自拟清胰汤对早期重症胰腺炎的疗效探析

Therapeutic effect of self made Qingyi decoction on early severe pancreatitis

目的探讨自拟清胰汤联合西药治疗早期重症胰腺炎的临床疗效。方法将2016年10月至2018年10月常州市金坛区人民医院收治的早期重症胰腺炎病人94例,按照随机数字表法分为两组,各47例。对照组行生长抑素2 mL/h微泵注射等常规西药治疗,观察组在此基础上联合自拟清胰汤治疗。药物组成:大黄、厚朴、赤芍、黄芩、黄连、柴胡、茯苓各15 g,枳实、木香、桃仁、丹参、陈皮、法半夏、甘草各10 g。水煎煮2次,合并再制成200 mL,分2袋包装,1剂/天,早晚各服1袋,用鼻肠管注入,共治疗10 d。对比两组临床疗效、各项临床症状、体征恢复时间、实验室指标恢复时间、CT检查胰腺组织各径及不良反应发生率。结果观察组临床总有效率(95.74%)高于对照组(74.47%);观察组不良反应发生率(4.26%)低于对照组(23.40%);观察组肛门排便恢复时间(3.51±1.44)d比(5.65±2.29)d、腹痛消失时间(3.22±1.34)d比(5.73±1.52)d、腹胀消失时间(3.52±1.22)d比(6.35±1.52)d、发热消失时间(2.71±1.29)d比(5.28±1.53)d、肠鸣音恢复时间(3.55±1.14)d比(6.26±1.61)d、肾功能恢复时间(2.15±0.55)d比(3.96±0.65)d、呼吸功能恢复时间(2.58±0.74)d比(4.74±1.44)d均短于对照组;观察组血淀粉酶恢复正常时间(4.42±1.15)d比(7.26±1.27)d、白细胞水平恢复正常时间(4.41±1.22)d比(9.25±2.03)d、尿淀粉酶恢复正常时间(4.42±1.15)d比(7.26±1.27)d、血脂肪酶恢复正常时间(3.11±1.13)d比(5.72±1.62)d均短于对照组;观察组治疗后CT检查胰腺组织各径(26.05±5.31)mm(23.16±4.32)mm(22.13±4.69)mm均显著低于对照组(28.50±6.15)mm(25.67±5.01)mm(24.96±6.13)mm,差异有统计学意义(P<0.05)。结论自拟清胰汤联合西药治疗早期重症胰腺炎病人可显著提高临床疗效,减轻病人临床症状,促进身体恢复,降低不良反应发生率,值得推广。

Objective To explore the clinical efficacy of self made Qingyi Decoction combined with Western medicine in the treat ment of early severe pancreatitis.Methods Ninety four patients with early severe pancreatitis who admitted to Jintan District People’s Hospitalof Changzhou city from October 2016 to October 2018 were assigned into two groups according to the random number table,with 47 cases in each group.The control group was treated with conventional western medicine(with injecting 2mL/h somatostatin by micropump),while the observation group was treated with conventional western medicine combined with self made Qingyi Decoction.Drug composition includes 15g each of rhubarb,Magnolia officinalis,Radix Scutellariae,Scutellaria baicalensis,Coptis chinensis,Bupleurum and Poria,10g each of Zhishi,Muxiang,Taoren,Danshen,Chenpi,French Pinellia and Licorice.The medicine was boiled 2 times,and combined into 200 mL,divided into 2 bags,with 1 dose/day,1 bag was taken in the morning and evening,and injected into the naso intestinal tube for 10 days.The clinical efficacy,clinical symptoms,recovery time of the signs,re covery time of laboratory indicators,CT examination of pancreatic tissue,and incidence of adverse reactions were compared be tween the two groups.Results The total effective rate of the observation group(95.74%)was higher than 74.47%of the control group;the incidence of adverse reactions(4.26%)in the observation group was lower than 23.40%of the control group;the recov ery time of anal defecation[(3.51±1.44)d vs.(5.65±2.29)d],the disappearance time of abdominal pain[(3.22±1.34)d vs.(5.73±1.52)d],the disappearance time of abdominal distension[(3.52±1.22)d vs.(6.35±1.52)d],the disappearance time of fever[(2.71±1.29)d vs.(5.28±1.53)d],the recovery time of bowel sounds[(3.55±1.14)d vs.(6.26±1.61)d],the recovery time of kid ney function[(2.15±0.55)d vs.(3.96±0.65)d],and the recovery time of respiratory function[(2.58±0.74)d vs.(4.74±1.44)d]in the observation group were shorter than those of the control group;the normal time of blood amylase[(4.42±1.15)d vs.(7.26±1.27)d],leukocyte level[(4.41±1.22)d vs.(9.25±2.03)d],urinary amylase[(4.42±1.15)d vs.(7.26±1.27)d]and blood lipase recovery[(3.11±1.13)d vs.(5.72±1.62)d]in the observation group were shorter than those of the control group;the different diameter of pancreatic tissue in the observation groupwere(26.05±5.31)mm,(23.16±4.32)mm and(22.13±4.69)mm,respectively,which were significantly lower than(28.50±6.15)mm,(25.67±5.01)mm and(24.96±6.13)mm of the control group,and the difference was statis tically significant(P<0.05).Conclusion Self made Qingyi Decoction combined with Western medicine in the treatment of pa tients with early severe pancreatitis can significantly improve clinical efficacy,reduce clinical symptoms,promote physical recovery,and reduce the incidence of adverse reactions,which is worth promoting.