本文關(guān)鍵詞： 急性梗阻性化膿性膽管炎 茵陳蒿湯 白細(xì)胞介素-6 C反應(yīng)蛋白　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：急性梗阻性化膿性膽管炎(AOSC)由于膽管梗阻和細(xì)菌感染,膽管內(nèi)壓升高,造成以肝膽系統(tǒng)病損為主,合并多器官損害的全身嚴(yán)重感染性疾病,是急性膽管炎的嚴(yán)重表現(xiàn)形式,成為我國(guó)膽道疾病最突出的疾病,臨床死亡率達(dá)到33.6%。AOSC治療包括非手術(shù)及手術(shù)治療,主要是解除膽道梗阻,通暢膽流,去除病灶,抗炎、抗感染,減少內(nèi)毒素形成維持內(nèi)環(huán)境穩(wěn)定,預(yù)防和治療并發(fā)癥等。急性梗阻性化膿性膽管炎屬中醫(yī)的“急黃”、“高熱”等范疇,與傷寒論“茵陳蒿湯”病機(jī)主癥“身如橘子色”、“小便不利”、“腹微滿”為辨證要點(diǎn)相同,臨床運(yùn)用茵陳蒿湯加減方治療AOSC不乏其例,但從循證醫(yī)學(xué)角度進(jìn)行系統(tǒng)考證較少。本研究旨在觀察茵陳蒿湯結(jié)合手術(shù)治療AOSC,通過(guò)觀察其臨床療效及對(duì)炎癥因子的影響,探討其作用機(jī)理及經(jīng)方在臨床AOS C治療中的應(yīng)用價(jià)值。方法：選擇我院自2013年1月～2015年12月收治急性梗阻性化膿性膽管炎60例,根據(jù)治療方法分為觀察組與對(duì)照組,每組30例。兩組入院后均行相應(yīng)檢查、禁食、補(bǔ)液、抗感染等綜合治療,均在全麻下行手術(shù)治療。觀察組在術(shù)后西醫(yī)治療的基礎(chǔ)上于48小時(shí)內(nèi)開(kāi)始服用茵陳蒿湯：茵陳30g,梔子12g,大黃(去皮)6g,用500m1水煎至200m1,于早晚分別服用100ml。對(duì)照組單純采用西醫(yī)治療。通過(guò)對(duì)臨床療效指標(biāo)及實(shí)驗(yàn)室指標(biāo)分析進(jìn)行綜合評(píng)價(jià)。結(jié)果：從綜合療效、臨床療效指標(biāo)及實(shí)驗(yàn)室檢查指標(biāo)分析,觀察組臨床治療效果明顯優(yōu)于對(duì)照組。結(jié)論：茵陳蒿湯具有清熱、利濕、退黃的功效,在結(jié)合西醫(yī)方式治療AOSC時(shí)能夠取得明顯臨床療效,并能顯著抑制炎癥因子和C反應(yīng)蛋白的水平。
[Abstract]:Objective: acute obstructive suppurative cholangitis (AOSCC) due to bile duct obstruction and bacterial infection, increased intrabiliary pressure, resulting in liver and bile system lesions, with multiple organ damage of the serious systemic infectious disease. Acute cholangitis is the serious manifestation of biliary diseases in China the most prominent disease clinical mortality reached 33.6% AOSC treatment including non-surgical and surgical treatment mainly to relieve biliary obstruction. The acute obstructive suppurative cholangitis belongs to the category of "acute yellow" and "high fever" in traditional Chinese medicine, such as unobstructed bile flow, removing focus, anti-inflammation, anti-infection, reducing endotoxin formation and maintaining internal environment stability, prevention and treatment of complications and so on. It is the same as the syndrome differentiation key points of "Yinchenhao decoction", "orange color", "unfavorable urination" and "abdominal microfullness". Clinical application of Yinchen Artemisia decoction to treat AOSC is not lack of cases. The purpose of this study was to observe the therapeutic effect of Yinchenhao decoction combined with surgery on AOSC.Through observing its clinical effect and the effect on inflammatory factors. To explore its mechanism and the value of meridian prescription in the treatment of AOS C. methods: from January 2013 to December 2015, 60 cases of acute obstructive suppurative cholangitis were treated in our hospital. According to the treatment methods were divided into the observation group and the control group, each group of 30 cases. The two groups were treated with the corresponding examination, fasting, fluid rehydration, anti-infection and other comprehensive treatment. The observation group began to take Yinchen Artemisia decoction within 48 hours on the basis of postoperative western medicine treatment: Yinchen 30g, Gardenia jasminoides 12g, rhubarb (exfoliation 6g). Saute with 500m1 to 200m1. Take 100ml in the morning and evening. The control group was treated with western medicine only. Through the clinical efficacy index and laboratory index analysis comprehensive evaluation. Results: from the comprehensive curative effect. The clinical curative effect index and the laboratory examination index analysis, the observation group clinical treatment effect is obviously superior to the control group. Conclusion: Yinchenhao decoction has the effect of clearing heat, promoting dampness and reducing yellow. In combination with western medicine treatment of AOSC can obtain obvious clinical efficacy, and can significantly inhibit the levels of inflammatory factors and C-reactive protein.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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本文編號(hào)：1441949