甘遂治疗重症急性胰腺炎的前瞻性临床研究

The Clinical Study of Kansui Root Therapy for Severe Acute Pancereatitis

目的 探讨中药甘遂在治疗重症急性胰腺炎 (SAP)中的作用及其机制。方法 将 3 7例SAP患者随机分为甘遂组和对照组 ,观测和对比两组临床指数 ,实验室指标和BalthazarCT评分。结果 ⑴两组入院时的相关指标均无显著性差异 (均 P >0 0 5 )。⑵血清TNFα、IL -6:治疗后 3 ,7,14d甘遂组显著低于对照组 (P <0 0 5或P <0 0 1)。⑶血浆TXB2 、6-keto -PGF1α及TXB2 /6-keto -PGF1α比值 :入院后 3 ,7,14dTXB2 较对照组显著降低 (P <0 0 5或P <0 0 1) ,而 6-keto -PGF1α各时点两组无显著差别 (P<0 0 5 ) ,TXB2 /6-keto -PGF1α比值于入院后 14d甘遂组显著低于对照组 (P <0 0 5或P <0 0 1)。⑷腹痛缓解时间、肠鸣音恢复时间、血、尿淀粉酶正常时间、体温和白细胞计数恢复时间 :甘遂组均显著短于对照组 (均P <0 0 1)。⑸APACHEII评分和BalthazarCT分级评分 :入院后 7,14d于APACHEII评分均显著低于对照组 (P <0 0 5或P <0 0 1) ;BaltharzarCT分级评分于入院后 14d甘遂组低于对照组 ( P <0 0 5 )。⑹平均住院日、并发症发生率 :甘遂组均显著低于对照组 ( P <0 0 5或 P <0 0 1)。⑺中转手术率、死亡率 :两组比较无显著性差异 (P >0 0 5 )。结论 ⑴甘遂组治疗SAP有确切疗效。

Objective To study the treatment effect of kansui root on severe acute pancreatitis(SAP) and its mechanism.Methods Thirty-seven cases of SAP were randomly divided into kansui root treatment group and control group. Patients in control group received routine treatment, and patients in kansui root group received routine treatment plus kansui root therapy. The clinical and laboratory parameters and balthazar CT scores were determined and compared between the two groups. Results ⑴On admitted to hospital, all the indices between the two groups were not obviously different (P>0.05); ⑵Serum TNFα and IL-6 levels in kansui root group were significantly lower than those in control group at the third, 7th and 14th days after treatment(P<0.05 or P<0.01); ⑶Plasma TXB 2 levels in kansui root group were significantly lower than those in control group at the third,7th and 14th days after treatment(P<0.05 or P<0.01), While there was no significant difference in the plasma 6-keto-PGF 1α level between the two groups at each time point. The ratio of TXB 2/6-keto-PGF 1α in kansui root group was significantly lower than that in control group at the 14th day after treatment(P<0.05 or P<0.01); ⑷The time of abdominal pain relief, bowel sound recovery, and restoration of serum and urine amylase level, body temperature and leukocyte count in kansui root group were significantly shorter than that in control group (P<0.01); ⑸The scores of APACHE II in kansui root group were significantly lower than those in control group at the 7th and 14th days after treatment (P<0.05 or P<0.01). And the scores of Balthazar CT classification in kansui root group were significantly lower than those in control group at the 14th day after treatment(P<0.05); ⑹Mean hospitalized days and complications in kansui root group were significantly lower than those in control group (P<0.05 or P<0.01); ⑺The operation rate and mortality between the two groups were no significantly differences(P>0.05). Conclusion ⑴kansui root therapy was effective for SAP, ⑵kansui root therapy ameliorated SAP possibly by decreasing the levels of serum TNFα and IL-6, ⑶kansui root therapy improved microcirculation of pancreas possibly by decreasing the ratio of TXA 2/PGI 2, and ⑷kansui root treating SAP may be multi-pathway and multi-target.