茵陈蒿汤对梗阻性黄疸患者血流动力学及凝血功能的影响

发布时间：2018-01-03 22:17

  本文关键词：茵陈蒿汤对梗阻性黄疸患者血流动力学及凝血功能的影响　出处：《天津医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 茵陈蒿汤 梗阻性黄疸 血流动力学 凝血功能 肝功能

【摘要】：目的:观察并分析梗阻性黄疸患者的血流动力学、凝血功能及肝功能的变化,探讨茵陈蒿汤对其的影响机制,为临床围手术期合理应用中药提供理论依据。方法:2012年6月-2014年6月,南开医院肝胆外科76例梗阻性黄疸患者。其中有胆总管结石37例,胆道损伤2例,壶腹部乳头状腺瘤2例,另外还包括胆管癌6例,胰头癌5例,黄疸型肝癌9例及壶腹癌15例。分别对患者采用相应的外科手术或经内镜胆道引流术。所有患者无凝血机制障碍,术前2周内未服用过抗凝、抗血小板聚集、非甾体类等对凝血机制有影响的药物,否认药物过敏史。随机分组为常规治疗(对照组,38例)组和常规治疗加服茵陈蒿汤组(研究组,38例)。用药7d后比较两组的血流动力学指标(全血粘度、血浆粘度、血红细胞压积、血沉)、凝血功能的各项指标(活化部分凝血活酶时各项间APTT、凝血酶原时间PT、纤维蛋白原FIB以及血浆D-二聚体)、肝功能的各项指标(谷丙转氨酶ALT、碱性磷酸酶ALP、谷氨酰转移酶GGT),(血清总胆红素TBIL、直接胆红素DBIL、总胆汁酸TBA)的变化。结果:1.两组血流动力学指标比较术后第8d(给药结束),研究组全血粘度、血浆粘度、红细胞压积水平与本组术前(给药前)和对照组同时点的指标比较,均显著降低(P0.05);而血沉与本组术前比较则显示明显增加(P0.05)。2.两组凝血指标比较术后第8d(给药结束),研究组血浆PT、APTT、血浆D-二聚体水平与本组术前(给药前)、对照组同时点指标相比较,均提示明显增加(P0.05);FIB水平与(给药前)、对照组指标相比较,有显著减少(P0.05)。3.两组肝功能指标比较术后第8d(给药结束),研究组血清ALT、AST、TBIL、DBIL、TBA、ALP、GGT水平与本组术前(给药前)、对照组同时点指标相比较,均提示有明显的减少(P0.05)。结论:1.术后常规治疗组和常规治疗加服茵陈蒿汤组的全血粘度、血浆粘度、红细胞压积以及血浆PT、APTT等指标,与本组给药前和对照组同时点的指标比较,均有显著降低。2.两组血沉和FIB水平与本组给药前和对照组同时点的指标比较均有显著增加。3.茵陈蒿汤有利于改善梗阻性黄疸病人术后的高凝异常状态,维持良好的血液循环,推荐临床在术后常规治疗基础上增加茵陈蒿汤的应用。4.梗阻性黄疸患者在通过手术干预治疗梗阻后常规西医保肝治疗的基础上加用茵陈蒿汤,可以加速退黄,促进肝功能的恢复。
[Abstract]:Objective: to observe and analyze the changes of hemodynamics, coagulation function and liver function in patients with obstructive jaundice, and to explore the influence mechanism of Yinchenhao decoction on it. Methods: from June 2012 to June 2014, 76 patients with obstructive jaundice underwent hepatobiliary surgery in Nankai Hospital, including 37 patients with choledocholithiasis. Bile duct injury occurred in 2 cases, ampullary papillary adenoma in 2 cases, cholangiocarcinoma in 6 cases and pancreatic head carcinoma in 5 cases. 9 cases of jaundice type liver cancer and 15 cases of ampullary carcinoma were treated with corresponding surgery or endoscopic biliary drainage respectively. There was no coagulation mechanism disorder in all patients, no anticoagulant and anti-platelet aggregation were taken in 2 weeks before operation. Non-steroidal drugs which have influence on coagulation mechanism denied the history of drug allergy. They were randomly divided into routine treatment group (control group 38 cases) and routine therapy plus Yinchenhao decoction group (study group). The hemodynamic indexes (whole blood viscosity, plasma viscosity, hematocrit, erythrocyte sedimentation rate) were compared 7 days later. Indexes of coagulation function (APTT, prothrombin time, fibrinogen FIB and plasma D-dimer). The indexes of liver function (alanine aminotransferase alt, alkaline phosphatase ALP, glutamyl transferase GGTT) (serum total bilirubin TBIL, direct bilirubin DBIL). The changes of total bile acid TBA.Results the hemodynamic indexes of the two groups were compared on the 8th day after operation (at the end of administration, the whole blood viscosity and plasma viscosity of the study group). The level of hematocrit was significantly lower than that of preoperation (before administration) and control group (P 0.05). The erythrocyte sedimentation rate (ESR) was significantly increased compared with that before operation (P 0.05). The blood coagulation indexes in the two groups were compared on the 8th day after operation (end of administration, plasma PTT APTT in the study group). The plasma level of D-dimer was significantly higher than that before administration and control group (P 0.05). The level of FIB was significantly lower than that of control group (before administration, compared with that of control group). The liver function indexes of the two groups were compared on the 8th day after operation (at the end of administration, the serum alt of the study group was higher than that of the control group). The levels of GGT in TBILD and TBABA were compared with those before administration and control group. Conclusion 1. The whole blood viscosity, plasma viscosity, hematocrit and plasma PT of routine treatment group and routine treatment plus Yinchenhao decoction group were significantly reduced. The indexes of APTT were compared with those of the control group and the control group before administration. The levels of ESR and FIB in both groups were significantly increased compared with those before administration and in control group. Yinchenhao decoction was helpful to improve the hypercoagulant abnormality in patients with obstructive jaundice after operation. State. Maintain good blood circulation. Recommended clinical treatment on the basis of routine treatment to increase the application of Yinchenghao decoction .4. obstructive jaundice patients in the treatment of obstruction through surgical intervention after routine western medicine liver protection treatment on the basis of adding Yinchenhao decoction. 4. It can accelerate the recovery of liver function.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259
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本文编号：1375833