摘要
[目的]探讨急性胰腺炎(acute pancreatitis,AP)中医证候特点及早期中西医结合内科保守治疗的疗效和方法。[方法]分别采用Ranson标准、APACHE-Ⅱ评分和Balthazar CT分级系统对5年间159例AP住院患者进行回顾性分级评价,并进一步分析了中西医结合治疗轻症急性胰腺炎(mild acute pancreatitis,MAP)和重症急性胰腺炎(severe acute pancreatitis,SAP) 的临床疗效。[结果]MAP组97例,其中肝郁气滞型18例,肝胆湿热型60例,脾胃实热型16例,瘀热互结型2例,蛔虫上扰型1例;SAP组62例,其中肝郁气滞型7例,肝胆湿热型31例,脾胃实热型11例,瘀热互结型4例,气阴两虚型4 例,腑闭血瘀型4例,内闭外脱型1例。经Ridit分析,MAP组和SAP组的中医证型分布具有显著性差异(P<0.05)。两组疗效分析:MAP痊愈61例(62.89%),显效36例(37.11%),无效和死亡均为0例;SAP组内科保守治疗62例,痊愈20 例(32.26%),显效12例(19.35%),无效26例(41.94%),不适合手术而内科保守治疗死亡4例(6.45%),内科保守治疗无效转行手术治疗26例,术后全部好转出院。两组疗效比较,MAP组疗效优于SAP组(P<0.01)。MAP组的平均住院时间为10 d,SAP组的平均住院时间为15.5 d。[结论]MAP和SAP均以湿热、气滞、血瘀等实证为主,但SAP有部分表现为腑闭血瘀型和内闭外脱型等危重证型。早期采用中西医结合保守治疗对MAP的疗效满意,可免行外科手术治疗;而对SAP的疗效较差,有大约一半的病人需转外科手术治疗,但保守治疗也可为其创造必要的手术条件,提高手术成功率。
[Objective] To investigate the characteristics of classified pattems in traditional Chinese medicine （TCM） and therapeutic effect of early traditional Chinese and western medicine for acute pancreatitis （AP）. [ Methods ] A retrospective grading trial was carried out in 159 cases of AP within 5 years by the methods of Ranson Standard, APACHE- Ⅱ scoring and Balthazar CT classified system. The effect of TCM and westem medicine （WM） for mild acute pancreatitis （MAP） and severe acute pancreatitis （SAP） was observed. [Results] In 97 cases of MAP, 18 were classified as liver Qi stagnation, 60 as damp-heat in liver and gallbladder, 16 as excessive-heat in spleen and stomach, 2 as stagnation of bloed-stasis and heat, and 1 as ascaris disturbing the upper; in 62 cases of SAP, 7 were classified as liver Qi stagnation, 31 as damp-heat in liver and gallbladder, 11 as excessive-heat in spleen and stomach, 4 as stagnation of bloed-stasis and heat, 4 as deficiency of Qi and yin, 4 as fu-organ Qi obstruction and bloed-stasis and 1 as internal obstruction and external collapse. The result of Ridit analysis showed that the distribution of TCM syndrome patterns in MAP differed from that in SAP （ P 〈 0.05）. In the MAP cases, 61 （62.89%） were cured, 36 （37.11% ） markedly effective, and there was no ineffective and dead case. In 62 cases receiving conservative treatment, 20 （32.26%） were cured, 12 （19.35%） markedly effective, 26 （41.94%） ineffective, 4 （6.45%） not suitable for surgical operation received conservative treatment and died, and 26 recovered after surgery when conservative treatment was ineffective. The therapeutic effect in MAP cases was better than that in SAP cases （P 〈 0.01 ）; the mean hospitalization time was 10 days in MAP cases and 15.5 days in SAP cases. [Conclusion] MAP and SAP cases were mainly classified as excess syndrome patterns such as damp-heat, Qi stagnation, bloed-stasis, but some SAP cases were manifested as severe syndrome patterns such as fu-orga
出处
《广州中医药大学学报》
CAS
2005年第6期421-425,共5页
Journal of Guangzhou University of Traditional Chinese Medicine
