早期使用益活清下法治疗重症急性胰腺炎并肝功能不全18例

目的：探讨早期应用益活清下法治疗重症急性胰腺炎（SAP）合并肝功能不全的疗效。方法：36例SAP并发肝功能不全患者，随机分为早期组和晚期组，每组18例。早期组入院时即应用益活清下法治疗；晚期组入院3天后在基础治疗的同时加用益活清下法的中药治疗。结果：早期组与晚期组并发症发生率比较差异无显著性（P〉0．05）。早期组肠麻痹、肾功能衰竭、心功能衰竭、脑病和低蛋白血症的持续时间低于晚期组（P〈0．05或P〈0．01）I治疗后早期组血清总胆红素（TBil）、直接胆红素（DBil）、丙氨酸氨基转移酶（ALT）和天冬氨酸氨基转移酶（AST）水平低于晚期组（P〈0．05）；早期组病死率、感染率、手术中转率均低于晚期组，住院病程也较晚期组短。结论：早期使用益活清下法对减轻SAP合并肝功能不全的程度。促进肝功能恢复，降低感染率、病死率，缩短病程有重要意义。

Treatment of 18 Cases of Severe Acute Pancreatitis with Hepatic Insufficiency by Yihuo Qingxia Method at Early Stage

Objective:To explore therapeutic effect of Yihuo Qingxia method(method of reinforcing,activiting,clearing and purging) at early stage on severe acute pancreatitis with hepatic insufficiency.Methods:Thirty-six cases of severe acute pancreatitis with hepatic insufficiency were randomly divided into an early stage group and a late stage group,18 cases in each.The early stage group were treated by Yihuo Qingxia method from admission,and the late stage group by basic treatment plus Chinese medicines in Yihuo Qingxia method 3 days after admission.Results:There was no significant difference between the two groups in the occurance rate of the complication(P>0.05),but the lasting time of intestinal paralysis,renal failure,cardiac failure,encephalopathy and hypoproteinemia in the early stage group was shorter than that in the late stage group (P<0.05 or P<0.01).After treatment,serum total bilirubin,direct bilirubin,alanine aminotransferase and aspartate aminotransferase level in the early stage group was lower than that in the late stage group(P<0.05).The mortality,infective rate and operation rate was lower and admission duration was shorter than those in the late stage group.Conclusion:Yihuo Qingxia method at early stage is of important significance for alleviating severe acute pancreatitis with hepatic insufficiency,promoting recovery of hepatic functions,decreasing infective rate and mortality,shortening duration of illness.