基于中医“通腑泻热”理论的中西医结合治疗重症急性胰腺炎的临床观察

Clinical Observation of the Combination of Traditional Chinese and Western Medicine in the Treatment of Severe Acute Pancreatitis Based on the Theory of“TongfuXiere Decoction”in Traditional Chinese Medicine

目的基于中医“通腑泻热”理论,探索中西医结合治疗重症急性胰腺炎的临床价值。方法选取2022年1月至2024年6月在重庆市綦江区中医院就诊的84例重症急性胰腺炎患者,根据随机数字表法分为观察组(通腑泻热汤灌肠+常规西医治疗)与对照组(常规西医治疗),每组各42例。对比两组患者中医证候评分、肠道黏膜屏障功能相关指标、血清炎症因子以及临床疗效。结果治疗前,两组患者腹痛、腹胀、恶心呕吐、便溏评分,D-乳酸、血清淀粉酶(AMS)、二胺氧化酶(DAO)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)水平均无显著差异(P>0.05);治疗后,观察组患者中医证候腹痛、腹胀、恶心呕吐、便溏评分,肠黏膜屏障功能指标D-乳酸、AMS、DAO,血清炎症因子hs-CRP、TNF-α、IL-6均显著低于对照组(P均<0.001)。且观察组中40例患者治疗有效(总有效率为95.24%),高于对照组中33例患者(总有效率为78.57%),差异有统计学意义(P<0.05)。结论基于中医“通腑泻热”理论,采取中西医联合用“通腑泻热汤”治疗重症急性胰腺炎,可明显改善患者中医证候评分,促进肠黏膜屏障功能恢复,降低炎症反应,提高临床疗效。

Objective Based on the traditional Chinese medicine(TCM)theory of“TongfuXiere Decoction”,this study aims to explore the clinical value of integrating traditional Chinese and Western medicine in the treatment of severe acute pancreatitis.Methods A total of 84 patients with severe acute pancreatitis,who were treated at Qijiang District Hospital of Traditional Chinese Medicine,Chongqing,from January 2022 to June 2024,were selected and randomly divided into an observation group(enema with“TongfuXiere Decoction”combined with conventional Western medicine treatment)and a control group(conventional Western medicine treatment alone),with 42 patients in each group.The two groups were compared in terms of TCM syndrome scores,intestinal mucosal barrier function-related indicators,serum inflammatory factors,and clinical efficacy.Results Before treatment,there were no significant differences between the two groups in terms of abdominal pain,abdominal distension,nausea and vomiting,loose stools scores,as well as D-lactate,AMS,DAO,hs-CRP,TNF-α,and IL-6 levels(P>0.05).After treatment,the observation group showed significantly lower TCM syndrome scores for abdominal pain,abdominal distension,nausea and vomiting,and loose stools,as well as lower levels of intestinal mucosal barrier function indicators(D-lactate,AMS,DAO)and serum inflammatory factors(hs-CRP,TNF-α,IL-6),compared to the control group(all P<0.001).Additionally,40 patients in the observation group were classified as effectively treated(total effective rate of 95.24%),which was significantly higher than the 33 patients in the control group(total effective rate of 78.57%)(P<0.05).Conclusion Based on the TCM theory of“TongfuXiere Decoction”,the integration of Western medicine with“TongfuXiere Decoction”in the treatment of severe acute pancreatitis can significantly improve patients'TCM syndrome scores,promote the recovery of intestinal mucosal barrier function,reduce inflammatory responses,and enhance clinical efficacy.