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目的 :探讨大承气颗粒剂和清胆灵对胆胰疾病所致全身性炎症反应的影响。 方法 :对 66例急腹症病人进行前瞻性研究 ;将内毒素血症期、SIRS及MODS患者分别按病种及APACHE Ⅱ评分 ,分层随机分为综合安慰组和综合中药组 ,对后者根据病种使用大承气颗粒剂或清胆灵 ;动态观察血LPO、TNFα、IL 6、内毒素等的变化。 结果 :内毒素血症期 ,综合中药组第1dLPO及第 3d内毒素降低 ,用清胆灵 1d后LPO降低 (P <0 0 5) ,第 3d有降低趋势 ;SIRS阶段 ,大承气颗粒剂或并用清胆灵于用药 3、7d能显著降低急性胰腺炎或胆道感染伴结石者LPO、内毒素 (P <0 0 5) ,第 3d大承气颗粒剂并清胆灵能降低胆道感染伴结石者IL 6、TNFα(P <0 0 5) ;MODS阶段 ,大承气颗粒剂用药 3、7d分别降低内毒素、TNFα(P <0 0 5)。 结论 :清胆灵、大承气颗粒剂具有一定的抗全身性炎症反应的作用 ,能降低LPO、TNFα、IL 6及内毒素水平。清胆灵清除或抑制ROS产生 ,大承气颗粒剂主要通过通里攻下 ,减少内毒素等所致ROS形成 ;用药 3～ 6d ,每天大便 4次以上 ,降低LPO的效果更佳
Objective: To investigate the effects of Dachengqi Granules and Qingdanling on systemic inflammatory reactions caused by biliary and pancreatic diseases. METHODS: A prospective study was performed on 66 patients with acute abdomen; patients with endotoxemia, SIRS, and MODS were randomly divided into comprehensive placebo group and comprehensive Chinese medicine group according to disease and APACHE II scores. According to the type of disease, Dachengqi Granules or Qingdanling was used; changes in blood LPO, TNFα, IL 6, endotoxin, etc. were dynamically observed. RESULTS: At the endotoxemia stage, the LPO at the 1st day and the endotoxin at the 3rd day in the Chinese traditional medicine group were decreased, and the LPO of the Qingdanling group decreased after being used for 1 d (P<0.05), and the trend was decreased at the 3rd day. In the SIRS stage, Dachengqi Granules Or with Qingdanling on medication 3, 7d can significantly reduce the acute pancreatitis or biliary tract infection with stones LPO, endotoxin (P <0 05), 3d Dachengqi granules and bile can reduce the biliary tract infection with Stones of IL 6, TNFα (P <0 05), MODS, Dachengqi granules were reduced by endotoxin and TNFα on the 3rd and 7th day respectively (P <0 05). Conclusion : Qingdanling and Dachengqi granules have a certain anti-systemic inflammatory response and can reduce LPO, TNFα, IL 6 and endotoxin levels. Qingdanling removes or inhibits ROS production. Dachengqi granules are mainly taken through Tongli to reduce the formation of ROS due to endotoxin, etc. The use of 3 to 6 days of daily bowel movements is more than 4 times, and the effect of reducing LPO is better.