中西医结合早期治疗重症急性胰腺炎30例疗效观察

Clinical observation of 30 cases of severe acute pancreatitis early treated by integrated traditional Chinese and western medicine

目的观察中西医结合早期治疗重症急性胰腺炎的疗效。方法将60例重症急性胰腺炎患者随机分为2组,对照组30例予西医常规治疗,治疗组30例在对照组治疗的基础上早期加大承气汤加味治疗。观察比较2组主要症状、体征改善时间(包括腹痛、腹胀缓解时间,肠鸣音恢复时间)及住院时间;统计2组住院期间主要并发症[急性呼吸窘迫综合征(ARDS)、多器官功能障碍综合征(MODS)、急性肾衰竭(ARF)、腹腔感染或脓肿、胰腺炎性脑病及休克]发生率及死亡率;比较2组治疗前及治疗10 d时血清淀粉酶、尿淀粉酶水平及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分变化;统计2组临床疗效。结果2组治愈率及总有效率比较差异均有统计学意义(P<0.05),治疗组疗效优于对照组。治疗组腹痛、腹胀缓解时间,肠鸣音恢复时间及住院时间均短于对照组(P<0.05)。2组住院期间均无病例死亡,ARDS、MODS、ARF发生率及并发症总发生率比较差异均有统计学意义(P<0.05),治疗组低于对照组。2组治疗10 d时血清、尿淀粉酶水平均较本组治疗前显著下降,APACHEⅡ评分降低,且治疗组低于对照组,比较差异均有统计学意义(P<0.05)。结论中西医结合治疗重症急性胰腺炎,疗效确切,能有效减少并发症的发生,降低死亡率,改善预后。

Objective To observe the effect of integrated traditional Chinese and western medicine on the treatment of severe acute pancreatitis. Methods 60 cases of severe acute pancreatitis were randomly divided into two groups,30 cases in control group were treated by conventional western treatment,30 cases in treatment group were treated by Dachengqi decoction on the basis of the control group. The improvement time of main symptoms and signs including the time of abdominal pain,abdominal distension remission time and bowel sound recovery and hospital stay were observed and compared in two groups. The incidence and mortality of major complications including acute respiratory distress syndrome( ARDS),multiple organ dysfunction syndrome( MODS),acute renal failure( ARF),abdominal infection or abscess,shock were evaluated during hospitalization in two groups. The levels of serum amylase and urinary amylase,and the score changes of acute physiology and Acute Physiology and Chronic Health Evaluation Ⅱ( APACHE Ⅱ) before and after treatment 10 d were compared between the two groups. The clinical effects were evaluated in two groups. Results There were statistical differences on cure rate and total effective rate between the two groups( P < 0. 05),and which in treatment group was superior to that in control group. The times of abdominal pain,abdominal distension remission time and bowel sound recovery and hospital stay in treatment group were shorter than that in control group( P < 0. 05). No cases of death during hospitalization in both groups and there were statistical differences on the incidence of ARDS,MODS,ARF and the total incidence of complications during hospitalization between the two groups( P < 0. 05),and which in treatment group was lower than that in control group. The levels of serum amylase,urine amylase and APACHE Ⅱ scores were reduced after treatment 10 d in two groups( P < 0. 05),and which in treatment group was lower than that in control group. Conclusion Integrated traditional Chinese and western medicine treatment has exact effect on severe acute pancreatitis,it can effectively reduce the incidence of complications and improve prognosis,it is worthy of using widely in clinical.