中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
5期
499-503
,共5页
杨国红%朱沛文%王晓%曾震军%李春颖%李合国
楊國紅%硃沛文%王曉%曾震軍%李春穎%李閤國
양국홍%주패문%왕효%증진군%리춘영%리합국
中医辨证四联疗法%胰腺炎,急性%肿瘤坏死因子-α%白细胞介素-8%细胞间黏附分子-1
中醫辨證四聯療法%胰腺炎,急性%腫瘤壞死因子-α%白細胞介素-8%細胞間黏附分子-1
중의변증사련요법%이선염,급성%종류배사인자-α%백세포개소-8%세포간점부분자-1
The quadruple therapy of traditional Chinese medicine syndrome differentiation%Acute pancreatitis%Tumor necrosis factor-α%Interleukin-8%Intercellular adhesion molecule-1
目的 观察中医辨证四联疗法治疗急性胰腺炎(AP)的临床疗效及对患者血清炎性因子的影响.方法 采用前瞻性研究方法.将2014年4月至2015年4月河南中医学院第一附属医院脾胃肝胆科收治的83例AP患者按随机数字表法分为中西医结合治疗组(43例)和西医对照组(40例).两组均予常规西医对症支持治疗,中西医结合治疗组同时加用中医辨证四联疗法.① 中药灌胃:肝胆湿热证方药采用柴胡、生大黄、枳实、黄芩、清半夏、白芍等;胃肠实热证方药采用大承气汤(大黄、枳实、厚朴、芒硝),辨证后制备成中药煎剂100 mL,每4 h经胃管注入1次,夹闭1 h后开放.② 灌肠:方药采用大承气汤加桃仁、莱菔子等,煎剂200 mL,每6 h高位(距肛门20 cm)保留灌肠1次.③ 外敷:方药采用乳香、没药、黄柏、黄芩、黄连、蒲公英等研末,凡士林调和外敷胰腺体表投影处,荷叶外覆包扎,每日1次.④ 静脉滴注(静滴)灯盏花素注射液40 mL/d;伴有气阴两虚、心悸、休克者静滴生脉注射液40 mL/d;阳气欲脱者用参附注射液40 mL/d 静滴;瘀毒互结者用血必净注射液100 mL/d静滴.观察两组患者腹胀、腹痛消失时间,肠鸣音、血淀粉酶(AMS)、脂肪酶、C-反应蛋白(CRP)、白细胞计数(WBC)恢复正常时间,治疗前后修正的CT严重指数(MCTSI)评分的变化,以及治疗前和治疗后7 d、14 d血清肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、细胞间黏附分子-1(ICAM-1)水平.结果 中西医结合治疗组腹胀消失时间(d:3.79±1.93比5.12±2.41)、腹痛消失时间(d:3.81±1.94比5.45±2.27)、肠鸣音恢复时间(d:3.67±1.86比5.15±2.17)、AMS恢复正常时间(d:3.78±1.92比5.27±2.63)、脂肪酶恢复正常时间(d:5.13±2.47比6.23±2.87)、CRP恢复正常时间(d:7.07±2.89比8.91±2.75)、WBC恢复正常时间(d:4.14±2.18比5.94±2.78)均较西医对照组明显缩短(均P<0.05);两组治疗后MCTSI评分均较治疗前明显降低,且以中西医结合治疗组的下降程度较西医对照组更显著(分:1.89±1.81比3.03±2.12, P<0.05);两组治疗后7 d、14 d血清TNF-α、IL-8、ICAM-1水平均较治疗前降低,且以中西医结合治疗组治疗后14 d的下降程度较同期西医对照组更显著〔TNF-α(ng/L): 13.69±4.02比17.24±5.16,IL-8(ng/L): 326.71±182.65比461.57±163.54,ICAM-1(μg/L): 1.32±0.89比2.43±1.16,均P<0.05〕.结论 中医辨证四联疗法早期干预能阻断AP病情进展,减轻胰腺炎症反应,从而改善患者的临床症状及各项实验室指标.
目的 觀察中醫辨證四聯療法治療急性胰腺炎(AP)的臨床療效及對患者血清炎性因子的影響.方法 採用前瞻性研究方法.將2014年4月至2015年4月河南中醫學院第一附屬醫院脾胃肝膽科收治的83例AP患者按隨機數字錶法分為中西醫結閤治療組(43例)和西醫對照組(40例).兩組均予常規西醫對癥支持治療,中西醫結閤治療組同時加用中醫辨證四聯療法.① 中藥灌胃:肝膽濕熱證方藥採用柴鬍、生大黃、枳實、黃芩、清半夏、白芍等;胃腸實熱證方藥採用大承氣湯(大黃、枳實、厚樸、芒硝),辨證後製備成中藥煎劑100 mL,每4 h經胃管註入1次,夾閉1 h後開放.② 灌腸:方藥採用大承氣湯加桃仁、萊菔子等,煎劑200 mL,每6 h高位(距肛門20 cm)保留灌腸1次.③ 外敷:方藥採用乳香、沒藥、黃柏、黃芩、黃連、蒲公英等研末,凡士林調和外敷胰腺體錶投影處,荷葉外覆包扎,每日1次.④ 靜脈滴註(靜滴)燈盞花素註射液40 mL/d;伴有氣陰兩虛、心悸、休剋者靜滴生脈註射液40 mL/d;暘氣欲脫者用參附註射液40 mL/d 靜滴;瘀毒互結者用血必淨註射液100 mL/d靜滴.觀察兩組患者腹脹、腹痛消失時間,腸鳴音、血澱粉酶(AMS)、脂肪酶、C-反應蛋白(CRP)、白細胞計數(WBC)恢複正常時間,治療前後脩正的CT嚴重指數(MCTSI)評分的變化,以及治療前和治療後7 d、14 d血清腫瘤壞死因子-α(TNF-α)、白細胞介素-8(IL-8)、細胞間黏附分子-1(ICAM-1)水平.結果 中西醫結閤治療組腹脹消失時間(d:3.79±1.93比5.12±2.41)、腹痛消失時間(d:3.81±1.94比5.45±2.27)、腸鳴音恢複時間(d:3.67±1.86比5.15±2.17)、AMS恢複正常時間(d:3.78±1.92比5.27±2.63)、脂肪酶恢複正常時間(d:5.13±2.47比6.23±2.87)、CRP恢複正常時間(d:7.07±2.89比8.91±2.75)、WBC恢複正常時間(d:4.14±2.18比5.94±2.78)均較西醫對照組明顯縮短(均P<0.05);兩組治療後MCTSI評分均較治療前明顯降低,且以中西醫結閤治療組的下降程度較西醫對照組更顯著(分:1.89±1.81比3.03±2.12, P<0.05);兩組治療後7 d、14 d血清TNF-α、IL-8、ICAM-1水平均較治療前降低,且以中西醫結閤治療組治療後14 d的下降程度較同期西醫對照組更顯著〔TNF-α(ng/L): 13.69±4.02比17.24±5.16,IL-8(ng/L): 326.71±182.65比461.57±163.54,ICAM-1(μg/L): 1.32±0.89比2.43±1.16,均P<0.05〕.結論 中醫辨證四聯療法早期榦預能阻斷AP病情進展,減輕胰腺炎癥反應,從而改善患者的臨床癥狀及各項實驗室指標.
목적 관찰중의변증사련요법치료급성이선염(AP)적림상료효급대환자혈청염성인자적영향.방법 채용전첨성연구방법.장2014년4월지2015년4월하남중의학원제일부속의원비위간담과수치적83례AP환자안수궤수자표법분위중서의결합치료조(43례)화서의대조조(40례).량조균여상규서의대증지지치료,중서의결합치료조동시가용중의변증사련요법.① 중약관위:간담습열증방약채용시호、생대황、지실、황금、청반하、백작등;위장실열증방약채용대승기탕(대황、지실、후박、망초),변증후제비성중약전제100 mL,매4 h경위관주입1차,협폐1 h후개방.② 관장:방약채용대승기탕가도인、래복자등,전제200 mL,매6 h고위(거항문20 cm)보류관장1차.③ 외부:방약채용유향、몰약、황백、황금、황련、포공영등연말,범사림조화외부이선체표투영처,하협외복포찰,매일1차.④ 정맥적주(정적)등잔화소주사액40 mL/d;반유기음량허、심계、휴극자정적생맥주사액40 mL/d;양기욕탈자용삼부주사액40 mL/d 정적;어독호결자용혈필정주사액100 mL/d정적.관찰량조환자복창、복통소실시간,장명음、혈정분매(AMS)、지방매、C-반응단백(CRP)、백세포계수(WBC)회복정상시간,치료전후수정적CT엄중지수(MCTSI)평분적변화,이급치료전화치료후7 d、14 d혈청종류배사인자-α(TNF-α)、백세포개소-8(IL-8)、세포간점부분자-1(ICAM-1)수평.결과 중서의결합치료조복창소실시간(d:3.79±1.93비5.12±2.41)、복통소실시간(d:3.81±1.94비5.45±2.27)、장명음회복시간(d:3.67±1.86비5.15±2.17)、AMS회복정상시간(d:3.78±1.92비5.27±2.63)、지방매회복정상시간(d:5.13±2.47비6.23±2.87)、CRP회복정상시간(d:7.07±2.89비8.91±2.75)、WBC회복정상시간(d:4.14±2.18비5.94±2.78)균교서의대조조명현축단(균P<0.05);량조치료후MCTSI평분균교치료전명현강저,차이중서의결합치료조적하강정도교서의대조조경현저(분:1.89±1.81비3.03±2.12, P<0.05);량조치료후7 d、14 d혈청TNF-α、IL-8、ICAM-1수평균교치료전강저,차이중서의결합치료조치료후14 d적하강정도교동기서의대조조경현저〔TNF-α(ng/L): 13.69±4.02비17.24±5.16,IL-8(ng/L): 326.71±182.65비461.57±163.54,ICAM-1(μg/L): 1.32±0.89비2.43±1.16,균P<0.05〕.결론 중의변증사련요법조기간예능조단AP병정진전,감경이선염증반응,종이개선환자적림상증상급각항실험실지표.
Objective To observe the clinical effect of quadruple therapy of traditional Chinese medicine (TCM) syndrome differentiation for treatment of patients with acute pancreatitis (AP) and its influence on serum inflammatory cytokines.Methods A prospective study was conducted, and 83 patients with AP in Department of Digestology of the First Affiliated Hospital of Henan University of TCM from April 2014 to April 2015 were divided into combined TCM and western medicine treatment group (43 cases) and western medicine control group (40 cases) by random number table method. Conventional western medicine treatment was given to both groups, and the combined treatment group was additionally treated by the quadruple therapy of the TCM syndrome differentiation, including: ① Intra-gastric administration of TCM decoction: in cases with liver and gallbladder damp heat syndrome, the formula of radix bupleuri, radix et rhizoma rhei, Aurantii Fructus Immaturus, scutellaria, pinellia, radix paeoniae alba, etc was used, and in cases with gastrointestinal repletion heat syndromes, Dachengqi decoction was applied (ingredients: rhubarb, Aurantii Fructus Immaturus, magnolia bark, glauber's salt). After differentiation of syndromes, the TCM decoction 100 mL was prepared for corresponding patients. The decoction was injected through a stomach tube, once every 4 hours, after once injection the tube was closed by a clip for 1 hour and then opened. ② Enema: 200 mL Dachengqi decoction with addition of peach seed, radish seed, etc. was used for high retention enema (20 cm from the anus), once every 6 hours. ③ External application: the external applied agent was prepared by vaseline evenly mixed with powders of following ingredients: frankincense, myrrh, phellodendron bark, scutellaria, coptis, dandelion, and dressed on the body surface of pancreatic region, covered with lotus leaf once a day. ④ Intravenous drip (IV) of Breviscapine injection 40 mL/d; in cases with Qi and Yin deficiency, heart palpitations and shock, Shengmai injection 40 mL/d IV drip was used; in cases with Yang Qi ready to desert, IV drip of Shenfu injection 40 mL/d was applied; in cases with toxin involved in blood stasis, Xuebijing injection 100 mL/d IV drip was given. The time for abdominal pain and distention disappearance, the time for normal bowel sounds recovery, the times for recovery to normal levels of serum amylase, lipase, C-reaction protein (CRP) and white blood cell count (WBC), the changes of the grade of modified computed tomography severity index (MCTSI) before and after treatment, and the changes of levels of tumor necrosis factor-α (TNF-α), interleukin-8 (IL-8) and intercellular adhesion molecule-1 (ICAM-1) of patients before and after treatment for 7 days and 14 days in both groups were observed.Results The times for disappearance of abdominal distention (days: 3.79±1.93 vs. 5.12±2.41), for abdominal pain (days: 3.81±1.94 vs. 5.45±2.27), and the recovery times to normal levels of bowel sounds (days: 3.67±1.86 vs. 5.15±2.17), blood amylase (days: 3.78±1.92 vs. 5.27±2.63), lipase (days: 5.13±2.47 vs. 6.23±2.87), CRP (days: 7.07±2.89 vs. 8.91±2.75) and WBC (days: 4.14±2.18 vs. 5.94±2.78) in combined treatment group were significantly shorter than those of the western medicine control group (allP < 0.05). After treatment, the MCTSI scores in both groups were obviously lower than those before treatment, and the degree of descent was more marked in the combined treatment group than that of the western medicine control group (1.89±1.81 vs. 3.03±2.12,P < 0.05); on the 7th and 14th day after treatment, the serum TNF-α, IL-8 and ICAM-1 levels of the two groups were lower than those before treatment, and the descent levels of above indexes on the 14th day in the combined treatment group were more significant than those in the western medicine control group [TNF-α (ng/L): 13.69±4.02 vs. 17.24±5.16, IL-8 (ng/L): 326.71±182.65 vs. 461.57±163.54, ICAM-1 (μg/L): 1.32±0.89 vs. 2.43±1.16, allP < 0.05].Conclusion The early intervention treatment in accord with the quadruple therapy of TCM syndrome differentiation for patients with AP can block the progress of the disease, reduce pancreatic inflammation, thereby it may improve the clinical symptoms and various laboratory indicators.
