通下化瘀方早期干预重症急性胰腺炎胰腺微循环紊乱的临床研究

Clinical early intervention of Tongxia Huayu Decoction on pancreatic microcirculatory disturbance in severe acute pancreatitis

目的:探讨通下化瘀方早期干预重症急性胰腺炎胰腺微循环紊乱,改善其预后的作用机制。方法:53例重症急性胰腺炎患者随机分为治疗组28例与对照组25例,治疗组在对照组治疗基础上给予通下化瘀方,观察治疗1周;治疗前及治疗第7天作血、尿淀粉酶及血C反应蛋白(C-reactive protein,CRP)、内皮素(endothelin,ET)水平检测。结果:治疗组总有效率98.4%,对照组总有效率80%,两组总有效率相比,差异有统计学意义(P<0.05)。治疗前两组患者血、尿淀粉酶、CRP和血浆ET水平相比,差异无统计学意义;治疗后均下降(P<0.01),且治疗组下降幅度大于对照组(P<0.01)。结论:通下化瘀方对重症急性胰腺炎具有良好的疗效,其作用机制可能与通下化瘀方药减少ET释放,抑制ET所诱发的胰腺微循环改变与腺泡细胞损伤等作用有关。

Objective： To study the mechanisms of Tongxia Huayu Decoction （a Chinese herbal decoction for purgation and removing blood stasis） in prognostic improvement for severe acute pancreatitis by early intervention on pancreatic microcirculatory disturbance. Methods： Fifty-three patients with severe acute pancreatitis were divided randomly into treatment group （n=28） and control group （n=25）. Tongxia Huayu Decoction was given to the patients in treatment group in addition to the normal treatment in control group for one week. The clinical symptoms and signs, hemodiastase, urinary amylase, C-reactive protein （CRP） and endothelin （ET） of the patients in the two groups before and after treatment were observed and detected.Results： The total response rate of the treatment group was 98.4%, while that of the control group was 80%, with significant difference between them （P〈0.05）. There was no significant difference of the contents of hemodiastase, urinary amylase, CRP and ET between the two groups before treatment, while they were significantly decreased after treatment （P〈0.01） with more obvious change in treatment group （P〈0.01）. Conclusion： Tongxia Huayu Decoction brings satisfied therapeutic effect on severe acute pancreatitis. The mechanisms may associate with its reducing function on ET releasing so as to inhibit the pancreatic microcirculatory disturbance and acinar cell injury induced by ET.