中西医结合治疗重症急性胰腺炎62例临床研究

Clinical Study on Traditional Chinese Combined with Western Medicine in Treating 62 Cases of Severe Acute Pancreatitis

目的:探讨急性胰腺炎患者中医证候分布规律和中西医结合治疗重症急性胰腺炎(severe acute pancreatitis,SAP)的效果。方法:分别采用Ranson标准、APACHE-Ⅱ评分和Balthazar CT分级系统对5年间159例AP住院患者进行回顾性分级评价,并进一步分析中西医结合治疗62例SAP的临床疗效。结果:62例SAP患者中肝胆湿热型31例,肝郁气滞型7例,脾胃实热型11例,瘀热互结型5例,腑闭血瘀型3例,内闭外脱型1例,气阴两虚型4例;平均住院天数为15.5 d;痊愈20例(32.26%),显效12例(19.35%),无效26例(41.94%),不适合手术而内科保守治疗死亡4例(6.45%);内科保守治疗无效转行手术治疗26例,术后全部好转出院。结论:入院时肝胆湿热型>脾胃实热型>肝郁气滞型,三型占79%以上;SAP患者早期予辨证施治、进行个体化治疗是必要的;早期中西医结合治疗能够提高SAP的临床治愈率,减少并发症和死亡率,降低病人住院天数和住院费用。

Objective：To probe the TCM syndromes of distribufing principle of patients with acute pancreatitis and the curative effect for severe acute pancreatitis by traditional Chinese combined with Western medicine.Methods：Ranson Standard,APACHE-Ⅱ Grading and Balthazar CT Grading Systern were taken respectively to have a review grading evaluation on 159 cases of in patients with acute panereatitis in five years.And the clinical effectiveness of 62 cases of SAP patients by traditional Chinese combined with Western medicine were further analyzed.Results：Sixty-two cases（31 cases of darnpness and heat in the liver and the gallbladder type,7 cases of stagnation of liver-qi type,11 cases of damp-heat in the spleen and the stomach type,5 cases of blood stasis combined with heat type,1 case of loss of conscicusness and collapse type,4 cases of deficiency of both qi and yin type） had an ayerage 15.5 days in hospital.20 cases（32.26%） were cured.12 cases （19.35%） had effectiveness,26 cases（41.94%） had no effect,4 cases （6.45%）died which were not suitable for operative treatment but for conservative medical treatment.26 cases operated because of the ineffectiveness for conservative medical treatment were cured and discharged from hospital.Conclusion：Three types（dampness and bcat in the liver and the gallbladder type,damp-heat in the spleen and the stomach type and stagnation of liver-qi type） make up more than 79 percent of patients.It＇s necessary to treat the SAP patients by differentiating,syndromes and have an individual treatment at the early stage.Traditional Chinese combined with Westerm medical treatment at the early stage can inerease the clinieal curative rate for SAP.decrease the complicated disease and death rate and reduce the days and expenses of patients in hospital.