Clinical observation on modified Chaiqin Chengqi Decoction combined with external application of Jiuxiaosan in the treatment of moderately severe acute pancreatitis of Fushi-Rejie type
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摘要: 目的 回顾性分析柴芩承气汤加减联合九消散外敷治疗腑实热结型中度重症急性胰腺炎的临床疗效，为中医药治疗该病提供临床资料和理论依据。方法 回顾性收集2019年10月—2022年10月于广西中医药大学附属瑞康医院住院的腑实热结型中度重症急性胰腺炎患者。最后共纳入65例符合标准的患者，采用西医常规治疗的31例患者为对照组；西医常规治疗基础上应用中药柴芩承气汤加减联合九消散外敷治疗的34例患者为治疗组。2组患者均进行1个疗程(7 d)的治疗，对2组患者治疗前后的各种观察指标进行分析，评价柴芩承气汤加减联合九消散外敷治疗腑实热结型中度重症急性胰腺炎的临床疗效。结果 ① 治疗组总有效率为97.05%，对照组总有效率为90.32%，治疗组效果优于对照组，差异有统计学意义(P < 0.05)；②治疗后，治疗组患者的腹痛、腹胀缓解时间及进食、排便恢复正常时间均短于对照组，差异有统计学意义(P < 0.05)；③治疗后，治疗组血清C反应蛋白、白细胞计数、血淀粉酶恢复正常时间均短于对照组，差异有统计学意义(P < 0.05)。④治疗后，2组患者血清C反应蛋白、白细胞计数、血淀粉酶恢复正常时间均短于对照组，差异有统计学意义(P < 0.05)；且治疗组效果明显优于对照组，差异有统计学意义(P < 0.05)。结论 柴芩承气汤加减联合九消散外敷可明显改善腑实热结型中度重症急性胰腺炎患者的症状、体征，改善胃肠功能，促进炎症指标恢复正常，中西医结合疗效优于单纯西医治疗。Abstract: Objective Through retrospective analysis, to evaluate the clinical efficacy of modified Chaiqin Chengqi Decoction combined with external application of Jiuxiaosan in the treatment of moderate severe acute pancreatitis of Fushi-Rejie type. To provide clinical data and theoretical basis for the treatment of this disease with Traditional Chinese Medicine, and guide clinical medication.Methods Retrospective collection of patients with moderately severe acute pancreatitis of Fushi-Rejie type hospitalized in Ruikang Hospital affiliated with Guangxi University of Traditional Chinese Medicine from October 2019 to October 2022. Finally, a total of 65 cases meeting the criteria were included, and a total of 31 patients treated with conventional Western medicine were included as the control group; A total of 34 patients were treated with modified Chaiqin Chengqi Decoction combined with external application of Jiuxiaosan based on conventional Western medicine treatment as a treatment group. Both groups of patients were treated for a course of treatment (7 days), and various observation indicators of the two groups of patients before and after treatment were analyzed to evaluate the clinical efficacy of modified Chaiqin Chengqi Decoction combined with external application of Jiuxiao Powder in the treatment of moderate-severe acute pancreatitis of Fushi-Rejie type.Results ① The total response rate of the control group was 90.32%, the total response rate of the treatment group was 97.05%, and the effect of the treatment group was better than that of the control group, with a statistical difference (P < 0.05). ②After treatment, the relief time of abdominal pain and abdominal distension and the normal recovery time of eating and defecation in the treatment group was shorter than that of the control group, which was statistically significant (P < 0.05). ③After treatment, serum CRP, white blood cell count, and blood amylase recovery time in the treatment group were shorter than that of the control group, with statistical difference (P < 0.05). ④After treatment, the serum CRP, white blood cell count, and blood amylase decreased, with statistical differences(P < 0.05); and the effect was significantly better than that of the control group, with statistical differences(P < 0.05).Conclusion Modified Chaiqin Chengqi Decoction combined with external application of Jiuxiaosan can significantly improve the symptoms and signs of patients with moderate-severe acute pancreatitis of Fushi-Rejie type, improve gastrointestinal function, and promote the return of inflammatory indicators to normal. The efficacy of integrated traditional Chinese and Western medicine is superior to that of simple Western medicine treatment.
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表 1 2组治疗前后相关实验室指标比较
X±S 组别 WBC/(×109/L) CRP/(mg/L) 血淀粉酶/(U/L) 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗组(n=34) 12.02±1.50 7.51±1.411)2) 53.66±22.39 11.05±2.151)2) 354.45±153.69 73.07±26.311)2) 对照组(n=31) 11.83±0.96 8.27±0.781) 53.43±21.99 12.75±2.881) 351.54±139.97 97.41±28.201) 与同组治疗前比较，1)P < 0.05；与对照组比较，2)P < 0.05。 
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表 2 2组WBC、CRP、血淀粉酶恢复时间比较
d，X±S 组别 WBC恢复时间 CRP恢复时间 血淀粉酶恢复时间 治疗组(n=34) 4.70±0.811) 7.48±0.721) 5.96±1.131) 对照组(n=31) 5.67±2.22 8.29±1.61 6.74±1.26 与对照组比较，1)P < 0.05。
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表 3 2组患者临床症状恢复情况及住院时间比较
d，X±S 组别 腹胀缓解时间 腹痛缓解时间 进食恢复时间 排便恢复时间 住院时间 治疗组(n=34) 4.41±0.851) 4.67±1.221) 4.58±0.981) 4.51±0.921) 9.00±1.80 对照组(n=31) 4.80±0.69 5.16±0.54 5.09±0.70 5.09±0.49 9.54±3.32 与对照组比较，1)P < 0.05。
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表 4 2组临床疗效比较
例 组别 痊愈 显效 有效 无效 总有效率/% 治疗组(n=34) 12 18 3 1 97.051) 对照组(n=31) 6 12 10 3 90.32 与对照组比较，1)P < 0.05。
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