中西医结合治疗急性重症胆管炎伴多脏器功能失常综合征

目的：观察急性重症胆管炎（ＡＣＳＴ）伴多脏器功能失常综合征（ＭＯＤＳ）的中西医结合治疗的疗效。方法：对４５例ＡＣＳＴ患者（其中１１例并发ＭＯＤＳ）采用中西医结合治疗：宏观上对整体进行“扶正”，用中药扶正方剂（三参汤、生脉散、四逆汤）经胃管减压后灌入；电针有关经穴；输液、输血，升压药维持收缩压最低在１２ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）；增加静脉营养或胃肠外营养。“祛邪”用自拟“清胆汤”、广谱抗生素与甲硝唑防治厌氧菌，及时手术祛除病灶，体现“菌毒与有害介质并治”、“脏腑兼病同治”。微观上改善休克时细胞的内环境紊乱，采用“五法”（即扩容、纠酸、稳膜、供能、给氧）。结果：４５例中４４例恢复，１例死亡。伴ＭＯＤＳ的１１例中有５例治愈（其中４个脏器受累者４例，２个脏器受累者１例），另６例死亡（受累脏器均在２个以上，且皆为６０岁以下老年患者）。结论：对ＡＣＳＴ并ＭＯＤＳ采用宏观与微观结合的扶正及祛邪并用，菌毒和有害介质并治，脏腑兼病同治，能提高抢救成功率

Treatment for acute cholangitis of severe type with integrated traditional Chinese and western medicine

Objective :To observe the curative effects of integrated traditional Chinese and western medicine (TCM WM) on acute cholangitis of severe type (ACST) and multiple organ dysfunction syndrome (MODS). Methods :45 cases with ACST (11 cases complicating MODS among them) were treated with integrated TCM WM.In macroscopical reinforcing the bodys vital energy with related decoctions Sanshen Decoction ,Shengmai Powder ,Sini Decoction given via nasogastric tube after depressing pressure was used meanwhile electro acupuncturing related meridian points ,infusion,transfusion,elevating blood pressure and keeping it above 12 kPa(1 kPa=75 mmHg) with drugs,increasing venous or parenteral nutrition,eliminating pathogenic factors using Qingdan Decoction prepared by authors wide spectrum antibiotics and metronidazole used to prevent and treat anaerobic bacteria,operation for eliminating disease focus,treatment for bacterial toxins and harmful mediators simultaneously and diseases of both the viscera and bowels were used too.Otherwise in microscopical improving disturbances of cellular homeostasis in shock,applying five methods (volemic expansion,correcting acidosis,stabilizing cellular membrane,providing energies,and supplying oxygen). Results :44 of 45 case were recovered and 1 case was died.5 cases were cured among 11 cases complicating MODS(among them 4 organs were involved in 4 cases and two organs involved in 1 case).Other 6 cases were died (in all of them involved organs were more than four and ages more than 60 years old). Conclusions :In macroscopical and microscopical using both reinforcing the bodys vital energy and eliminating pathogenic factors,treating both bacterial toxins and harmful mediators simultaneously,and therapy of diseases of both the viscera and bowels are able to increase the successful rate of rescue.