋氨酸肠溶片),观察组在对照组基础上加用茵陈蒿汤,疗程1周。检测患者黄疸指标[总胆红素(TBIL)、直接胆红素(DBIL)]、肝功能[谷丙转氨酶(ALT)、谷氨酰转移酶(GGT)]、血总胆汁酸(TBA)、尿TBA、中医证候评分、临床疗效变化。结果:与术后第1天比较,两组患者解除胆道梗阻后第7天的TBIL、DBIL、ALT、GGT、血TBA均有所降低(P<0.05),与对照组比较,治疗组降低更明显(P<0.05);两组患者尿TBA、24h尿量均增加(P <0.05),与对照组比较,治疗组增加更加明显(P <0.05)。治疗组中医症状量化评分低于对照组(P <0.05);治疗组总有效率优于对照组(P <0.05)。两组不良反应发生率比较差异无统计学意义(P>0.05)。结论:阻塞性黄疸热重于湿证患者胆道梗阻解除后,给予茵陈蒿汤联合常规治疗可以促进患者胆汁酸排泄,减轻黄疸,保护肝功能,有效改善患者中医临床症状,进而提高患者的临床治疗有效率,耐受性较好。Objective To explore the clinical efficacy of Yinchenhao decoction in combination with conventional treatment for patients suffering from obstructive jaundice and hot over dampness syndrome.Methods 96 patients with obstructive jaundice admitted to Nankai Hospital in Tianjin from June 2020 to December 2021 were selected,and they were randomly divided into a control group and a treatment group,with 48 individuals in each group.The control group received conventional treatment(ATP adenosine uridine triphosphate enteric-coated capsules)while the treatment group was given Yinchenhao Tang in addition to the conventional treatment.The treatment course lasted for one week.The study measured the following indicators:jaundice index(TBIL and DBIL),liver function(GGT and ALT),blood bile acid(TBA),urine bile acid,traditional Chinese medicine syndrome score and clinical efficacy.Results Compared to the first day after surgery,both groups of patients exhibited a decrease in TBIL,DBIL,ALT,GGT and blood TBA levels on the 7th day after relieving biliary obstruction(P<0.05).The treatment group showed a more significant decrease when compared to the control group(P<0.05).Additionally,both groups of patients experienced an increase in urinary TBA levels and 24-hour urine volume(P<0.05),with the treatment group demonstrating a more significant increase compared to the control group(P<0.05).The treatment group displayed a lower quantitative score of traditional Chinese medicine symptoms in comparison to the control group(P<0.05).Furthermore,the treatment group exhibited a higher total effective rate of disease treatment than the control group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion Relief of biliary obstruction in individuals with obstructive jaundice and hot over dampness syndrome can be attained through Yinchenhao decoction in combination with conventional treatment.This protocol can promote bile acid excretion,alleviate jaundice and pro

关 键 词：茵陈蒿汤 常规治疗 阻塞性黄疸 湿热 

分 类 号：R269[医药卫生—中西医结合]