【作者】 陈建宏；

【导师】 李健；

【作者基本信息】 广州中医药大学 ， 中西医结合临床（专业学位）， 2020， 硕士

【摘要】 目的:通过观察通胰利胆汤联合推按运经仪在胆源性胰腺炎患者经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography,ERCP)后的作用,探索两者作用机理及临床应用价值,为胆源性胰腺炎ERCP术后的延伸治疗提供新思路。方法:将60例肝胆湿热证急性胆源性胰腺炎(acute biliary pancreatitis,ABP)ERCP术后患者随机分为对照组和治疗组各30例,术后对照组采用西医常规治疗,治疗组则在对照组基础上加予口服通胰利胆汤联合推按运经仪治疗。观察两组治疗前后腹痛、腹胀、上腹部压痛、肠蠕动、恶心呕吐、发热积分和血清白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、总胆红素(TBIL)、谷丙转氨酶(ALT)、γ谷氨酰转肽酶(GGT)、淀粉酶(AMY)水平并进行疾病综合疗效评价。结果:(1)两组术后第5天腹痛、腹胀、上腹压痛、肠蠕动、恶心呕吐、发热积分均较治疗前显著下降(P<0.05),而治疗组术后第5天腹痛、腹胀、肠蠕动积分均较对照组下降更显著(P<0.05),但两组术后第5天上腹压痛、恶心呕吐、发热积分均无显著性差异(P＞0.05)。(2)与治疗前比较,两组术后第5天血清WBC、hs-CRP、TBIL、ALT、GGT、AMY水平均较对照组显著下降(P<0.01),而治疗组术后第5天血清WBC、TBIL、ALT、AMY水平均较对照组下降更显著(P<0.05),但两组术后第5天血清hs-CRP、GGT水平均无显著性差异(P＞0.05)。(3)治疗组疾病综合疗效明显优于对照组(P<0.05)。结论:口服通胰利胆汤联合推按运经仪治疗肝胆湿热证胆源性胰腺炎ERCP术后患者有助于促进胰腺炎症消除及消化道功能恢复,从而改善临床症状、体征,提高ERCP术后治疗效果。更多还原

【Abstract】 ObjectiveBy observing the effect of Tongyi Lidan Decoction combined with meridian-pressing instrument on the patients with biliary pancreatitis after.endoscopic retrograde cholangiopancreatography(ERCP)operation treatment,explore the mechanism and clinical application value of Tongyi Lidan Decoction and meridian-pressing instrument to provide new ideas for the extended treatment of the patients with biliary pancreatitis after ERCP operation treatment.MethodsSixty patients with acute biliary pancreatitis(ABP)of liver-biliary damp-heat syndrome were randomly divided into the control group and the treatment group of 30 cases each after ERCP operation treatment.After ERCP operation treatment,the control group was treated with western medicine routine treatment,and the treatment group was given oral Tongyi Lidan Decoction combined with meridian-pressing instrument on that basis.The scores of abdominal pain,abdominal distension,upper abdominal tenderness,intestinal peristalsis,nausea and vomiting,fever,the level of serum white blood cell count(WBC),serum hypersensitive C-reactive protein(hs-CRP),serum total bilirubin(TBIL),serum alanine aminotransferase(ALT),serum y-glutamyl transpeptidase(GGT)and serum amylase(AMY)before and after treatment of two groups were observed.And the comprehensive efficacy of the disease of two groups was evaluated.Results(1)The scores of the abdominal pain,abdominal distension,upper abdominal tenderness,intestinal peristalsis,nausea and vomiting and fever of the two groups on day 5 after ERCP operation treatment were significantly lower than that before treatment(P<0.05),and the scores of the abdominal pain,abdominal distension and intestinal peristalsis of the treatment group on day 5 after ERCP operation treatment were more significantly decreased than that of the control group(P<0.05),but there were no significant differences in the scores of upper abdominal tenderness,nausea and vomiting and fever between the two groups on day 5 after ERCP operation treatment(P>0.05).(2)The levels of serum WBC,serum hs-CRP,serum TBIL,serum ALT,serum GGT and serum AMY of the two groups on day 5 after ERCP operation treatment were significantly lower than that before treatment(P<0.01),and the levels of serum WBC,serum TBIL,serum ALT and serum AMY of the treatment group on day 5 after ERCP operation treatment were more significantly decreased than that of the control group(P<0.05),but there were no significant differences in the the levels of serum hs-CRP and serum GGT between the two groups on day 5 after ERCP operation treatment(P>0.05).(3)The comprehensive efficacy of the disease of the treatment group was significantly better than that of the control group(P＜0.05).ConclusionTreating the patients with the biliary pancreatitis of liver-biliary damp-heat syndrome with oral Tongyi Lidan Decoction combined with meridian-pressing instrument after ERCP operation treatment is helpful to promote the elimination of pancreatic inflammation and the recovery of digestive tract function,and then significantly improve the clinical signs and symptoms,and improve the treatment effect after ERCP operation treatment.更多还原