早期应用柴芩承气汤治疗胆源性重症急性胰腺炎的临床研究

1、早期应用柴芩承气汤治疗胆源性重症急性胰腺炎的临床研究         07-09-12 15:49:00     编辑：studa20           作者：薛平，黄宗文，郭佳，赵健蕾，李永红，王忠朝 【关键词】  ,胆源性重症急性胰腺炎    摘要  目的：探讨早期应用柴芩承气汤治疗胆源性重症急性胰腺炎（severe ac

2、ute pancreatitis, SAP）的疗效。方法：90例符合病例选择标准并接受柴芩承气汤治疗的胆源性SAP住院患者，按院外病程长短分为早期组（3 d内入院接受治疗，54例）和晚期组（37 d内入院接受治疗，36例），比较治疗过程中两组患者并发症的发生率、住院时间、手术中转率及病死率。结果：早期组胰性脑病、感染和消化道出血的发生率明显低于晚期组（P0.05）。早期组和晚期组住院时间分别为（24.9±18.4）d和（51.6±45.9）d，早期组和晚期组病死率分别为7.4%（4/54例）和25.0%（9/36例），早期组和晚期组中转手术率分别为11.1%（6/54例）和

3、27.8%（10/36例），两组比较差异均有统计学意义（P0.05）。结论：早期应用柴芩承气汤治疗胆源性SAP，可减少并发症的发生、缩短住院时间、减少手术中转率及降低病死率。关键词  胆源性重症急性胰腺炎; 柴芩承气汤; 临床研究Clinical study of Chaiqin Chengqi Decoction in treating severe acute biliary pancreatitis ABSTRACT  Objective: To study the therapeutic effects of Chaiqin Chengqi Decoction (C

4、QCQD) in treating severe acute biliary pancreatitis. Methods: Ninety patients with severe acute biliary pancreatitis were treated with CQCQD, and they were divided into two groups: earlytreated group (54 patients treated with CQCQD within 3 days after the onset of severe acute biliary pancreatitis)

5、and latetreated group (36 patients treated with CQCQD between 3 and 7 days after the onset of severe acute biliary pancreatitis). The complication incidence rate, operation rate, mortality rate and hospitalization period were examined. Results: The incidence rates of encephalopathy, infection and ga

6、strointestinal hemorrhage were lower in the earlytreated group than those in the latetreated group (P0.05）. The hospitalization periods of the early and latetreated groups were (24.9±18.4) days and (51.6±45.9) days respectively (P0.05）. The general mortality rate was 14.4%. The mortality r

7、ate of the earlytreated group (7.4%) was significantly lower as compared with that of the latetreated group (25.0%) (P0.05）. The operation rate of the earlytreated group (11.1%) was also significantly lower as compared with that of the latetreated group (27.8%) (P0.05）. Conclusion: Treating severe a

8、cute biliary pancreatitis with CQCQD in early stage may reduce the complication incidence rate, shorten the hospitalization period，and decrease the operation rate and mortality rate.KEY WORDS  severe acute biliary pancreatitis; Chaiqin Chengqi Decoction; clinical studies重症急性胰腺炎（severe acute pan

9、creatitis, SAP）是常见的外科急腹症之一，国内报道胆道疾病是其发病的主要诱因，约占60%1。有学者认为：胆源性胰腺炎诊断明确后应尽早行外科手术或行内镜下Oddis括约肌切开术（endoscopic sphincteropapillotomy, EST）和取石术。近年来，我院采用中西医结合法治疗胆源性SAP取得了较好的疗效，现报道如下。1  资料与方法1.1  病例选择  纳入标准：我院中西医结合科2003年4月1日2004年7月31日收治的胆源性SAP患者；符合2002年世界胃肠病大会颁布的急性胰腺炎处理指南SAP诊断标准2，经B超或CT证实有胆囊结石

10、或（和）胆管结石。排除标准：SAP伴化脓性梗阻性胆管炎；伴有严重的肝肾功能不全；发病7 d后入院患者；入院前曾接受中药治疗。1.2  一般资料  共收集符合病例选择标准的SAP患者90例，按院外病程长短分成早期组和晚期组。早期组：发病3 d内入院，共54例，男26例，女28例，年龄2277岁，平均（52.6±16.8）岁；晚期组：发病后37 d入院，共36例，男12例，女24例，年龄2874岁，平均（56.0±12.9）岁。两组经统计学比较无差异。1.3  治疗方法  入院后所有患者均予以常规治疗（补液、抗感染、抑制胃酸分泌、维持体内

11、酸碱及电解质平衡）及柴芩承气汤治疗。柴芩承气汤组成：柴胡15 g，黄芩15 g，厚朴15 g，枳实15 g，生大黄（后下）20 g，芒硝（冲服）20 g。应用时辨证施治，黄疸重者加用茵陈、栀子、金钱草；热毒炽盛者加用蒲公英、紫花地丁、鱼腥草；气滞痛盛者加用延胡索、川楝子、木香等。每剂加水煎成300 ml药汁。服用前先抽空患者胃液，再经胃管注入药汁50 ml，夹闭胃管，每2 h重复灌注1次。患者呕吐症状减轻后，改为口服，夹闭胃管1 d后，无呕吐，则停止胃肠减压。严重肠麻痹者同时给予药汁200 ml灌肠，35次/d，配合针刺足三里促进肠蠕动。待肠蠕动恢复，大便通畅后，将生大黄、芒硝减量直至停止灌肠。伴有呼吸衰竭患者用呼吸机辅助呼吸治疗。出现胰周或（和）胰腺感染患者转外科行手术治疗。1.4  观察指标  入院第1天的急性胰腺炎Ranson评分，急性生理和慢性健康评价指标（acute physiology and chronic health evaluation, APACHE ）评分，CT评分，并发症的发生率，后期感染率，手术中转率，病程及病死率。1.5  统计学方法  采用SPSS软件进行统计学分析，正态分布计量资料采用t检验，非正态分布计量资料采用秩和检验，计数资料采用卡方检验。2  结果2.1  入院时各项评分的比较&