规范并全程应用通腑导滞法治疗重度急性胰腺炎阳明腑实证临床观察

Clinical Research of Standardized Whole-process Catharsis and Removing Food Stagnation Method in Treating Patients with Severe Acute Pancreatitis Excess of Yangming fu-viscera Syndrome

目的观察规范并全程应用通腑导滞法治疗重度急性胰腺炎(SAP)阳明腑实证的临床疗效。方法将52例SAP阳明腑实证患者根据治疗方法不同分成治疗组27例和对照组25例。治疗组在常规西医内科治疗的基础上,加用统一的通腑导滞法方案给予全程治疗至缓冲期;对照组在常规西医内科治疗的基础上,仅在疾病早期阶段(即至大便排出)加以通腑导滞法治疗,并且治疗未规范统一。比较两组实验室指标、量表评分、中医临床证候积分、腹痛评分、胃肠功能障碍及不良事件发生率。结果治疗组较对照组能更快地改善血淀粉酶、白细胞计数、C反应蛋白、血钙、急性生理与慢性健康评分、急性胰腺炎严重度床边指数、中医临床证候积分、CT严重程度指数(P<0.05);而且治疗组也较对照组更快地缓解腹痛,更好地改善胃肠功能障碍、降低继发感染、死亡等不良事件的发生率(P<0.05)。结论规范的通腑导滞法全程治疗SAP患者能更快地缓解腹痛,改善胃肠功能障碍,降低继发感染、死亡等不良事件的发生率,改善患者的预后。

Objective To examine the therapeutic effect of standardized whole-process catharsis and removing food stagnation method in treating severe acute pancreatitis（SAP） excess of Yangming fu-viscera syndrome.Methods Fifty-two SAP patients with excess of Yangming fu-viscera syndrome were divided into a treatment group（27 cases） and a control group（25 cases） according to different therapeutic methods. In addition to routine western medicine treatment,the treatment group was added unified method of catharsis and removing food stagnation plan and whole-process treatment until the buffer period. In addition to basic western medicine treatment,the control group was added method of catharsis and removing food stagnation treatment only in the early stage of the disease（until fecal excretion）,and the treatment was not standardized and unified. Laboratory indexes,scale scores,Chinese medicine clinical syndrome scores,abdominal pain scores,incidence of gastrointestinal dysfunction and adverse events in both groups were compared. Results The improvement of hemodlastase,leucocyte count,C-reactive protein,blood calcium,acute physiology and chronic health score,bedside index of acute pancreatitis severity,Chinese medicine clinical syndrome scores and CT severity index in the treatment group was faster than those in the control group（P〈0. 05）. Abdominal pain seemed to be relieved faster in the treatment group than in the control group. Gastrointestinal dysfunction seemed to be improved better in the treatment group than in the control group. The incidence of adverse events,such as secondary infection and death, seemed to be reduced in the treatment group（P〈0. 05）.Conclusion Standardized method of catharsis and removing food stagnation whole-process treatment in SAP patients might quickly relieve abdominal pain,improve gastrointestinal dysfunction,reduce the incidence of adverse events,such as secondary infection and death,as well as improve patients＇ prognosis.