以“益活清下”为主的中西医结合综合疗法治疗重症急性胰腺炎1161例疗效报告

"Yi-Huo-Qing-Xia"(益活清下) method as the main therapy in integrated traditional Chinese and western medicine on severe acute pancreatitis: a report of 1161 cases

目的:在中医热病理论指导下,探讨进一步规范重症急性胰腺炎(SAP)中西医结合非手术治疗的原则和方案。方法:回顾性分析四川大学华西医院1994年1月—2003年12月综合运用中医益气救阴、活血化瘀、清热解毒、通里攻下(简称“益活清下”)疗法治疗的1 161例SAP患者临床资料,评价该疗法对病死率、并发症发生率及手术率的影响,验证SAP的中医热病观理论框架及“益活清下”疗法对SAP的价值。结果:1 161例患者的总体手术率为19.38%,主要并发症的总体发生率为34.71%,病死率降低至10.77%。结论:中医热病理论较好地诠释了SAP的证候特点和病机传变规律;“益活清下”非手术治疗对SAP是有效的治疗方法,中药治疗SAP具有多靶位、综合调节的特点,并贯穿于4期的始终;手术治疗主要针对病程后期继发的胰腺感染并发症,早期手术指征应从严掌握。

Objective： To investigate the standard therapeutic principles and schemes of integrated traditional Chinese and western medicinal non-surgical treatment guided by theory of febrile disease （热病理论） on severe acute pancreatitis （SAP）. Methods. The clinical data of 1161 patients with SAP in west China Hospital of Sichuan University from January 1994 to December 2003 treated by integrated traditional Chinese and western medicine were analyzed retrospectively. The therapy of traditional Chinese medicine was under the direction of theory of febrile disease, and the principles of treatment were supplementing Qi and bring back Yin （益气救阴）, promoting blood circulation and removing blood stasis （活血化瘀）, clearing away heat and toxic materials （清热解毒） and removing stasis by purgation （通里攻下） simplified as ＂Yi-Huo-Qing-Xia＂（益活清下）. The mortality, the rate of complications, the rate of operation, etc were summed up and analyzed. Results： In the 1 161 eases, the rate of operation occupied a proportion of 19.38%, the rate of major complications was 34.71%, while the mortality descended to 10. 77%. Conclusion： The theory of febrile disease of traditional Chinese medicine can theoretically make reasonable interpretation on the characteristics of clinical manifestations of SAP and the patterns of its pathological changes. Chinese herbs play the roles of multiple target sites and comprehensive modulations in therapy. Among the non-surgical treatments, the ＂Yi-Huo-Qing-Xia＂ therapy is effective, as the treating principle, should be used from the beginning to the end of all four stages. The surgical method is mainly used when complication occurs in the later course of SAP as the secondary infection of pancreas. The operative treatment at the early stage should be carefully considered and restrictively managed.