| Objective: In recent years, the morbidity of the acute pancreatitis has shown an upwardtendency. The mild acute pancreatitis (MAP) is self-limited, the prognosis will be good if thetreatment is received in time. The clinical process of the severe acute pancreatitis (SAP) iscritical. Although current treatment has improved greatly, the mortality of the illness stillwandered around 20% or so. The curative effect of the treatment of the acute pancreatitis by Chinesemedicine has been affirmed. Clinical researches have focused on the core pathophysiologic processsuch as the restraint of activation of pancreatic enzymes and that of the release of inflammatorymediators, and anti-endotoxemia etc. However, as for the researches of earlier events of the acutepancreatitis such as the remission of obstruction of the bile-pancreatic duct and the improvementof the pancreas microcirculation are very few. We've worked out Dongfang Danshu Decoction withlarge dose of raw rhubarb, Radix Bupleuri and Herba Artemisiae Capillaris. In order to observethe function of Dongfang Danshu Decoction in preventing acute pancreatitis from getting worsein earlier period and reducing occurrence rates of complications, and to study the relatedmechanism that it could promote the condition of mild acute pancreatitis to tend to self-limitedin earlier period. There was a patient dead at last in section B, who had undergone continuousvenou-venous hemofiltration (CVVH) during hospitalization, by which had ever made him better.We put forward that case in order to probe into applicational value and functional mechanism ofCVVH during the treatment of severe acute pancreatitis. Methods: We analyzed retrospectively history data of forty-seven patients who had sufferedfrom acute or chronic pancreatitis during past four years from December of 1999 to December of2003. According to the diagnosis standard revised by the Chinese Medical Association SurgeryBranch Association Pancreas Surgery Section in 2000, forty-two patients, whose hospitalizingdiagnosis matched, were selected. Among them, twenty-one were received combination treatment oftradition Chinese and western medicine, Dongfang Danshu Decoction was taken through thenasal-stomach tube (section A). Another twenty-one patients were taken for control group andreceived single treatment of western medicine (section B). Admission circumstance, duration ofrecovering from fasting and of breaking wind, days of hospitalization, and complicationsoccurrence were compared. The improvement of bile duct dilation was also contrasted. The APACHE score was used to evaluate the curative effect on day 1, 3, 5, 7 after hospitalizationrespectively. In that case, the patient underwent CVVH for 61 hours through right thighvenipuncture, the filtration rate was 150ml/h, replacing filtrate once an hour. The change ofbody temperature at 7am, white blood cell count, arterial gas analysis including oxygenoussaturation index and chemic assay index including the volume of urine and Ccr before CVVH, onthe first second day during CVVH, after CVVH and before death were continuously observed. Theevolvement of the disease that was reflexed by such index was also included. Calculate the APACHEscore of each day, and evaluate and compare the individual risk coefficient R and death riskcoefficient. Results: Twenty patients were cured (47.62%) and the total efficiency rate was 80.95%, amongwhich section A (95.24%) was obviously better than section B (66.67%) and had significantdifference P<0.05 . The duration of recovering from breaking wind, days of disappearance ofsymptom and sign, and days of hospitalization were all shorter in section A than in section BP<0.05 . Seven patients in section B had complications, one was dead, two became chronicpancreatitis, one had pancreatic pseudocyst, three transferred to operate for having common bileduct stone with acute cholangitis. The complication rate was higher than that in section A, inwhich there was only one patient ha... |
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