清热利胆汤治疗高龄急性胆囊炎PTGBD术后临床研究

发布时间：2018-06-12 07:13

本文选题：高龄急性胆囊炎 + 经皮经肝胆囊穿刺引流术　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:通过观察清热利胆汤治疗高龄急性胆囊炎PTGBD术后的症状改善情况、实验室指标下降情况来探讨其临床疗效,通过检测血WBC、谷丙转氨酶、谷草转氨酶、γ—GT、总胆红素水平来探讨清热利胆汤的临床疗效机制。方法:收集江苏省中医院2015年6月至2017年3月普通外科收治的15例高龄急性胆囊炎患者资料,将这15例病患随机分为对照组7例和治疗组8例。对照组7例患者行经皮经肝胆囊穿刺引流术,术后予常规补液、抗感染治疗;治疗组8例患者行经皮经肝胆囊穿刺引流术,术后在常规补液、抗感染基础上口服中药清热利胆汤,每日一剂,每剂分早晚两次煎服。设定5天为一个疗程,一个疗程后,观察两组治疗前后的症状体征变化、以及检测血WBC、谷丙转氨酶、谷草转氨酶、y—GT、总胆红素水平,采用SPSS19.0软件进行数据处理并分析结果。结果:1.治疗后疗效比较:治疗组8例痊愈0例(0),好转6例(75%),未愈2例,总有效6例(75%);对照组7例痊愈0例(0)好转4例(57.14%),未愈3例(42.86%),总有效4例(57.14%)。治疗组优于对照组P0.05。2.血WBC水平比较:治疗组治疗后平均达9.12±0.96× 10^9/L,对照组治疗后平均达9.45± 0.89× 10^9/L,治疗组治疗前后经检验,有显著性差异P0.05;对照组治疗前后经检验有显著统计学差异P0.05,治疗组较对照组下降幅度大,两组间经检验有显著统计学差异P0.05。3.肝功能比较:治疗组谷丙及谷草数值治疗前后经检验,有显著性差异P0.05;对照组治疗前后谷丙及谷草数值经检验有显著统计学差异P0.05,两组治疗对肝功能的好转均有效,治疗组较对照组下降幅度大,两组间经检验有显著统计学差异P0.05。4.总胆红素水平比较:治疗组治疗前后总胆红素数值经检验,有显著性差异P0.05;对照组治疗前后胆红素数值经检验有显著统计学差异P0.05,治疗组较对照组下降幅度大,两组间经检验有显著统计学差异P0.05。5.治疗后患者局部疼痛均有显著改善(P0.05),但是体温变化无明显统计学意义(P0.05),治疗组与对照组在疼痛改善方面无明显差异(P0.05)结论:PTGBD术后服用清热利胆汤能显著降低高龄急性胆囊炎患者血清中白细胞计数、谷丙转氨酶、谷草转氨酶、总胆红素、γ-GT数值,改善局部炎症反应,对急性胆囊炎有显著的临床效果。
[Abstract]:Objective: to investigate the clinical efficacy of Qingre Lidan decoction in the treatment of senile acute cholecystitis after PTGBD. To explore the clinical therapeutic mechanism of Qingre Lidan decoction by glutamic oxaloacetic transaminase, 纬 -GT and total bilirubin levels. Methods: the data of 15 aged patients with acute cholecystitis treated in Jiangsu traditional Chinese Medicine Hospital from June 2015 to March 2017 were collected. The 15 patients were randomly divided into control group (n = 7) and treatment group (n = 8). In the control group, 7 patients were treated with percutaneous transhepatic cholecystectomy and treated with routine fluid rehydration, and 8 patients in the treatment group were treated with percutaneous transhepatic cholecystectomy. Anti-infection on the basis of oral Chinese medicine Qingre Lidan decoction, one dose daily, each dose is divided into morning and evening two decoction. Five days were set as a course of treatment. After a course of treatment, the changes of symptoms and signs before and after treatment were observed, and the levels of serum WBC, alanine aminotransferase, glutamic oxaloacetic transaminase and total bilirubin were detected. The data were processed with SPSS 19.0 software and the results were analyzed. The result is 1: 1. Comparison of curative effects after treatment: 8 cases in the treatment group were cured in 0 cases, 7 cases in the treatment group were cured in 0 cases, 6 cases were improved, 2 cases were not recovered, 6 cases were effective, 6 cases were effective, and 7 cases in the control group were cured in 0 cases (0 case) 4 cases improved 57.14%, 3 cases did not recover, and the total effective rate was 57.14% (4 cases). The treatment group was superior to the control group (P0.05.2). Comparison of blood WBC levels: after treatment, the average WBC in the treatment group was 9.12 卤0.96 脳 10 ^ 9 / L, and that in the control group was 9.45 卤0.89 脳 10 ^ 9 / L before and after treatment. There was a significant difference (P0.05) between the two groups before and after treatment, and there was a significant difference between the two groups before and after treatment (P0.05), and the decrease of the treatment group was larger than that of the control group (P0.05.3). Comparison of liver function: before and after treatment, there was a significant difference between treatment group and control group (P 0.05), and between control group and control group before and after treatment (P 0.05). Both groups were effective in improving liver function. The decrease of treatment group was larger than that of control group, and there was a significant difference between the two groups (P 0.05.4). Comparison of total bilirubin level: the value of total bilirubin in the treatment group was significantly different before and after treatment (P0.05), while in the control group there was a significant difference in the bilirubin value before and after treatment (P0.05), and the decrease in the treatment group was larger than that in the control group. There was a significant difference between the two groups (P0.05.5). There was significant improvement in local pain after treatment, but there was no significant difference in the change of body temperature between the treatment group and the control group in pain improvement (P0.05). Conclusion taking Qingre Lidan decoction after treatment with 10% PTGBD can significantly reduce the elderly. Leukocyte count in serum of patients with acute cholecystitis, Alanine aminotransferase, total bilirubin, 纬 -GT, improve the local inflammatory response, and have a significant clinical effect on acute cholecystitis.
【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】：2017
【分类号】：R259

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