通腑行气活血方内服外用对重症急性胰腺湿热毒蕴证的辨证治疗效果分析

Syndrome Differentiation and Treatment of Tongfu Xingqi Huoxue Formula by Internal and External Way of Severe Acute Pancreatitis of Damp-Heat and Toxin Syndrome

目的：探讨通腑行气活血方内服外用对重症急性胰腺湿热毒蕴证的辨证治疗效果方法：选择2014年4月—2016年4月本院接诊的90例重症急性胰腺炎患者,中医辨证为属湿热毒蕴证。以随机数表法分为观察组（n=45）和对照组（n=45）,对照组给予重症急性胰腺炎常规治疗,观察组联合通腑行气活血方内服和灌肠,均连续用药14 d。比较两组肠道功能恢复时间,治疗前后急性生理学和慢性健康状况评分（APACHEⅡ）、血清淀粉酶、内毒素、D乳酸的变化,比较临床疗效,随访3个月,记录全身炎症反应综合征（SIRS）、多器官功能障碍综合征（MODS）发生率、中转手术率、死亡率。结果：观察组首次排便、腹胀缓解、腹痛缓解、肠鸣音恢复时间均明显比对照组短（P〈0.05）;治疗后,两组APACHE-Ⅱ评分、血清淀粉酶、内毒素、D乳酸较治疗前比较均显著改善（P〈0.05）,观察组APACHE-Ⅱ评分、血清淀粉酶、内毒素、D乳酸均明显低于对照组（P〈0.05）;观察组临床疗效总有效率明显高于对照组[95.56%（43/45）vs75.56%（34/45）]（P〈0.05）;随访过程中,观察组SIRS、MODS发生率明显比对照组低[6.67%（3/45）vs31.11%（14/45）,4.44%（2/45）vs28.89%（13/45）]（P〈0.05）,两组中转手术率、死亡率比较无显著差异（P〉0.05）。结论：在湿热毒蕴证重症急性胰腺炎患者中,应用通腑行气活血方内服外用效果显著,可有效改善临床症状及肠道屏障功能,提高预后。

Objective： To study the syndrome differentiation and treatment effect of Tongfu Xingqi Huoxue Formula by internal and external way in treatment of severe acute pancreatitis with damp-heat and toxin syndrome. Methods： Ninety patients of severe acute pancreatitis of damp-heat and toxin syndrome who received therapy from April 2014 to April 2016 in our hospital were selected. According to random number table,those patients were divided into the observation group（n = 45） and the control group（n = 45）. The control group was treated with routine treatment,while the observation group was combined with Tongfu Xingqi Huoxue Formula orally and by enema,continuously for 14 d. The recovery time of intestinal function was compared between the two groups,the changes of acute physiology and chronic health score（APACHE II）,serum amylase,endotoxin and D lactic acid before and after treatment,and the clinical efficacy were compared. All patients were followed up for 3 months,and the incidence of systemic inflammatory response syndrome（SIRS）,multiple organ dysfunction syndrome（MODS）,transit operation rate and mortality were recorded. Results： The first time defecation,abdominal distension,abdominal pain and bowel sound recovery time in the observation group were significantly shorter than those of the control group（P〈0. 05）. After treatment,the scores of APACHE-II,serum amylase,endotoxin and D lactic acid were significantly improved compared with those before treatment（P〈0. 05）.The APACHE-II,serum amylase,endotoxin and D lactic acid in the observation group were significantly lower than those of the control group（P〈0. 05）. The total effective rate of the observation group was significantly higher than that of the control group[95. 56%（43/45） vs 75. 56%（34/45） ]（P〈0. 05）. During the follow-up period,the incidence of SIRS and MODS in the observation group was significantly lower than that of the control group[6. 67%（3/45） vs31. 11%（14/45）,4. 44%（2/45）vs28. 89%（13/45） ]（P〈0. 05）. There was no significant difference between the two groups in transit operation rate or mortality rate（P〉0. 05）. Conclusion： Tongfu Xingqi Huoxue Formula is well for severe acute pancreatitis,which can effectively improve the clinical symptoms,intestinal barrier function and prognosis.