本文選題：高齡急性膽囊炎 + 經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù)��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:通過觀察清熱利膽湯治療高齡急性膽囊炎PTGBD術(shù)后的癥狀改善情況、實驗室指標下降情況來探討其臨床療效,通過檢測血WBC、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、γ—GT、總膽紅素水平來探討清熱利膽湯的臨床療效機制。方法:收集江蘇省中醫(yī)院2015年6月至2017年3月普通外科收治的15例高齡急性膽囊炎患者資料,將這15例病患隨機分為對照組7例和治療組8例。對照組7例患者行經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù),術(shù)后予常規(guī)補液、抗感染治療;治療組8例患者行經(jīng)皮經(jīng)肝膽囊穿刺引流術(shù),術(shù)后在常規(guī)補液、抗感染基礎(chǔ)上口服中藥清熱利膽湯,每日一劑,每劑分早晚兩次煎服。設(shè)定5天為一個療程,一個療程后,觀察兩組治療前后的癥狀體征變化、以及檢測血WBC、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、y—GT、總膽紅素水平,采用SPSS19.0軟件進行數(shù)據(jù)處理并分析結(jié)果。結(jié)果:1.治療后療效比較:治療組8例痊愈0例(0),好轉(zhuǎn)6例(75%),未愈2例,總有效6例(75%);對照組7例痊愈0例(0)好轉(zhuǎn)4例(57.14%),未愈3例(42.86%),總有效4例(57.14%)。治療組優(yōu)于對照組P0.05。2.血WBC水平比較:治療組治療后平均達9.12±0.96× 10^9/L,對照組治療后平均達9.45± 0.89× 10^9/L,治療組治療前后經(jīng)檢驗,有顯著性差異P0.05;對照組治療前后經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05,治療組較對照組下降幅度大,兩組間經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05。3.肝功能比較:治療組谷丙及谷草數(shù)值治療前后經(jīng)檢驗,有顯著性差異P0.05;對照組治療前后谷丙及谷草數(shù)值經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05,兩組治療對肝功能的好轉(zhuǎn)均有效,治療組較對照組下降幅度大,兩組間經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05。4.總膽紅素水平比較:治療組治療前后總膽紅素數(shù)值經(jīng)檢驗,有顯著性差異P0.05;對照組治療前后膽紅素數(shù)值經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05,治療組較對照組下降幅度大,兩組間經(jīng)檢驗有顯著統(tǒng)計學(xué)差異P0.05。5.治療后患者局部疼痛均有顯著改善(P0.05),但是體溫變化無明顯統(tǒng)計學(xué)意義(P0.05),治療組與對照組在疼痛改善方面無明顯差異(P0.05)結(jié)論:PTGBD術(shù)后服用清熱利膽湯能顯著降低高齡急性膽囊炎患者血清中白細胞計數(shù)、谷丙轉(zhuǎn)氨酶、谷草轉(zhuǎn)氨酶、總膽紅素、γ-GT數(shù)值,改善局部炎癥反應(yīng),對急性膽囊炎有顯著的臨床效果。
[Abstract]:Objective: to investigate the clinical efficacy of Qingre Lidan decoction in the treatment of senile acute cholecystitis after PTGBD. To explore the clinical therapeutic mechanism of Qingre Lidan decoction by glutamic oxaloacetic transaminase, 緯 -GT and total bilirubin levels. Methods: the data of 15 aged patients with acute cholecystitis treated in Jiangsu traditional Chinese Medicine Hospital from June 2015 to March 2017 were collected. The 15 patients were randomly divided into control group (n = 7) and treatment group (n = 8). In the control group, 7 patients were treated with percutaneous transhepatic cholecystectomy and treated with routine fluid rehydration, and 8 patients in the treatment group were treated with percutaneous transhepatic cholecystectomy. Anti-infection on the basis of oral Chinese medicine Qingre Lidan decoction, one dose daily, each dose is divided into morning and evening two decoction. Five days were set as a course of treatment. After a course of treatment, the changes of symptoms and signs before and after treatment were observed, and the levels of serum WBC, alanine aminotransferase, glutamic oxaloacetic transaminase and total bilirubin were detected. The data were processed with SPSS 19.0 software and the results were analyzed. The result is 1: 1. Comparison of curative effects after treatment: 8 cases in the treatment group were cured in 0 cases, 7 cases in the treatment group were cured in 0 cases, 6 cases were improved, 2 cases were not recovered, 6 cases were effective, 6 cases were effective, and 7 cases in the control group were cured in 0 cases (0 case) 4 cases improved 57.14%, 3 cases did not recover, and the total effective rate was 57.14% (4 cases). The treatment group was superior to the control group (P0.05.2). Comparison of blood WBC levels: after treatment, the average WBC in the treatment group was 9.12 鹵0.96 脳 10 ^ 9 / L, and that in the control group was 9.45 鹵0.89 脳 10 ^ 9 / L before and after treatment. There was a significant difference (P0.05) between the two groups before and after treatment, and there was a significant difference between the two groups before and after treatment (P0.05), and the decrease of the treatment group was larger than that of the control group (P0.05.3). Comparison of liver function: before and after treatment, there was a significant difference between treatment group and control group (P 0.05), and between control group and control group before and after treatment (P 0.05). Both groups were effective in improving liver function. The decrease of treatment group was larger than that of control group, and there was a significant difference between the two groups (P 0.05.4). Comparison of total bilirubin level: the value of total bilirubin in the treatment group was significantly different before and after treatment (P0.05), while in the control group there was a significant difference in the bilirubin value before and after treatment (P0.05), and the decrease in the treatment group was larger than that in the control group. There was a significant difference between the two groups (P0.05.5). There was significant improvement in local pain after treatment, but there was no significant difference in the change of body temperature between the treatment group and the control group in pain improvement (P0.05). Conclusion taking Qingre Lidan decoction after treatment with 10% PTGBD can significantly reduce the elderly. Leukocyte count in serum of patients with acute cholecystitis, Alanine aminotransferase, total bilirubin, 緯 -GT, improve the local inflammatory response, and have a significant clinical effect on acute cholecystitis.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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