清胰汤联合DAR治疗急性胰腺炎的临床疗效

Clinical efficacy of Qingyi decoction combined with DAR for the treatment of acute pancreatitis

目的研究清胰汤联合DAR（[D]地塞米松、[A]山莨菪碱、[R]生大黄粉）治疗急性胰腺炎的临床效果。方法本研究为前瞻性、对照性研究。纳入2005年1月至2012年4月西安交通大学第二附属医院急诊科收治的急性胰腺炎患者387例，排除了不遵循既定治疗方案或中途无故要求终止治疗者；因其他因素转入其他医院或科室诊治，无法继续原有治疗方案者；儿童、妊娠和／或哺乳期；有使用该方案药物过敏或使用禁忌者；病程1周以上者。将轻型急性胰腺炎（mild acute pancreatitis，MAP）、重症急性胰腺炎（severe acute pancreatitis，SAP）患者分别随机（随机数字法）分为传统治疗组（T）、DAR组（DAR）、清胰汤组（Q）及清胰汤联合DAR组（Q＋DAR），比较各组在治疗转归、禁食时间、腹痛缓解时间、血清淀粉酶恢复时间、胰腺或胰腺周围并发症、平均住院日方面的差异，采用SPSS13．0统计软件分析处理数据。结果MAP各治疗组均无死亡；SAP患者各组病死率相比较差异无统计学意义（P〉0．05）。各组中MAP患者在禁食时间、腹痛缓解时间、血清淀粉酶恢复时间及住院时间上均显著短于SAP（P〈0．05）。Q＋DAR组、DAR组在禁食时间、腹痛缓解时间及住院时间方面均显著短于T和Q组，差异具有统计学意义（P〈0．05），但Q＋DAR与DAR组在腹痛缓解时间上比较差异无统计学意义（P〉0．05），而Q＋DAR组禁食时间短于DAR组，差异具有统计学意义（P〈0．05）；在血清淀粉酶恢复时间方面，各组间比较差异无统计学意义（P〉0．05）。SAP患者发生胰腺或胰腺周围并发症的概率大于MAP，但SAP患者在T、DAR、Q、Q＋DAR组发生相应并发症比较差异无统计学意义（P〉0．05）。结论无论是MAP还是SAP患者，清胰汤联合DAR或单纯应用DAR都是一种优于传统治疗的可选方案，但在减轻患者痛苦、缩短禁食时间及平均住院日、减少医疗费用上，应用清胰汤联合DAR具有更多优势。

Objective To explore the clinical efficacy of,Qingyi decoction （a preparation of Chinese herbal medicine） combined with DAR （combined use of dexamethasone, anisodamine and rhubarb） for the treatment of acute pancreatitis. Methods A total of 387 eligible patients met the criteria of acute pancreatifis were enrolled from January 2005 to April 2012 for prospective study. All patients, mild acute pancreatitis （MAP） or severe acute pancreatitis （SAP） , were divided （ random niumber） into four groups, namely conventional therapy （T）, DAR therapy （DAR）, Qingyi decoction therapy （Q） and Qingyi decoction combined with DAR therapy （ Q ＋ DAR）. Outcome, fasting time, serum amylase, abdominal pain relief time, pancreatic or peri-pancreatic complications and average hospital-stay were analyzed with SPSS 13.0 statistic software. P 〈 0. 05 was considered statistically significant. Results None of MAP patients died. Of SAP patients, there was no difference in mortality among different groups （P 〉 0. 05 ）. Length of fasting time, time elapsed for abdominal pain relief, time required for normalized serum amylase level and length of hospital stay in MAP patients were significantly shorter than those in SAP patients regardless of different therapies （P 〈 0. 05 ）. Either patients of SAP or MAP treated with Q ＋ DAR or DAR suffered shorter length of time than those treated with T or Q in respect of fasting, abdominal pain relief, serum amylase level normalization and hospital stay （P 〈 0, 05）. For SAP or MAP patients, there was no difference in abdominal pain relief time between receiving DAR and Q ＋ DAR treatment （P 〉 0. 05 ）, but the fasting time in Q ＋ DAR was shorter than that in DAR （P 〈 0. 05 ）. Patients with SAP were more likely to suffer pancreatic or per-pancreatic complications than those with MAP, but there was no difference for SAP or MAP with different treatments. Conclusions DAR or Q ＋ DAR was an alternative to conventional treatment for MAP or SAP, and they were both superior to conventional treatment. And Q ＋ DAR was more advantageous than DAR when fasting time, hospital-stay time and cost were considered.