本文關鍵詞：茵陳蒿湯對梗阻性黃疸患者血流動力學及凝血功能的影響　出處：《天津醫(yī)科大學》2016年碩士論文　論文類型：學位論文

  更多相關文章： 茵陳蒿湯 梗阻性黃疸 血流動力學 凝血功能 肝功能

【摘要】：目的:觀察并分析梗阻性黃疸患者的血流動力學、凝血功能及肝功能的變化,探討茵陳蒿湯對其的影響機制,為臨床圍手術期合理應用中藥提供理論依據。方法:2012年6月-2014年6月,南開醫(yī)院肝膽外科76例梗阻性黃疸患者。其中有膽總管結石37例,膽道損傷2例,壺腹部乳頭狀腺瘤2例,另外還包括膽管癌6例,胰頭癌5例,黃疸型肝癌9例及壺腹癌15例。分別對患者采用相應的外科手術或經內鏡膽道引流術。所有患者無凝血機制障礙,術前2周內未服用過抗凝、抗血小板聚集、非甾體類等對凝血機制有影響的藥物,否認藥物過敏史。隨機分組為常規(guī)治療(對照組,38例)組和常規(guī)治療加服茵陳蒿湯組(研究組,38例)。用藥7d后比較兩組的血流動力學指標(全血粘度、血漿粘度、血紅細胞壓積、血沉)、凝血功能的各項指標(活化部分凝血活酶時各項間APTT、凝血酶原時間PT、纖維蛋白原FIB以及血漿D-二聚體)、肝功能的各項指標(谷丙轉氨酶ALT、堿性磷酸酶ALP、谷氨酰轉移酶GGT),(血清總膽紅素TBIL、直接膽紅素DBIL、總膽汁酸TBA)的變化。結果:1.兩組血流動力學指標比較術后第8d(給藥結束),研究組全血粘度、血漿粘度、紅細胞壓積水平與本組術前(給藥前)和對照組同時點的指標比較,均顯著降低(P0.05);而血沉與本組術前比較則顯示明顯增加(P0.05)。2.兩組凝血指標比較術后第8d(給藥結束),研究組血漿PT、APTT、血漿D-二聚體水平與本組術前(給藥前)、對照組同時點指標相比較,均提示明顯增加(P0.05);FIB水平與(給藥前)、對照組指標相比較,有顯著減少(P0.05)。3.兩組肝功能指標比較術后第8d(給藥結束),研究組血清ALT、AST、TBIL、DBIL、TBA、ALP、GGT水平與本組術前(給藥前)、對照組同時點指標相比較,均提示有明顯的減少(P0.05)。結論:1.術后常規(guī)治療組和常規(guī)治療加服茵陳蒿湯組的全血粘度、血漿粘度、紅細胞壓積以及血漿PT、APTT等指標,與本組給藥前和對照組同時點的指標比較,均有顯著降低。2.兩組血沉和FIB水平與本組給藥前和對照組同時點的指標比較均有顯著增加。3.茵陳蒿湯有利于改善梗阻性黃疸病人術后的高凝異常狀態(tài),維持良好的血液循環(huán),推薦臨床在術后常規(guī)治療基礎上增加茵陳蒿湯的應用。4.梗阻性黃疸患者在通過手術干預治療梗阻后常規(guī)西醫(yī)保肝治療的基礎上加用茵陳蒿湯,可以加速退黃,促進肝功能的恢復。
[Abstract]:Objective: to observe and analyze the changes of hemodynamics, coagulation function and liver function in patients with obstructive jaundice, and to explore the influence mechanism of Yinchenhao decoction on it. Methods: from June 2012 to June 2014, 76 patients with obstructive jaundice underwent hepatobiliary surgery in Nankai Hospital, including 37 patients with choledocholithiasis. Bile duct injury occurred in 2 cases, ampullary papillary adenoma in 2 cases, cholangiocarcinoma in 6 cases and pancreatic head carcinoma in 5 cases. 9 cases of jaundice type liver cancer and 15 cases of ampullary carcinoma were treated with corresponding surgery or endoscopic biliary drainage respectively. There was no coagulation mechanism disorder in all patients, no anticoagulant and anti-platelet aggregation were taken in 2 weeks before operation. Non-steroidal drugs which have influence on coagulation mechanism denied the history of drug allergy. They were randomly divided into routine treatment group (control group 38 cases) and routine therapy plus Yinchenhao decoction group (study group). The hemodynamic indexes (whole blood viscosity, plasma viscosity, hematocrit, erythrocyte sedimentation rate) were compared 7 days later. Indexes of coagulation function (APTT, prothrombin time, fibrinogen FIB and plasma D-dimer). The indexes of liver function (alanine aminotransferase alt, alkaline phosphatase ALP, glutamyl transferase GGTT) (serum total bilirubin TBIL, direct bilirubin DBIL). The changes of total bile acid TBA.Results the hemodynamic indexes of the two groups were compared on the 8th day after operation (at the end of administration, the whole blood viscosity and plasma viscosity of the study group). The level of hematocrit was significantly lower than that of preoperation (before administration) and control group (P 0.05). The erythrocyte sedimentation rate (ESR) was significantly increased compared with that before operation (P 0.05). The blood coagulation indexes in the two groups were compared on the 8th day after operation (end of administration, plasma PTT APTT in the study group). The plasma level of D-dimer was significantly higher than that before administration and control group (P 0.05). The level of FIB was significantly lower than that of control group (before administration, compared with that of control group). The liver function indexes of the two groups were compared on the 8th day after operation (at the end of administration, the serum alt of the study group was higher than that of the control group). The levels of GGT in TBILD and TBABA were compared with those before administration and control group. Conclusion 1. The whole blood viscosity, plasma viscosity, hematocrit and plasma PT of routine treatment group and routine treatment plus Yinchenhao decoction group were significantly reduced. The indexes of APTT were compared with those of the control group and the control group before administration. The levels of ESR and FIB in both groups were significantly increased compared with those before administration and in control group. Yinchenhao decoction was helpful to improve the hypercoagulant abnormality in patients with obstructive jaundice after operation. State. Maintain good blood circulation. Recommended clinical treatment on the basis of routine treatment to increase the application of Yinchenghao decoction .4. obstructive jaundice patients in the treatment of obstruction through surgical intervention after routine western medicine liver protection treatment on the basis of adding Yinchenhao decoction. 4. It can accelerate the recovery of liver function.
【學位授予單位】：天津醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259
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本文編號：1375833