清胰汤加减治疗重症急性胰腺炎疗效研究

Clinical study on modified Qingyi decoction in treatment of patients with severe acute pancreatitis

目的:分析清胰汤加减治疗重症急性胰腺炎(SAP)疗效及对血清炎症指标影响。方法:选取SAP患者86例,按随机数字表法分为研究组(n=43)、对照组(n=43)。对照组予生长抑素及连续性肾脏替代疗法(CRRT),研究组在对照组基础上予清胰汤加减治疗,两组均治疗1周。比较两组临床疗效、症状改善时间,治疗前后疾病严重程度、血清炎症指标、疾病相关因子。结果:研究组肛门排便恢复时间、腹痛消失时间、腹胀消失时间、发热消失时间、肠鸣音恢复时间均短于对照组,差异有统计学意义(均P<0.05)。治疗后,两组急性生理与慢性健康状况(APACHEⅡ)得分、全血白细胞计数(WBC)、血清活动性肠肽(VIP)、微管相关蛋白1轻链3(MAP1-LC3)、髓样细胞触发受体-1(TREM-1)、血清C反应蛋白(CRP)、血淀粉酶(AMS)水平均较治疗前降低,且研究组低于对照组,差异有统计学意义(均P<0.05)。治疗后,研究组总有效率高于对照组,差异有统计学意义(P<0.05)。结论:清胰汤加减联合CRRT治疗SAP效果较好,可促进临床症状消失、降低疾病严重程度,其机制可能与调节机体疾病相关因子水平,抑制炎症反应有关。

Objective:To analyze efficacy of modified Qingyi decoction in the treatment of patients with severe acute pancreatitis(SAP)and effect of levels of serum inflammatory indexes.Methods:86 patients with SAP were divided into the study group(n=43)and the control group(n=43)by random number table method.The control group received somatostatin and continuous renal replacement therapy(CRRT)treatment,and the study group received the modified Qingyi decoction on the basis of the control group.Both groups were treated for one week.The clinical efficacy,symptom improvement time and disease severity,serum inflammatory indexes,disease-related factors before and after treatment were compared between the two groups.Results:The recovery time of anal defecation,abdominal pain,abdominal distension,fever and bowel sounds in the study group were all shorter than those in the control group(all P<0.05).After treatment,the score of acute physiology and chronic health status(APACHEⅡ),the levels of complete blood white blood cell(WBC),serum vasoactine intrestinal peptide(VIP),microtubule-associated protein 1 light chain 3(MAP1-LC3),triggering receptors expressed on myeloid cells-1(TREM-1),C-reactive protein(CRP)and amylase(AMS)in the study group were lower than those before treatment,and the study group were lower than those in the control group(all P<0.05).After treatment,the total effective rate in the study group was higher than that in the control group,difference statistically significant(P<0.05).Conclusion:Modified Qingyi decoction combined with CRRT has definite curative effect in the treatment of patients with SAP,which colud accelerate the disappearance of clinical symptoms and reduce the severity of disease,analysis related to the regulation of the level of the body’s disease-related factors and the inhibition of inflammatory response.