Assessment Of Efficacy Of The Strategy Of Using Integrated Traditional Chinese And Western Medicine To Treat Severe Acute Pancreatitis

Part Ⅰ Analysis of relevant factors in Severe Acute Pancreatitis-associated lung injuryObjectives:To investigate clinical features in the natural course of severe acute pancreatitis (SAP) and regularity for change of tongue, pulse, syndromes of Traditional Chinese Medicine(TCM).Methods:Relying on the research named "Research on therapeutic efficiency for severe acute pancreatitis by Integrated traditional Chinese and Western medicine", supported by national issues of Science and Technology Support Program, we collected102cases of SAP in the acute phase response from July2007to July2010. Retrospectively analyzing related clinic feature,including:clinic bio-chemistry indicators、hospitalization expenses、length of stay and mortality, in Severe Acute Pancreatitis-associated lung injury and elucidating the relationship between change of tongue, pulse and the Severe Acute Pancreatitis-associated lung injury. Results:102cases of SAP in acute response period were collected,39cases of them having lung injure, including24cases of ALI and15cases of ARDS. In the mortality of the two groups, lung injure group have5cases and non-lung injure group have1case (p<0.05).In the length of stay and hospitalization expenses, the mean is28.48days and45663.47yuan in non-lung injure group;59.46days and86695.71yuan in lung injure group respectively (p<0.05). The averages of APACHE Ⅱ score is6.97±3.44and11.79±6.93in non-lung injury group and lung injure group(p<0.05);but the means of Balthazar CT score,4.81±0.88and4.82±1.23,has no statistic significant. There are mainly yellow-white coating on the tongue and string-like pulse in double groups, but Red Jiang tongue is higher proportion in lung injure group. Through the Logic regression analysis, urea nitrogen、red cell、white cell、and sodium have the relativity with Severe Acute Pancreatitis-associated lung injury. Conclusions:The APACHE Ⅱ score, but not age of patients、gender、pathogen、complication, emerged as significant correlates of Severe Acute Pancreatitis-associated lung injury。Clinic bio-chemistry indicators have effective function in forecast the lung injure, specially and mainly urea nitrogen、red cell、white cell、and sodium.Part Ⅱ Assessment of efficacy of the strategy of using integrated traditional Chinese and western medicine to treat Severe Acute PancreatitisObjectives:To observe the value of the strategy of using integrated traditional Chinese and western medicine on the treatment for the early period of severe acute pancreatitis (SAP). Methods:Relying on the research named "Research on therapeutic efficiency for severe acute pancreatitis by Integrated traditional Chinese and Western medicine", by using a multi-centre, central random, blank control, physician-patient double-blind research methods, we collected254cases of SAP from July2007to July2010. Patients were divided into the integrated traditional Chinese and western medicine treatment group (treatment group) and the routine treatment group (control group), by collect data on admission,1,3,5,7and14days. We observed mortality, clinical results, changes of severe degree, infection, C-reactive protein (CRP), social economics of treatment. Results:There were121paitents in the treatment group and133patients in the control group. The mortality in the treatment group was2.5%(3/121), the other was6.8%(9/133). The total effective rates of the treatment group and the control group were85.8%and67.6%, comparison of the two groups was different significantly. The severe degree for patients were decline, APACHE-Ⅱ score in the treatment group was significantly lower than the control group on days3,5,7and14, but not for CT severity score. The infection rates in the treatment goup (13/121) was significantly lower than that in the control group (48/133), the main time of infection was1-2weeks, The predominant infections were gram-negative bacterium and mixed infection. To compare with the control group, serum CRP levels of the treatment group were showed significant difference on5,7and14d. Comparison of survival patients in two groups for health economics, time of antibiotic use, hospitalization days and hospital charges in the treatment group were significantly shorter than the control group. Conclusions:the strategy of integrated traditional Chinese and western medicine can play a effective role in control and treatment on the occurrence and development of SAP, prevent further deterioration, and have a clear social economic advantage through multi-link and multi-level. Part Ⅲ Effect of ligation of abdominal lymph duct for acute pancreatitis-lung injure in RatObjective:Through creating ligation abdominal lymph duct-acute pancreatitis model in Rat, to evaluate the protective action of ligation lymph duct for acute pancreatitis-lung injure. Methods:Creating ligation abdominal lymph duct model in Rat. After that,inducing acute pancreatitis in the model through Caerulein injection(A group).At same time, building up pure-ligation group(B group)、 pure-acute pancreatitis group(C group)and cham-operation group(D group).Six hours after modeling, boold plasma and collected bronchoalveolar lavage fluid (BALF) were collected. Detecting the cytokines IL-1、ICAM-1、and ANG-2in boold plasma and BALF,assaying MPO and quantitation of protein in BALF.Result:The mortality after modeling and we-dry weight of lung have no statistic significant between four groups. In MPO assay, C group has difference with both A group and D group(p<0.05).There is diversity between A group and C group in quantitation of protein,but not between D group and others.In blood plasma, the numerical value of expression of cytokines in blood plasma is extremely too discrete to calculate in statistics. But in BALF, expression of IL-1in A、C group is higher than B、D group(p<0.05); the expression of ICAM-1is no different between four groups; expression of ANG-2is lower than C group. Conclusions:Comparing with pure-acute pancreatitis group(C group),ligation of lymph duct (A group) cause lower expression of ANG-2、ICAM-1in BALF, alleviating neutrophile granulocyte infiltration and reducing exudation of protein to alveolar. Therefore, ligation of abdominal lymph duct has the positive effect in protecting the lung injure during acute pancreatitis induced by Caerulein injection in Rat.