消炎利胆汤联合乌司他丁治疗重症急性胰腺炎肝胆湿热证临床研究

Observation on the effect of Xiaoyan Lidan decoction combined with ulinastatin in the treatment of liver-biliary dampness and heat syndrome of severe acute pancreatitis

目的:探究消炎利胆汤联合乌司他丁(UTI)治疗重症急性胰腺炎(SAP)肝胆湿热证的效果。方法:选取128例SAP患者,按随机数字表法分为对照组及观察组,各64例。对照组采用UTI治疗,观察组采用自拟消炎利胆汤联合UTI治疗。连续治疗7 d后评估患者临床疗效及中医证候评分,检测血清炎症因子水平[C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、内毒素及可溶性细胞间黏附分子-1(sICAM-1)],评估患者胃肠道功能(GSRS量表),统计患者临床相关指标(腹胀、腹痛消失时间、血清淀粉酶恢复正常时间,肠鸣音恢复时间及病死率)及药物不良反应。结果:观察组SAP患者总有效率为93.75%,高于对照组的79.69%(P<0.05);两组SAP患者治疗后主症、次症及总评分均降低,其中观察组SAP患者各项评分均低于对照组(P<0.05);两组SAP患者治疗后CRP、TNF-α、IL-6及内毒素水平均降低,sICAM-1水平升高,观察组CRP、TNF-α、IL-6、内毒素及sICAM-1水平均低于对照组(P<0.05);两组SAP患者治疗后GSRS评分均降低,观察组GSRS评分低于对照组(P<0.05);观察组SAP患者腹胀、腹痛消失时间、血清淀粉酶恢复正常时间及肠鸣音恢复时间均短于对照组,病死率低于对照组(P<0.05);观察组药物不良反应率为6.25%,低于对照组的18.75%(P<0.05)。结论:消炎利胆汤联合UTI能够提高SAP肝胆湿热证患者的临床疗效,改善患者中医症状及血清炎症因子水平,提高胃肠道功能,降低不良反应的发生。

Objective:To investigate the effect of Xiaoyan Lidan decoction combined with ulinastatin(UTI)in the treatment of severe acute pancreatitis(SAP).Methods:A total of 128 SAP patients were selected and randomly divided into control group and observation group,with 64 cases in each group.The control group was treated with UTI,and the observation group was treated with Xiaoyan Lidan decoction combined with UTI.After 7 days of continuous treatment,the clinical efficacy and TCM syndrome score of the patients were evaluated,and the levels of serum inflammatory factors[C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),Interleukin-6(IL-6),Endotoxin and Soluble intercellular Adhesion molecule-1(sICAM-1)]were detected.The gastrointestinal function(GSRS scale)of the patients were evaluated,and the clinical related indicators(the time when abdominal distension and abdominal pain disappeared,the time when serum amylase returned to normal,the time when intestinal sound returned and the fatality rate)and adverse drug reactions were calculated.Results:The effective rate of SAP patients in the observation group was 93.75%,which was higher than that in the control group 79.69%(P<0.05).After treatment,the main syndrom,secondary syndrom and total score of SAP patients in both groups were decreased,and the SAP patients in the observation group were lower than those in the control group(P<0.05).After treatment,the levels of CRP,TNF-α,IL-6 and endotoxin in SAP patients in two groups were decreased,while the levels of sICAM-1 were increased.The levels of CRP,TNF-α,IL-6,endotoxin and sICAM-1 in observation group were lower than those in control group(P<0.05).The GSRS score of SAP patients in both groups was decreased after treatment,and the GSRS score of observation group was lower than that of control group(P<0.05).The disappearance time of abdominal distension,abdominal pain,self-defecation time and hospital stay of SAP patients in observation group were shorter than those in control group(P<0.05).The ADR rate of observation group was lower than that of control group(P<0.05).The adverse reaction rate of the observation group was 6.25%,lower than the control group's 18.75%(P<0.05).Conclusion:Xiaoyan Lidan decoction combined with UTI can improve the clinical efficacy of SAP patients with liver-biliary dampness and heat syndrome,improve the level of TCM symptoms and serum inflammatory factors,improve gastrointestinal function and reduce the occurrence of adverse reactions.