清肝利胆法配合胆囊穿刺引流治疗高龄重症急性胆囊炎临床研究

Clinical study on clearing liver and gallbladder puncture drainage for advanced severe acute cholecystitis

目的:探讨给予高龄重症急性胆囊炎患者胆囊穿刺引流+清肝利胆法治疗的效果。方法:选取医院收治的60例高龄重症急性胆囊炎患者,经随机数表法分为两组。对照组(30例)患者进行超声引导下经皮肝胆囊穿刺置管引流术(PTGBD)治疗,治疗组(30例)患者进行PTGBD+清肝利胆法治疗。观察患者相关血清指标、炎性因子水平变化情况及临床症状体征改善、总疗效。结果:两组经过治疗后,治疗组患者WBC、ALT及GGT水平相比治疗前、对照组均明显更低,差异有统计学意义(P<0.05);治疗组患者CRP、IL-6及TNF-α水平均低于治疗前,同时低于对照组,差异有统计学意义(P<0.05);治疗后,治疗组患者各项中医症候评分相比对照组均更低,差异有统计学意义(P<0.05);两组患者临床治疗总有效率分别为73.33%、90.00%,治疗组总有效率明显更高,差异有统计学意义(P<0.05)。结论:选用PTGBD+清肝利胆法的中西医结合方案,给予高龄重症急性胆囊炎患者治疗,能够更好地改善患者相关血清指标、炎性因子水平,减少患者不适情况,提高患者临床症状和体征的改善效果,获得更理想总体疗效。

Objective:To explore the effect of gallbladder puncture and drainage 60 clear liver bile in elderly patients with severe acute cholecystitis.Methods:elderly patients with severe acute cholecystitis admitted were grouped by random numbers.The control group(30 patients)were treated with ultrasound-guided percutaneous catheterization(PTGBD)by transliver and gallbladder puncture,and PTGBD+clear liver and gallbladder therapy in the patients(30 patients).Changes in relevant serum indicators,inflammatory factors,clinical symptoms and signs,and overall efficacy were observed.Result:After the treatment,The levels of WBC,ALT and GGT were significantly lower compared with the pre-treatment and control groups,The difference was statistically significant(P<0.05);The levels of CRP,IL-6 and TNF-αin the treatment group were lower than before treatment,Also lower than that in the control group,The difference was statistically significant(P<0.05);post-treatment,The various TCM syndrome scores in the treatment group were lower compared with the control group,The difference was statistically significant(P<0.05);The total clinical response rate of the two groups was 73.33%and 90.00%,respectively,0verall response rate was significantly higher in the treatment group,The difference was statistically significant(P<0.05).Conclusion:PTCBD+combined traditional Chinese and western medicine for severe acute cholecystitis patients can improve the relevant serum indexes and inflammatory factors,improve the improvement effect of clinical symptoms and signs,and obtain a more ideal overall effect.