清腑灌肠方中药保留灌肠结合硝黄塌渍方对重症急性胰腺炎患者中医证候评分及生化指标的影响

Effect of Chinese medicine retention enema with Qingfu Guanchang decoction combined with Xiaohuang Tazi formula on scores of TCM syndromes and biochemical indicators in patients with severe acute pancreatitis

目的:探究清腑灌肠方中药保留灌肠结合硝黄塌渍方对重症急性胰腺炎(SAP)患者中医证候评分及生化指标的影响。方法:选取我院116例SAP患者为研究对象,按照随机数字表法分为中西组和西药组,西药组(n=58)给予常规西药治疗,中西组(n=58)在西药组基础上加以清腑灌肠方中药保留灌肠结合硝黄塌渍方治疗,比较两组患者临床疗效,中医证候评分、健康状况[慢性健康状况评分系统Ⅱ(APACHEⅡ)、改良多脏器功能障碍评分(Marshall)及急性胰腺炎Ranson评分]评分、血清炎症[组血清白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、C反应蛋白(CRP)及内毒素(ET)]、肠道屏障及肝功能[血清淀粉酶(AMY)、D-乳酸、血清二胺氧化酶(DAO)、谷丙转氨酶(ALT)、碱性磷酸酶(ALP)、总胆红素(TBIL)]结果:中西组临床有效率为94.83%,西药组为82.76%,两组比较差异有统计学意义(P<0.05);治疗1周后,两组各中医证候积分、APACHEⅡ、Marshall及Ranson评分均显著降低(P<0.05),血清IL-6、TNF-α、CRP、内毒素、AMY、D-乳酸、DAO、ALT、ALP、TBIL水平均显著降低(P<0.05),且治疗后上述指标组间比较差异有统计学意义(P<0.05)。结论:清腑灌肠方中药保留灌肠结合硝黄塌渍方治疗SAP,可显著提高治疗效果,改善临床症状,降低血清炎症,增强患者肠道屏障及肝功能,值得推荐。

Objective:To explore the effect of Chinese medicine retention enema with Qingfu Guanchang decoction combined with Xiaohuang Tazi formula on scores of TCM syndromes and biochemical indicators in patients with severe acute pancreatitis(SAP).Methods:116 patients with SAP in the hospital were selected as the research subjects,and they were divided into Chinese and Western medicine group and Western medicine group according to the random number table method.The Western medicine group(n=58)was treated with conventional Western medicine,and the Chinese and Western medicine group(n=58)was additionally given Chinese medicine retention enema with Qingfu Guanchang decoction combined with Xiaohuang Tazi formula based on the Western medicine group.The clinical efficacy,scores of TCM syndromes,health status[Acute Physiology and Chronic Health Evaluation II(APACHE II),Modified Multiple Organ dysfunction Score(Marshall)and Acute pancreatitis Ranson Score],serum inflammation[serum interleukin-6(IL-6),tumor necrosis factorα(TNF-α),C-reactive protein(CRP),endotoxin(ET)]and intestinal barrier and liver function[serum amylase(AMY),D-lactic acid,serum diamine oxidase(DAO),alanine aminotransferase(ALT),alkaline phosphatase(ALP),total bilirubin(TBIL)]were compared between the two groups of patients.Results:The clinical effective rate was 94.83%in Chinese and Western medicine group and was 82.76%in Western medicine group(P<0.05).After 1 week of treatment,the scores of TCM syndromes and scores of APACHE II,Marshall and Ranson in the two groups were significantly reduced(P<0.05),and the levels of serum IL-6,TNF-α,CRP,endotoxin,AMY,D-lactic acid,DAO,ALT,ALP and TBIL were obviously decreased(P<0.05),and there were statistically significant differences in the above indicators after treatment between the two groups(P<0.05).Conclusion:Chinese medicine retention enema with Qingfu Guanchang decoction combined with Xiaohuang Tazi formula can significantly enhance the therapeutic effect,improve the clinical symptoms,reduce serum inflammation and enhance the intestinal barrier and liver function in the treatment of SAP,thus it is worth recommending.