益活清下法治疗早期重症急性胰腺炎的临床观察

【作者】 张隽开；

【导师】 丁春元；

【作者基本信息】 湖北中医学院 ， 中西结合临床， 2003， 硕士

【摘要】 目的： 通过加味大柴胡汤合西药治疗早期重症急性胰腺炎(SAP)的临床观察，探索“益活清下法”治疗重症胰腺炎的作用机制，寻求中西结合治疗重症胰腺炎的有效方法。 方法： 将已确诊的早期重症胰腺炎患者分为两组：加味大柴胡汤合西医非手术治疗组(简称治疗组)，西医非手术治疗组(对照组)。西医非手术治疗组包括重症监护，给氧，禁食，胃肠减压，补充血容量，维持酸碱平衡及水电解质平衡，使用抑酶药物，利用抗生素，予营养支持，解痉，止痛等处理，有多器官功能衰竭者行器官功能支持。治疗组在西医非手术治疗基础上，加用加味大柴胡汤300ml，每日分三次予胃管注入及肠道灌注各50ml，分别观察入院第一天和第七天APACHE Ⅱ评分及Balthazar CT评分；观察腹部症状缓解时间，肠道功能恢复时间及胰腺感染发生率，并作出疗效评价。 结果： ①研究提示，两组均能明显降低APACHE Ⅱ评分及Balthazar CT评分(P＜0.01)，治疗组降低更明显。 ②加味大柴胡汤组缓解腹部症状时间及肠道功能恢复时间，与对照组间有显著差异(P＜0.05)。 ③统计分析表明，加味大柴胡汤组胰腺感染发生率明显低于对照组，差异显著(P＜0.01)。 结论： 益活清下法可迅速缓解SAP患者腹部症状，改善胃肠道功能，防治胰腺感染和坏死，抑制病情发展，在SAP的中西结合治疗中有重要作用，是一种有效的中医治疗方法。更多还原

【Abstract】 Objective:Through clinical study on the treament of early Severe Acute Pancreatitis(SAP) with integrated traditional Chinese herbal soup and western medicine,to explore the mechanism of YI-HUO-QING-XIA therapeutic method for finding the effective treatment of SAP. Method:The early SAP cases who have been made a definite diagnosis of were divided into groups:Integrated traditional Chinese herbal soup and western medicine group(treatment group),Western medicine group(contrast group).Western medicine therapy include heavy sickness guardianship,giving oxygen,fasts,stomach and intestines decompression,supplement of blood capacity,maintenance of acid-alkali balance and water-electrolyte balance,using restraining enzyme medicine and antibiotic,giving nutrition surpport,spasmolysis and stoping pain and so on;cases with multi-organs function failure giving organ function support.On the basis of the above,the treatment group add Chinese herbal soup pouring from stomach tube and rectum.Each case is observed APACHE II marks and Balthazar CT grades in the first day and seventh day .abdomen symptoms alleviating time,intestinal tract function restoring time and pancreatic infection incidence,then make evaluation of curative effect. Result:oth of two groups can obviously reduce APACHE II marks and Balthazar CT grades(P<0.01),the treatment group reducing more obviously. ?Abdomen symptoms alliviating time and intestinaltract function restoring time have remarkable differences between the treatment group and contrast group(P<0.05). ?The pancreatic infection incidence of the treatment group is lower compared to that of the contrast guoup(PO.Ol). Conclusion:YI-HUO-QING-XIA therapeutic method can relieve the abdomen symptoms of SAP patients vapidly,improve gastrointestinal tract function ,prevent and treat pancreatic infection and necrosis.lt is a effective therapeutic way of TCM for SAP that it can prevent the development of SAP effectly.更多还原