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目的:探讨中西医结合综合疗法治疗急性胰腺炎(AP)的临床疗效。方法:将103例AP患者随机分为对照组51例和观察组52例。对照组参照“急性胰腺炎中医诊疗专家共识意见”给予西医综合治疗,观察组在对照组的基础上加用中药内服、外敷、灌肠治疗。疗程均为7天,于第0、3、7天进行急性生理学及慢性健康状况评分(APACHEⅡ)评价;观察2组患者腹痛、腹胀、肠鸣音恢复、肛门排气等肠麻痹缓解时间及血清淀粉酶、尿淀粉酶、血白细胞恢复时间,记录治疗期间和治疗后1周并发症的发生情况,检测治疗前后血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)水平。结果:观察组腹痛、腹胀缓解时间、肠鸣音恢复时间和肛门排气均短于对照组(P<0.01);观察组血清淀粉酶、尿淀粉酶、血白细胞恢复时间均短于对照组(P<0.01);治疗后观察组血清TNF-α、IL-1β平低于对照组(P<0.01);治疗后第3、7天观察组APACHEⅡ评分低于对照组(P<0.01);观察组假性囊肿、胰性胸水、急性呼吸窘迫综合征(ARDS)和多器官功能衰竭综合征(MODS)的总发生率为15.38%,低于对照组的56.86%(P<0.01)。结论:中药内服、外敷和灌肠配合西医常规治疗AP,可减轻患者全身炎症反应,降低并发症发生率,缩短病程,具有较好的临床效果。
Objective: To explore the clinical efficacy of integrated traditional Chinese and western medicine in the treatment of acute pancreatitis (AP). Methods: A total of 103 AP patients were randomly divided into control group (n = 51) and observation group (n = 52). Control group with reference to “A consensus opinion of experts in TCM diagnosis and treatment of acute pancreatitis ” to give Western comprehensive treatment, the observation group in the control group based on the use of traditional Chinese medicine orally, topical, enema treatment. The course of treatment was 7 days. The acute physiology and chronic health assessment (APACHEⅡ) were evaluated on the 0th, the 3rd and the 7th day. The relief time of abdominal paralysis, abdominal distension, bowel sounds recovery, anal exhaust, Amylase, urinary amylase, white blood cell recovery time, record the incidence of complications during the treatment and 1 week after treatment, and detect the levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β )Level. Results: The abdominal pain, abdominal distension time, bowel sound recovery time and anal exhaust were shorter in the observation group than those in the control group (P <0.01). The recovery time of serum amylase, urine amylase and white blood cell in the observation group were shorter than those in the control group (P <0.01). After treatment, the serum levels of TNF-α and IL-1β in observation group were lower than those in control group (P <0.01). APACHEⅡ score in observation group was lower than that in control group on the 3rd and 7th day after treatment The total incidence of pseudocyst, pancreatic pleural effusion, acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) was 15.38%, which was lower than that of the control group (56.86%, P <0.01). Conclusion: Oral administration of Chinese herbs, external application and enema combined with conventional western medicine can reduce the systemic inflammatory response, reduce the incidence of complications, shorten the course of disease and have good clinical effect.