茵陈蒿汤治疗急性梗阻性化脓性胆管炎疗效及对炎症因子影响的分析研究

发布时间：2018-01-19 01:07

本文关键词： 急性梗阻性化脓性胆管炎茵陈蒿汤白细胞介素-6 C反应蛋白　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：急性梗阻性化脓性胆管炎(AOSC)由于胆管梗阻和细菌感染,胆管内压升高,造成以肝胆系统病损为主,合并多器官损害的全身严重感染性疾病,是急性胆管炎的严重表现形式,成为我国胆道疾病最突出的疾病,临床死亡率达到33.6%。AOSC治疗包括非手术及手术治疗,主要是解除胆道梗阻,通畅胆流,去除病灶,抗炎、抗感染,减少内毒素形成维持内环境稳定,预防和治疗并发症等。急性梗阻性化脓性胆管炎属中医的“急黄”、“高热”等范畴,与伤寒论“茵陈蒿汤”病机主症“身如橘子色”、“小便不利”、“腹微满”为辨证要点相同,临床运用茵陈蒿汤加减方治疗AOSC不乏其例,但从循证医学角度进行系统考证较少。本研究旨在观察茵陈蒿汤结合手术治疗AOSC,通过观察其临床疗效及对炎症因子的影响,探讨其作用机理及经方在临床AOS C治疗中的应用价值。方法：选择我院自2013年1月～2015年12月收治急性梗阻性化脓性胆管炎60例,根据治疗方法分为观察组与对照组,每组30例。两组入院后均行相应检查、禁食、补液、抗感染等综合治疗,均在全麻下行手术治疗。观察组在术后西医治疗的基础上于48小时内开始服用茵陈蒿汤：茵陈30g,栀子12g,大黄(去皮)6g,用500m1水煎至200m1,于早晚分别服用100ml。对照组单纯采用西医治疗。通过对临床疗效指标及实验室指标分析进行综合评价。结果：从综合疗效、临床疗效指标及实验室检查指标分析,观察组临床治疗效果明显优于对照组。结论：茵陈蒿汤具有清热、利湿、退黄的功效,在结合西医方式治疗AOSC时能够取得明显临床疗效,并能显著抑制炎症因子和C反应蛋白的水平。
[Abstract]:Objective: acute obstructive suppurative cholangitis (AOSCC) due to bile duct obstruction and bacterial infection, increased intrabiliary pressure, resulting in liver and bile system lesions, with multiple organ damage of the serious systemic infectious disease. Acute cholangitis is the serious manifestation of biliary diseases in China the most prominent disease clinical mortality reached 33.6% AOSC treatment including non-surgical and surgical treatment mainly to relieve biliary obstruction. The acute obstructive suppurative cholangitis belongs to the category of "acute yellow" and "high fever" in traditional Chinese medicine, such as unobstructed bile flow, removing focus, anti-inflammation, anti-infection, reducing endotoxin formation and maintaining internal environment stability, prevention and treatment of complications and so on. It is the same as the syndrome differentiation key points of "Yinchenhao decoction", "orange color", "unfavorable urination" and "abdominal microfullness". Clinical application of Yinchen Artemisia decoction to treat AOSC is not lack of cases. The purpose of this study was to observe the therapeutic effect of Yinchenhao decoction combined with surgery on AOSC.Through observing its clinical effect and the effect on inflammatory factors. To explore its mechanism and the value of meridian prescription in the treatment of AOS C. methods: from January 2013 to December 2015, 60 cases of acute obstructive suppurative cholangitis were treated in our hospital. According to the treatment methods were divided into the observation group and the control group, each group of 30 cases. The two groups were treated with the corresponding examination, fasting, fluid rehydration, anti-infection and other comprehensive treatment. The observation group began to take Yinchen Artemisia decoction within 48 hours on the basis of postoperative western medicine treatment: Yinchen 30g, Gardenia jasminoides 12g, rhubarb (exfoliation 6g). Saute with 500m1 to 200m1. Take 100ml in the morning and evening. The control group was treated with western medicine only. Through the clinical efficacy index and laboratory index analysis comprehensive evaluation. Results: from the comprehensive curative effect. The clinical curative effect index and the laboratory examination index analysis, the observation group clinical treatment effect is obviously superior to the control group. Conclusion: Yinchenhao decoction has the effect of clearing heat, promoting dampness and reducing yellow. In combination with western medicine treatment of AOSC can obtain obvious clinical efficacy, and can significantly inhibit the levels of inflammatory factors and C-reactive protein.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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