中西医联合治疗急性胆源性胰腺炎肝胆湿热证临床疗效分析

Curative effect of traditional Chinese medicine combined with Western medicine in the treatment of acute biliary pancreatitis with syndrome of damp-heat in liver and gallbladder

目的观察清热利湿通里攻下法联合十二指肠镜治疗急性胆源性胰腺炎(中医辨证为肝胆湿热证)的临床疗效。方法于2010年6月至2013年6月,将66例急性胆源性胰腺炎肝胆湿热证患者随机分为治疗组与对照组各33例。两组患者经十二指肠镜治疗后,均予以急性胰腺炎规范化西医治疗。治疗组在西医治疗基础之上,经胃管注入复方大柴胡汤。比较两组患者疗效、腹痛缓解时间、腹胀缓解时间、首次排便时间、血和尿淀粉酶恢复正常水平时间及治疗后第3天、第7天急性生理和慢性健康状况评分Ⅱ(APACHE-Ⅱ评分)、外周血白细胞总数正常率等。结果治疗组总有效率高于对照组,腹痛缓解时间、腹胀缓解时间、首次排便时间,以及血、尿淀粉酶恢复正常水平时间均短于对照组(P<0.05)。治疗后第3天、第7天,治疗组、对照组APACHE-Ⅱ评分均较治疗前下降,且治疗组下降更明显,治疗组外周血白细胞总数正常率高于对照组(P<0.05)。结论采用清热利湿通里攻下法,以复方大柴胡汤联合十二指肠镜治疗急性胆源性胰腺炎肝胆湿热证,疗效确切,在缩短病程、促进患者胃肠道功能恢复方面有明显优势,值得临床推广应用。

Objective To observe the curative effect of Qingrelishi and Tongligongxia method combined with duodenoscope in the treatment of acute biliary pancreatitis with syndrome of damp-heat in liver and gallbladder . Methods A total of 66 patients with acute biliary pancreatitis syndrome of damp-heat in liver and gallbladder were randomly divided into treatment group and control group ,with 33 cases in each group ,during Jun .2010 and Jun . 2013 .Patients of both groups were treated with standardized treatment of acute pancreatitis ,after treatment o duode-noscope ,and patients in treatment group were given Compound Dachaihu Decoction injection by the stomach tube at the same time .Therapeutic effect ,time for abdominal pain and abdominal distention relief ,the first defecation time , and the time of blood and urine amylase returning to normal level were examined and compared between the two groups .The acute physiology and chronic health evaluation Ⅱ （APACHE-Ⅱ ） scores ,and normal rate of leukocyte counting ,were evaluated before treatment and 3 days ,7 days after treatment ,and were also compared .Results Com-pared with control group ,curative effect in treatment group was higher ,remission time of abdominal pain and abdomi-nal distention ,of first defecation ,and of blood and urine amylase levels returning to normal were shortened （ P〈0 .05） .In both of the two groups ,APACHE-Ⅱ score ,evaluated at 3 and 7 days after treatment ,were all decreased , and the degree of decreasing in treatment group was more obvious ,and normal rate of blood leukocytes counting in treatment group was higher than control group （P〈0 .05） .Conclusion On the basis of the Qingrelishi and Tongli-gongxia method ,combined application of Compound Dachaihu Decoction and duodenoscope might be effective in the treatment of acute biliary pancreatitis with syndrome of damp-heat in liver and gallbladder ,with obvious advantages for promoting the recovery of gastrointestinal function ,speeding up the healing of patients ,which could be worthy of clinical application .