中药外敷结合常规疗法治疗急性胰腺炎腹痛临床研究与护理体会

Clinical Study and Nursing Experience of External Application of Chinese Herbal Medicine Combined with Routine Treatment for Abdominal Pain Caused by Acute Pancreatitis

目的:观察在常规疗法基础上加用大柴胡汤合大承气汤加减外敷治疗急性胰腺炎的效果。方法:将120例急性胰腺炎腑实热结证患者随机为对照组和观察组各60例。2组均给予综合治疗措施,观察组加用大柴胡汤合大承气汤加减外敷,2组均连续治疗7天。采用疼痛视觉模拟评分法(VAS)和非语言成人疼痛评估量表(NVPS)评价腹痛程度,记录腹痛和腹胀减轻时间、肠鸣音恢复时间以及首次排气、排便时间等以评估肠麻痹改善情况,治疗前后检测白细胞计数(WBC)、中性粒细胞计数(N)、血淀粉酶、C反应蛋白(CRP)水平。结果:治疗后,2组腹痛VAS评分(最严重和最轻)均逐渐下降(P<0.01)。观察组治疗3、5、7天腹痛最严重时的VAS评分均低于对照组(P<0.01),治疗3、5天腹痛最轻时的VAS评分均低于对照组(P<0.01)。观察组腹痛缓解时间、腹胀缓解时间均短于对照组,肠鸣音恢复时间、首次排气和排便时间均早于对照组,差异均有统计学意义(P<0.05)。2组WBC、N、血淀粉酶、CRP水平和NVPS评分均较治疗前下降(P<0.01),观察组5项指标值均低于对照组(P<0.01)。结论:在现代医学综合治疗基础上予大柴胡汤合大承气汤加减外敷治疗腑实热结型急性胰腺炎,可明显减轻患者的腹痛,改善肠麻痹症状,减轻炎症反应,有利于病情的恢复。

Objective:To observe the effect of external application of modified Dachaihu tang and Dachengqi tang on the basis of routine therapy for acute pancreatitis.Methods:Divided 120 cases of patients with acute pancreatitis and fu-organ excess and heat accumulation syndrome into the control group and the observation group randomly,with 60 cases in each group.Both groups were given comprehensive treatment measures and the observation group was additionally given the external application of modified Dachaihu tang and Dachengqi tang.The two groups were treated continuously for 7 days.Evaluated the degree of abdominal pain by using visual analogue scale(VAS) and non-verbal pain assessment scale for adults(NVPS).Recorded the alleviation time of abdominal pain and abdominal distension,the recovery time of borborygmi and the first exhaust and defecation time to evaluate the improvement of enteroparalysis.Detected the levels of white blood cell count(WBC),neutrophil count(N),hemodiastase and C-reactive protein(CRP) before and after treatment.Results:The VAS scores of abdominal pain(the most severe and the least severe) in the two groups after treatment were decreased gradually(P<0.01).The VAS scores in the observation group at 3,5 and 7 days of treatment with the most severe abdominal pain were lower than those in the control group(P<0.01),and the VAS scores at 3 and 5 days of treatment with the least severe abdominal pain were lower than those in the control group(P<0.01).In the observation group,the remission time of abdominal pain and abdominal distension were shorter than those in the control group(P<0.05),the recovery time of borborygmi and the first exhaust and defecation time were earlier than those in the control group(P<0.05).The levels of WBC,N,hemodiastase and CRP and the NVPS scores in the two groups were all lower than those before treatment(P<0.01),and these 5 indexes in the observation group were lower than those in the control group(P<0.01).Conclusion:The external application of modified Dachaihu tang and Dachengqi tang on the basis of modern medical comprehensive treatment for acute pancreatitis of fu-organ excess and heat accumulation syndrome can significantly relieve the abdominal pain of the patients,improve the symptoms of enteroparalysis,reduce the inflammatory reaction and benefit the recovery of the disease.