重症急性胰腺炎中西医结合治疗自然病程观察

Observation of Disease Process of Severe Acute Pancreatitis Treated by Integrated Traditional Chinese and Western Medicine

目的:研究在系统性描述就诊于三级医院、中西医结合治疗下的重型胰腺炎的自然病程。方法:回顾性分析302例重症胰腺炎患者的临床资料,均按照已确定的中西医结合方法规范治疗。结果:302例重症胰腺炎患者中59.6%出现器官功能障碍,肺损害是最常见受损器官,47.4%的初期患者和38.7%的进展期患者合并肺功能障碍。在中医临床见证中,早期多出现弦脉、红舌、黄苔,进展期多出现实脉、红绛舌、黄苔。结论:重症胰腺炎器官功能障碍常出现在疾病早期,中医临床见证在疾病各期有显著差别,APACHEII评分及胃肠道早期功能的恢复对疾病预后有相关性。

Objective To systematically describe the disease process of SAP treated by integrated traditional Chinese and western medicine in a tertiary hospital.Methods The medical records of 302 patients with SAP treated in Tianjin Nankai Hospital were retrospectively studied.All patients were managed by a predefined treatment protocol of integrated traditional Chinese and western medicine.Results Of the 302 patients （145 males,157 females,mean age 53.9 ±21.0 years） 59.6% had organ failure.In patients with organ failure,39.4% had one organ failure and 20.2% had multiple organ failure （MOF）.Pulmonary failure was the most common organ dysfunction in initial stage （47.4%） and progressing stage （38.7%） of the disease.String-tight pulse,red tongue and yellow tongue coating were the most common Chinese medicine clinical evidences in initial stage,while simultaneously replete pulse,purple-red tongue and yellow tongue coating mostly occurred in processing stage.Ten days after development of the disease,increasing again of APACHE II score were significant risk factors for the development of systemic infection.Conclusion Early recovery of the function of the gastrointestinal tract is beneficial to inhibit the occurance of MOF.Organ failure usually occurs early.The present findings support the primacy of pulmonary injury of organ dysfunction in SAP.The Chinese medicine clinic evidences were extremely different in each stage of SAP .A higher APACHE II score and early recovery of the function of gastrointestinal tract emerged as significant correlation of prognosis of the grave disease.