摘要
目的观察内镜下胆管内引流(ENBD)治疗急性重症胆管炎(A<ST)术后应用柴胡清胆汤的临床疗效。方法选择2016年10月至2017年10月天津市东丽区东丽医院和天津市南开医院收治的132例采用ENBD治疗的A<ST患者,根据是否接受中药治疗分为对照组(42例)及柴胡清胆汤组(90例)。两组患者均采取ENBD治疗;对照组术后给予常规抗炎治疗;柴胡清胆汤组在常规抗炎治疗基础上给予柴胡清胆汤加减(组成:柴胡18 g、茵陈30 g、黄罠20 g、赤芍20 g、黄苓15g、郁金15g、虎杖15 g、紫花地丁 30g、红藤30 g、连翘20 g、佛手15 g),每日1剂分2次服用,10d为1个疗程。治疗后观察两组患者手术成功率、术后腹痛缓解时间、体温恢复正常时间、肝功能、并发症发生情况和住院时间的差异。结果柴胡清胆汤组手术成功率髙于对照组〔97.78%(88/90)比95.24%(40/42)〕,但差异无统计学意义(P>0.05)。柴胡清胆汤组术后腹痛缓解时间明显短于对照组(d :6.1±1.1比7.4± 1.5, PV0.05),术后体温恢复正常时间较对照组缩短(d : 2.1 ±0.4比2.2±0.6, P>0.05)。随着时间延长,两组治疗后体温、白细胞计数(WB<)、直接胆红素(DBil)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)均逐渐降低,治疗后10 d达到最低水平,且柴胡清胆汤组治疗后上述指标均明显低于对照组〔体温(t ):36.44 ±0.24 比 37.04±0.39, WB<( X 109/L): 7.03± 1.23 比 8.92±2.11, DBil(pnol/L): 12.03±4.53 比 20.32±6.12, ALT(U/L): 31.23±4.23 比 68.92±6.19, AST(U/L): 34.03± 11.23 比78.92±22.19,均P<0.05〕;两组治疗后总胆红素(TBil)均较治疗前降低,且观察组治疗后5 d明显低于对照组(p.mol/L: 61.59± 11.64比82.33± 12.05, P<0.05)。柴胡清胆汤组并发症发生率明显低于对照组[3.33%(3/90)比28.57%(12/42), P<0.05〕,住院时间较对照组明显缩短(d: 11.4±2.2比18.2±3.4, P<0.05)。结论对于A<ST患者,ENBD术后联合柴胡清胆汤治疗能减少并发症发生率,缩短�
Objective To observe the clinical effect of using Chaihu Qingdan decoction in the treatment of acute severe cholangitis (ACST) after endoscopic biliary drainage (ENBD). Methods One hundred and thirty two patients with ACST with ENBD admitted to Dongli District Hospital of Tianjin from October 2016 to October 2017, they were divided into a control group (42 cases) and a Chaihu Qingdan decoction group (90 cases) according to whether the patients accepted traditional Chinese medicine (TCM) treatment or not. The patients in the control group and the Chaihu Qingdan decoction group (combined group) were all treated with ENBD;the control group received routine anti-inflammatory treatment;the combined group, on the basis of conventional anti-inflammatory treatment, additionally was treated with Chaihu Qingdan decoction (composition: bupleurum chinense 18 g, capillary artemisia 30 g, astragalus root 20 g, radix paeoniae rubra 20 g, radix Scutellariae 15 g, radix Scutellariae 15 g, polygoni 15 g, rhododendron bungeanum 30 g, red cane 30 g, forsythia 20 g, bergamot 15 g), 1 dose per day, 2 times daily, 10 days constituting a therapeutic course. After treatment, the difference of operation success rate, abdominal pain relief time, postoperative body temperature return to normal time, liver function, the incidence of postoperative complications, hospitalization time were observed. Results The success rate of operation in the combined group was higher than that in the control group [97.78%(88/90) vs. 95.24%(40/42)], but the difference was not statistically significant (P > 0.05);the relief time of abdominal pain in the combined group was significantly shorter than that of the control group (days: 6.1 ± 1.1 vs. 7.4 ± 1.5, P < 0.05), and the postoperative body temperature return to normal time in combined group was obviously shorter than that in the control group (days: 2.1 ±0.4 vs. 2.2 ±0.6, P > 0.05). With the prolongation of treatment, the levels of body temperature, white blood cell count (WBC), direct bilirubin (DBil),
作者
罗鹏
孙健
赵巍
Luo Peng;Sun Jian;Zhao Wei(Department of Emergency and Critical Care Medicine,Dongli District Hospital of Tianjin,Tianjin 300300,China;Department of Cardiology,Huaming Community Health Service Center,Dongli District,Tianjin 300300,China;Department of Critical Care Medicine,Nankai District Hospital of Tianjin,Tianjin 300100,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第2期171-175,共5页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
关键词
中西医结合疗法
急性重症胆管炎
胆管内引流
柴胡清胆汤
Integrated Chinese and western medicine
Acute severe cholangitis
Endoscopic biliary drainage
Chaihu Qingdan decoction
