中药泻下法治疗重症急性胰腺炎的临床观察

Clinical observation on diarrhea method (泻下疗法) of traditional Chinese medicine in treatment of severe acute pancreatitis

目的:观察中医泻下疗法治疗重症急性胰腺炎(SAP)的临床疗效。方法:95例SAP患者被随机分为A、B和C组。A组32例,采用单纯西医治疗;B组32例,在A组西医治疗基础上胃管注入泻下中药,每次注入后夹管1h,中药组成:柴胡、白芍、枳实、厚朴、黄芩,重用生大黄和芒硝,根据患者肠鸣音和大便情况调整剂量;C组31例,不行胃肠减压,单纯按照B组的中药方剂进行口服。观察各组患者临床症状改善时间、平均住院时间、并发症发生率、手术中转率、病死率及治疗前与治疗5 d后的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)的变化。结果:与A组比较,B组和C组开始排便、肠鸣音恢复、腹痛和腹胀缓解及平均住院时间均显著缩短(P均<0.05);3组死亡的10例患者中有9例患者死亡前无肠鸣音恢复和排便;A组治疗5d后的APACHEⅡ评分、胰腺感染发生率和手术中转率显著高于B组和C组,而低血钾的发生率显著低于B组和C组(P均<0.05);A组急性呼吸窘迫综合征和急性肾功能衰竭的发生率以及病死率均高于B组和C组,但差异无显著性;B组和C组的上述指标差异也均无显著性(P均>0.05)。结论:西医结合中医泻下法治疗SAP优于单纯的西医治疗,并能迅速、有效地缓解腹痛和腹胀等局部症状,无须进行胃肠减压;肠鸣音和排便可能是判断SAP预后的重要临床指标。

Objective： To observe the clinical effect of the traditional Chinese medicine （TCM） which induces diarrhea method （泻下疗法） in treatment of severe acute pancreatitis （SAP）. Methods： Ninety-five patients with SAP were randomly divided into three groups. A group （n=32） was treated by western medicine only. B group （n= 32） was treated by combination of western medicine and TCM decoction administered via a gastric tube; the ingredients of the TCM consisted of radix bupleuri （柴胡）, radix paeoniae alba （白芍）, fructus aurantii immaturus （枳实）, cortex magnoliae officinalis （厚朴）, radix scutellariae （黄芩） and high doses of radix et rhizoma rhei （生大黄） and natrii sulfas （芒硝）, after once perfusion the tube was nipped for 1 hour, and the dose of TCM was adjusted according to the condition of defecation and rugitus. C group （n= 31） was treated the same as B group except gastrointestinal decompression. The time of clinical symptom improvement and average duration of hospitalization, incidence of complications, operability and mortality were observed in various groups. Acute physiology and chronic health evaluation I （APACHE I ） scores were compared before the treatment and 5 days after treatment. Results： The time of beginning defecation, rugitus recovery, local symptom relief of abdominal pain and distension and average duration of hospitalization in A group was much longer than those in B and C group （all P〈0.05）, and nine of the ten dead patients in the three groups didn＇t have defecation and rugitus recovery. Five days after treatment, the APACHE I scores, infection rate of pancreas and operability of A group were significantly higher, while the incidence of hypopotassemia was lower than those of B and C group （all P〈0. 05）. The incidences of acute respiratory distress syndrome （ARDS）, acute renal failure and mortality of A group were higher than those of B and C group but not significantly （all P〉0. 05）. The comparisons of all the parameters between B and C group had no significant differences （all P 〉 0.05）. Conclusion： The therapeutic effect of combination of western medicine and diarrhea method of TCM for treatment of SAP is superior to that of the western medicine alone, it can relieve the abdominal pain and distension rapidly and efficiently, and no gastrointestinal decompression is necessary when the combination method is adopted. The recovery of defecation and rugitus may be the important clinical signs of SAP improvement.