内镜下逆行胆胰管造影术术后柴芩承气汤辅助治疗重症急性胆源性胰腺炎的临床疗效与安全性研究  

Clinical efficacy and safety of Chaiqin Chengqi Decoction as adjuvant therapy for severe acute biliary pancreatitis after endoscopic retrograde cholecancreatic angiography

作　　者：姬红波 王强 白瑞锋 昝松波 JI Hong-bo;WANG Qiang;BAI Rui-feng;ZAN Song-bo(Department of Gastroenterology,the Third People's Hospital of Luoyang,Luoyang 471000,Henan,CHINA)

机构地区：[1]洛阳市第三人民医院消化内科,河南洛阳471000

出　　处：《海南医学》2025年第5期653-658,共6页Hainan Medical Journal

基　　金：河南省洛阳市科技计划项目(编号:1725001A-9)。

摘　　要：目的探讨内镜下逆行胆胰管造影术(ERCP)后柴芩承气汤辅助治疗重症急性胆源性胰腺炎(SABP)的临床疗效及安全性。方法选取2022年1月至2024年1月于洛阳市第三人民医院行ERCP治疗的86例SABP患者纳入研究,按随机抽签法分为常规组和中药辅助组各43例。常规组患者ERCP术后给予生长抑素治疗,中药辅助组患者ERCP术后在常规组基础上给予柴芩承气汤辅助治疗。治疗7 d后,比较两组患者治疗效果、临床症状体征缓解时间,以及治疗前后的酶类指标[脂肪酶(LPS)、淀粉酶(AMS)]、炎性指标[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、IL-18]和胰腺代谢能力(血清葡萄糖、β-羟基丁酸、乙酰乙酸、尿液β-羟基丁酸、乙酰乙酸);同时比较两组患者治疗期间的并发症发生率。结果治疗后,中药辅助组患者的总有效率为95.35%,明显高于常规组的79.07%,差异有统计学意义(P<0.05);治疗后,中药辅助组患者的腹痛缓解、腹膜刺激征缓解、体温复常及脱离呼吸机时间分别为(1.98±0.35)d、(1.91±0.28)d、(2.26±0.51)d、(3.16±0.87)d,明显短于常规组的(2.41±0.44)d、(2.33±0.37)d、(2.83±0.65)d、(5.02±1.12)d,差异均有统计学意义(P<0.05);治疗后,中药辅助组患者的血清LPS、AMS、hs-CRP、TNF-α、IL-1β、IL-18、葡萄糖、β-羟基丁酸、乙酰乙酸、尿液β-羟基丁酸、乙酰乙酸水平明显低于常规组,差异均有统计学意义(P<0.05);治疗期间,中药辅助组患者的并发症总发生率为4.65%,明显低于常规组的20.93%,差异有统计学意义(P<0.05)。结论ERCP术后柴芩承气汤辅助治疗SABP能显著提高治疗效果,快速改善临床症状,增强胰腺代谢能力,减轻炎性反应,减少并发症的发生,有助于促进患者康复。Objective To investigate the clinical efficacy and safety of Chaiqin Chengqi Decoction as adjuvant therapy for severe acute biliary pancreatitis(SABP)after endoscopic retrograde cholecancreatic angiography(ERCP).Methods A total of 86 SABP patients admitted to the Third People's Hospital of Luoyang from January 2022 to January 2024 were were randomized into a conventional group and traditional Chinese medicine(TCM)assisted group according to random drawing method,with 43 cases in each group.Patients in the conventional group received somatostatin after ERCP,while those in the TCM assisted group received Chaiqin Chengqi Decoction in addition to somatostatin after ERCP.After 7 days of treatment,the therapeutic effect,remission time of clinical symptoms and signs,enzymatic indexes(lipase[LPS],amylase[AMS]),inflammatory indexes(hypersensitive C-reactive protein[hs-CRP],tumor necrosis factor-α[TNF-α],interleukin[IL]-1β,IL-18),pancreatic metabolic capacity(serum glucose,β-hydroxybutyric acid,acetoacetic acid,urine beta-hydroxybutyric acid,acetoacetic acid)before and after treatment were compared between the two groups;the incidence of complications during treatment was also compared.Results After treatment,the total effective rate of the TCM assisted group was 95.35%,which was significantly higher than 79.07%of the conventional group(P<0.05);the time of abdominal pain relief,peritoneal irritation relief,body temperature normalization,and ventilator in the TCM assisted group were(1.98±0.35)d,(1.91±0.28)d,(2.26±0.51)d,and(3.16±0.87)d,respectively,which were significantly shorter than(2.41±0.44)d,(2.33±0.37)d,(2.83±0.65)d,and(5.02±1.12)d in the conventional group(P<0.05);the serum LPS,AMS,hs-CRP,TNF-α,IL-1β,IL-18,glucose,β-hydroxybutyric acid,acetoacetic acid,urineβ-hydroxybutyric acid,and acetoacetic acid levels in the TCM assisted group were significantly lower than those in the conventional group(P<0.05).During treatment,the total incidence of complications in the TCM assisted group was 4.65%,which was s

关 键 词：重症急性胆源性胰腺炎 内镜下逆行胆胰管造影术 柴芩承气汤 临床疗效 胰腺代谢能力 安全性 

分 类 号：R657.51[医药卫生—外科学]