通降法治疗寒邪积滞型急性胰腺炎的临床研究  

Clinical Study on Therapy of Unblocking Bowels in the Treatment of AcutePancreatitis of Pathogenic-Cold Accumulation and Retention Type

作　　者：肖菁菁 李海怡 吴佩珊 周正[1] 黄广文 杨丽清 XIAO Jing-Jing;LI Hai-Yi;WU Pei-Shan;ZHOU Zheng;HUANG Guang-Wen;YANG Li-Qing(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》2024年第9期2340-2346,共7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】观察基于通降法运用大黄附子汤加减治疗寒邪积滞型急性胰腺炎的临床疗效。【方法】将78例寒邪积滞型急性胰腺炎患者随机分为研究组和对照组,每组各39例。对照组给予常规西医治疗,研究组在对照组的基础上给予口服或鼻饲大黄附子汤加减治疗,疗程为7 d。观察2组患者治疗前后血清胰腺酶学指标(血清淀粉酶和脂肪酶)、炎症因子[C反应蛋白(CRP)、降钙素原(PCT)、白细胞介素6(IL-6)、白细胞介素8(IL-8)]水平及急性生理与慢性健康状况Ⅱ(APACHEⅡ)评分、改良CT严重指数(MCTSI)评分的变化情况,比较2组患者的腹痛改善时间、腹胀改善时间、肛门排便时间,评价2组患者的临床疗效和用药安全性。【结果】(1)脱落情况方面,研究过程中,研究组和对照组各有1例患者脱落,最终各有38例纳入疗效统计。(2)疗效方面,治疗7 d后,研究组的总有效率为86.84%(33/38),对照组为78.95%(30/38),组间比较(秩和检验),研究组的疗效明显优于对照组(P<0.05)。(3)胰腺酶学指标方面,治疗后,2组患者的血清淀粉酶、脂肪酶水平均较治疗前下降(P<0.05),且研究组对血清淀粉酶、脂肪酶水平的下降幅度均明显优于对照组(P<0.05)。(4)炎症因子方面,治疗后,2组患者血清CRP、PCT、IL-6、IL-8水平均较治疗前下降(P<0.05),且研究组对血清CRP、PCT、IL-6、IL-8水平的下降幅度均明显优于对照组(P<0.05)。(5)量表评分方面,治疗后,2组患者的APACHEⅡ、MCTSI评分均较治疗前下降(P<0.05),且研究组对APACHEⅡ、MCTSI评分的下降幅度均明显优于对照组(P<0.05)。(6)症状改善时间方面,研究组的腹痛改善时间、腹胀改善时间、肛门排便时间均较对照组明显缩短,差异均有统计学意义(P<0.05)。(7)安全性方面,治疗过程中,2组患者均未发生明显不良反应,具有较高的安全性。【结论】在常规治疗的基础上,基于通腑法运用大黄附子汤加减治Objective To observe the clinical efficacy of modified Dahuang Fuzi Decoction following the therapy of unblocking bowels for the treatment of acute pancreatitis of pathogenic-cold accumulation and retention type.Methods A total of 78 patients with acute pancreatitis of pathogenic-cold accumulation and retention type were randomly divided into a study group and a control group,39 cases in each group.The control group was treated with conventional western medicine,and the study group was treated with oral use or nasogastric feeding of Dahuang Fuzi Decoction on the basis of treatment for the control group.The course of treatment covered seven days.The two groups were observed in the changes of serum pancreatic enzyme indicators of serum amylase and lipase,inflammatory factors of C-reactive protein(CRP),procalcitonin(PCT),interleukin-6(IL-6)and interleukin-8(IL-8),acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,and modified CT severity index(MCTSI)score before and after treatment.The time for abdominal pain relief,time for abdominal distension relief,and time for anal defecation were compared between the two groups.After treatment,the clinical efficacy and safety of the two groups were evaluated.Results(1)During the trial,there was one patient falling off separately from the study group and the control group,and 38 patients in each group were eventually included in the efficacy statistics.(2)After seven days of treatment,the total effective rate of the study group was 86.84%(33/38),and that of the control group was 78.95%(30/38).The intergroup comparison(tested by rank sum test)showed that the efficacy of the study group was significantly superior to that of the control group(P<0.05).(3)After treatment,the serum levels of pancreatic enzyme indicators of amylase and lipase in the two groups were decreased compared with those before treatment(P<0.05),and the decrease of serum amylase and lipase levels in the study group was significantly superior to that in the control group(P<0.05).(4)After treatment

关 键 词：急性胰腺炎 寒邪积滞型 通降法 大黄附子汤 淀粉酶 脂肪酶 炎症因子 

分 类 号：R259.76[医药卫生—中西医结合]