重症急性胰腺炎自然病程与中医辨证

Clinical Research on Natural Course of Severe Acute Pancreatitis and TCM Syndrome Differentiation

目的:通过六经辨证研究重症急性胰腺炎的自然病程演进中的临床特征、脏器功能障碍特点、死亡相关因素以及证候传变规律。方法:对346例患者按照入院时、1、3、5、7、14、28d共7个时间点分别记录APACHEII评分、各脏器功能状态,死亡相关因素,中医四诊。结果:重症急性胰腺炎自然病程中APACHEII评分呈双峰型分布;脏器衰竭最多受累器官为呼吸、外周循环、肾和胃肠道。初期中医辨证以少阳阳明合病或阳明腑实证为主,严重者则表现为结胸里实证,进展期多为毒热炽盛,热结腑实,恢复期多见气阴两伤。结论:重症急性胰腺炎自然病程分为初期、进展期和恢复期,肠麻痹持续时间是影响SAP自然病程的重要因素。

Objective To study the natural course of severe acute pancreatitis（SAP） by evolution of organ function,and clinical manifestations,causes of deaths,basing on four diagnostic methods of Chinese medicine and six-channel differentiation of syndromes.Methods Retrospective analysis of data of 346 cases of severe acute pancreatitis was done.In accordance with the admission,1st,3rd,5th 7th 14th and 28th days a total of sever time points APACHEII score were recorded,the status of various organs observed through the four TCM diagnostic methods of examination,and analysis made basing on the six-channel theory of syndrome differentiation.Results In severe acute pancreatitis natural progression,APACHEII score showed a double-peak type distribution.At the early and progressive phase,the most affected organs were those of the respiratory and peripheral circulation systems,kidney and gastrointestinal tract.At the early phase TCM syndrome differentiation showed mainly combined syndrome of Yang minor and Splendid Yang,or in severe conditions of the syndrome of obstructing chest and excessiveness in the interior.At the progressive phase excessive toxic heat syndrome and heat in bowel organ syndrome were shown.And at the recovery phase syndrome differentiation showed combined injury of Qi and Yin.Conclusion The course of severe acute pancreatitis can be divided into an early phase,progressive phase,and recovery phase.Intestinal paralysis is an important factor influencing natural course of SAP.