中医辨证治疗ICU重症急性胰腺炎的临床疗效研究

Clinical Observation on TCM Syndrome Differentiation in Treatment of ICU Severe Acute Pancreatitis

目的观察中医辨证分型联合西医常规治疗重症急性胰腺炎(SAP)的临床疗效。方法将88例SAP患者随机分为两组,对照组44例采用西医常规对症治疗;观察组44例在西医常规治疗基础上按肝郁气滞证、脾胃实热证、肝胆湿热证、蛔虫上扰证、气阴耗竭证分别给予自拟中药汤剂随证治疗,两组均以治疗5d为1个疗程,观察3个疗程后(5d、10d、15d)两组患者的APACHE-Ⅱ评分变化、患者各项诊疗情况的转归、临床疗效及患者预后状况。结果两组治疗后第5、10、15天观察组APACHE-Ⅱ评分均明显低于对照组(<0.05);观察组痊愈率和显效率明显高于对照组(<0.05);观察组患者临床症状改善时间、血清淀粉酶恢复时间、肠鸣音恢复时间、生命体征稳定时间及ICU住院治疗时间等各项时间均短于对照组(<0.05);观察组患者的并发症发生率均低于对照组(<0.05);观察组病死率(4.55%)明显低于对照组(22.73%)(<0.05)。结论中西医结合辨证分型用药治疗SAP的综合疗效显著,前景良好,值得进一步研究。

Objective To observe the clinical effect of traditional Chinese medicine(TCM)syndrome differentiation combined with routine western medicine in treatment of severe acute pancreatitis(SAP).Methods 88 cases of patients with SAP were randomly divided into control group and observation group,44 cases in each group.Control group was treated with conventional western medicine,observation group was treated with Chinese herbal decoction according to liver depression and qi stagnation,spleen and stomach excess heat,liver and gallbladder dampness-heat,ascaris disturbance and qi-yin exhaustion on the basis of control group.The APACHE-II scores of the two groups were observed on the 5 th,10 th and 15 th days after treatment as well as the prognosis,clinical efficacy and prognosis.Results The APACHE-II score of observation group was significantly lower than that of control group on the 5 th,10 th and 15 th days after treatment(<0.05);the recovery rate and marked efficiency of observation group were significantly higher than those of control group(<0.05);the improvement time of clinical symptoms,the recovery time of serum amylase,the recovery time of bowel sounds,the stabilization time of vital signs and the hospitalization time of ICU in observation group were shorter than those in control group(<0.05);the incidence of complications in observation group was lower than that in control group(<0.05);the mortality in observation group was lower than that in control group(<0.05).Conclusion Drug use based on TCM syndrome differentiation and routine western therapy is remarkable in treatment of SAP,and the prospect is good,which deserves further study.