清胰通腑汤联合腹部外敷对肝胆湿热型急性胆源性胰腺炎患者症状缓解及血、尿淀粉酶指标的影响

Effect of Qingyi Tongfu Decoction Combined with Abdominal External Application on Symptoms and Blood and Urine Amylase Levels in Patients with Acute Biliary Pancreatitis(Syndrome of Dampness-Heat in Liver and Gallbladder)

目的探讨清胰通腑汤联合腹部外敷对肝胆湿热型急性胆源性胰腺炎患者症状缓解及血、尿淀粉酶指标的影响。方法选取2018年3月—2020年1月期间河北省保定市第一中心医院收治的84例肝胆湿热型急性胆源性胰腺炎患者,随机分为对照组和观察组,每组各42例。对照组采用西医内科治疗,观察组在此基础上采用清胰通腑汤联合腹部外敷治疗。两组患者均治疗7 d后,观察比较两组患者治疗后症状缓解时间(腹痛、腹胀、发热、黄疸、恶心呕吐),治疗前后急性生理和慢性健康状况评分(Acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、急性胰腺炎严重程度床边指数(Bedside index of acute pancreatitis severity,BISAP)评分及血、尿淀粉酶水平的改善情况及临床疗效和药物安全性。结果治疗后观察组腹痛消失时间、腹胀消失时间、发热消失时间、黄疸消失时间及恶心呕吐消失时间均明显低于对照组,差异有统计学意义(P<0.05)。治疗7 d后,两组患者血、尿淀粉酶水平、APACHEⅡ评分和BISA评分均较治疗前明显降低,差异有统计学意义(P<0.05);且观察组血、尿淀粉酶水平、APACHEⅡ评分和BISA评分均较对照组明显降低,差异有统计学意义(P<0.05)。观察组总有效率90.48%(38/42)明显高于对照组73.81%(31/42),差异有统计学意义(P<0.05)。两组患者在给药治疗过程中均未发生严重的不良反应。结论在西医内科治疗基础上采用清胰通腑汤联合腹部外敷治疗肝胆湿热型急性胆源性胰腺炎,能够有效缓解局部症状,降低血、尿淀粉酶水平,有助于改善缓解胰腺损伤,促进疾病转归,治疗方案安全有效。

Objective To explore the effect of Qingyi Tongfu Decoction combined with abdominal external application on symptoms and blood and urine amylase levels in patients with acute biliary pancreatitis(syndrome of dampness-heat in liver and gallbladder).Methods Eighty-four patients with acute biliary pancreatitis(syndrome of dampness-heat in liver and gallbladder)treated in the Baoding No.1 Central Hospital from March 2018 to January 2020 were enrolled and randomly assigned into a control group and an observation group,with 42 patients in each group.The control group was treated with western medicine,and the observation group with Qingyi Tongfu decoction combined with abdominal external application on the basis of the therapy in the control group.Both groups were treated for seven days.The time to symptom(abdominal pain,abdominal distension,fever,jaundice,nausea,and vomiting)relief was recorded.Further,the Acute Physiology and Chronic Health EvaluationⅡ(APACHEⅡ)score,Bedside Index for Severity in Acute Pancreatitis Severity(BISAP)score,and the blood and urinary amylase levels were compared between before and after treatment and between the two groups.The clinical efficacy and drug safety of the two groups were compared.Results The observation group showed shortened time to symptom relief compared with the control group(P<0.05).After 7 days of treatment,the serum and urine amylase levels,APACHE II score,and BISAP score in the two groups reduced compared with those before treatment(P<0.05)and were lower in the observation group than in the control group(P<0.05).The total effective rate inthe observation group was 90.48%(38/42),higher than that[73.81%(31/42)]in the control group(P<0.05).Neither groups showed serious adverse reactions.Conclusion On the basis of western medicine treatment,Qingyi Tongfu Decoction combined with abdominal external application can relieve local symptoms,reduce the levels of amylase in blood and urine,alleviate pancreatic injury,and improve the prognosis.This treatment scheme is safe and effective for acute biliary pancreatitis(syndrome of dampness-heat in liver and gallbladder).