柴芩承气汤加减治疗急性胆源性胰腺炎的临床观察

Clinical Study of Chaiqin Chengqi Decoction in the Treatment of Acute Biliary Pancreatitis

目的观察柴芩承气汤加减治疗急性胆源性胰腺炎的临床效果并探讨其作用机制。方法60例患者采用随机数字表法分为对照组与观察组两组各30例。对照组采用西医常规治疗方案治疗,观察组采用柴芩承气汤加减联合常规基础治疗,连续治疗7d。比较两组治疗有效率、胃肠动力物质(胃动素、P-物质、消脂素、内皮素)水平、肠鸣音恢复时间、排便时间、肛门排气时间、腹痛缓解时间、住院时间、CTSI评分、炎性感染相关指标[白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)、C反应蛋白(CRP)平均血小板体积(MPV)、白细胞计数(WBC)]水平和不良反应发生情况。结果观察组治疗总有效率为93.33%,高于对照组的73.33%(P<0.05)。两组治疗后胃肠动力物质改善均优于治疗前,且观察组患者胃动素、P-物质均高于对照组,而消脂素、内皮素、CTSI评分则均低于对照组(均P<0.05)。观察组患者肠鸣音恢复时间、排便时间、肛门排气时间、腹痛缓解时间、住院时间均短于对照组(均P<0.05)。两组治疗后患者炎性感染相关指标改善均优于治疗前,且观察组IL-6、TNF-α、CRP、PCT、WBC、MPV水平均低于对照组,IL-10高于对照组(均P<0.05)。两组排便后1、3d腹腔压力均低于治疗前,且观察组1.3d的腹腔压力均低于对照组(P<0.05)。两组均未发生不良反应。结论柴芩承气汤加减治疗可有效改善急性胆源性胰腺炎患者临床症状及体征,减轻炎性反应,改善患者胃肠动力,且在减轻胰腺肿胀、胰周渗出、邻近间隙积液方面具有优势。

Objective:To explore the clinical effect of Chaiqin Chengqi Decoction in the treatment of acute biliary pancreatitis.Methods:Using the random number table method,60 patients with acute gallstone pancreatitis were divided into a control group and an observation group,30 cases in each group.Thecontrol group was treated by routine western medicine.The observation group was treated with modified Chaiqin Chengqi Decoction combined with routine treatment.Both groups were treated for consecutive 7 days.The clinical efficacy,levels of gastrointestinalmotility substances,recoveytime of bowel sounds,defecation time,anal exhaust time,hospital stay,CT-SI score,levels of inflammatory factors(IL-6、IL-10.TNF-α、PCT,CRP,MPV、WBC),and incidence of adverse reactions between two groups were compared.Results:The effective rate of observation group(93.33%)was significantly higher than that of control group(73.33%)(P<0.05).Motilin and Psubstance in the observation group were significantly higher than those in the control group.The levels of lipidin and endothelin in the observation group were significantly lower than those in control group(P<0.05).In the observation group,bowel sound recovery time,defecation time,anal exhaust time,abdominal pain relief time,hospital stay,CTSI score were significantly lower compared with the control group(P<0.05).The levels of IL-6,TNF-α,CRP,PCT,WBC count and MPV in the observation group were significantly lower than those in control group,while IL-10 in observation group was significantly higher than that in control group(P<0.05).Before defecation,the abdominal pressure of the two groups was significantly lower than that of the control group at 1 and 3 d after defecation(P<0.05).There were no adverse reactions in the two groups.Conclusion:Chaiqin Chengqi Decoction can effectively improve the clini-cal symptoms and signs of patients with acute biliary pancreatitis,reduce inflammatory reaction and improve gastro-intestinal motivity of patients,and is better in reducing pancreatic swelling,peripancreatic exudation and adjacent space effusion,promoting the recovery of patients.It is safe and effective,and is worthy of promotion.