Acute pancreatitis (AP), characterized by complex complications, substantial treatment expenses, and elevated mortality rates in severe instances involving multi-organ dysfunction and post-recovery challenges, has traditionally been addressed through Traditional Chinese Medicine (TCM) based on the “Hot Disease” theory. Recent research, however, indicates potential adverse effects from over-relying on this approach with bitter and cold purgative herbals. Evolving from this, a novel methodology, conceptualized by Professor ZHANG Zailiang, integrates the theory of typhoid fever, miscellaneous diseases and epidemic febrile diseases. This paradigm shift encompasses the entire AP spectrum, emphasizing early interventions for organ damage, proactive complication management, and meticulous post-recovery care. It proposes a comprehensive, tailored strategy for monitoring disease evolution and convalescence, signaling a significant advancement in the AP treatment paradigm, particularly in the context of TCM’s role in critical care.
目的:探讨早期采用益活清下法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)并肾功能不全的疗效。方法:35 例符合病例选择标准并接受益活清下法治疗的SAP并发肾功能不全患者,按发病后入院时间分为早期组(3d 内入院接受治疗,24例)和晚期组(3～7 d 内入院接受治疗,11例),比较治疗过程中两组患者各并发症的持续时间、病程、手术中转率及病死率。结果:两组入院48小时Ranson 评分、急性生理和慢性健康评价指标Ⅱ(APACHE Ⅱ )评分及CT 评分比较差异无显著性(Pgt; 0.05);早期组急性呼吸窘迫综合征、肾功能不全的持续时间低于晚期组(Plt; 0.05);早期组和晚期组中转手术率分别12.5%(3/24例)和 18.18%(2/11例),差异无统计学意义(Pgt; 0.05);病死率早期组和晚期组分别为 8.33%(2/24例)和9.09%(1/11例),差异无统计学意义(Pgt; 0.05);早期组和晚期组住院病程分别为(20.40±18.25)d 和(34.92±12.62)d,两组比较有统计学意义(Plt; 0.05)。结论:早期使用益活清下法对SAP合并肾功能不全可以取得更好疗效。
ObjectiveTo summarize and analyze the etiologies of recurrent acute pancreatitis (RAP) and then conclude the prevention and treatment strategies.MethodSearching relevant literatures of PubMed, CNKI, Wanfang data and other databases in recent years, the etiologies of RAP were analysed and reviewed, then the prevention and treatment strategies were developed.ResultsThe causes of RAP included abnormal function and structure of biliopancreatic duct, metabolic factors, bad living habits, genetic factors and so on. Then based on etiologies of RAP, prevention and treatment strategies of it were summarized.ConclusionsWith the developments of related researches and clinical diagnosis and treatment technologies, the etiologies of RAP are gradually revealed. It is of great significance to clarify the etiologies of RAP and make prevention and treatment strategies for reducing the recurrence of acute pancreatitis.
Objective To evaluate the effectiveness and safety of early veno-venous hemofiltration in patients with severe acute pancreatitis (SAP). Methods We searched Cochrane Central Register of Controlled Trials (Issue 4, 2005), MEDLINE (1990 to 2006) and CBMdisc (1990 to 2006). We also handsearched the references of relevant articles. We included randomized controlled trials (RCTs) and non-randomized clinical controlled trials (CCTs) comparing early veno-venous hemofiltration versus conventional therapy only, which reported either mortality rate, cure rate, or both. Two reviewers assessed the quality of each trial and extracted data independently. Trials were graded methodologically. The Cochrane Collaboration’s RevMan 4.2.8 software was used for statistical analysis. Results Ten RCTs and 6 CCTs involving 891 patients were included, all of which were China-based. The Jadad scores of all included RCTs were less than 3. Five trials were incorrectly described as having used random allocation. The baseline data of each trial were comparable. Meta-analyses showed that hemofiltration significantly increased the overall cure rate (OR 3.01, 95%CI 1.28 to 7.09) and decreased the overall mortality rate (OR 0.43, 95%CI 0.27 to 0.70). Moreover, APACHE-II score, conversion to operation rate and incidence of complications of SAP were reduced significantly., The duration of abdominal pain or distension and hospitalization stay were shortened compared with non-hemofiltration. However, continuous veno-venous hemofiltration (CVVH) did not improve overall prognosis, with greater possibility of adverse events. Repeated or intermittent short veno-venous hemfiltration (RSVVH/ISVVH) either with or without peritoneal dialysis, could improve the overall prognosis without any adverse events reported. Conclusions Based on these findings, early RSVVH/ISVVH was effective and safe for SAP, but the efficacy of CVVH could not be proven. Current studies were only available from China and were poor in methodological quality. Further, high-quality, large-scale, randomized controlled trials are required to identify reliably the effectiveness and safety of early veno-venous hemofiltration for SAP.
【摘要】 目的 观察利胆清微丸治疗慢性胆囊炎湿热蕴结兼血瘀证患者的疗效及安全性，进一步为临床研究提供依据。 方法 2001年4—7月，采用双盲、双模拟、随机平行对照临床试验，将40例患者随机分为试验组（20例）及对照组（20例）。试验组服用利胆清微丸3.5 g/次，3次/d，同时服用胆宁片模拟剂；对照组服用胆宁片3片/次，3次/d，同时服用利胆清微丸模拟剂。 结果 试验组痊愈1例，显效12例，有效5例，无效2例，显效率65%，有效率90%；对照组痊愈2例，显效10例，有效7例，无效1例，显效率60%，有效率95%，两组疗效比较差异无统计学意义（Pgt;0.05）。试验过程中未发现明显不良反应。 结论 利胆清微丸对于治疗慢性胆囊炎湿热蕴结兼血瘀证有良好效果，是一种安全有效的药物。【Abstract】 Objective To observe the safety and efficacy of Lidanqing pellet on chronic cholecystitis with damp and hot accumulate knot including blood stasis, and to provide a basis for further clinical trials. Methods A double-blind, double dummy, randomized, and controlled clinic trial was undertaken between April and July 2001. A total of 40 patients were randomly divided into trail group and control group. The trial group was given Lidanqin pellet 3.5 g per time, and three times per day; simultaneously taking Danning tablet simulation agent. The control group was given 3 tablets of Danning tablet per time and three times per day; simultaneously taking taking Lidanqing pellets simulation agent. Results In the trail group, one patient was cured, the therapeutic effect was obvious in 12, basically effective in five and invalid in two (with the rate of obvious effect of 65.00% and rate of basic effect of 90.00%). In the control group, two patients was cured, the therapeutic effect was obvious in 12, basically effective in 10, effective in seven and invalid in one (with the rate of basic effect of 60.00% and the rate of obvious effect of 95.00%). The difference between the two groups was significant (Pgt;0.05). Adverse reaction was not found in the trial group. Conclusion Lidanqing pellet, a safe medication, is effective on chronic cholecystitis with damp and hot accumulate knot including blood stasis.
Objective To assess the effectiveness and safety of Fushenqudu capsules in the treatment of chronic renal failure. Methods The double blind, double dummy and randomized controlled method was adopted. One hundred and thirty one patients were randomized to the trial group (n=88, Fushenqudu capsule, 4 capsules, qid) and the control group (n =43, Shenshuaining capsules, 4 capsules, qid). The therapeutic duration for both groups was 8 weeks. Results The results were analyzed on the basis of intention-to-treat. For effectiveness of treatment, the markedly effective rate was 27.3% (24/88); the total effective rate was 67.0% (59/88) in the treatment group; the markedly effective rate was 25.6% (11/43), the total effective rate was 58.1% (25/43) in the control group. There was no statistical difference between the two groups (Pgt;0.05). For effectiveness of Pishenqixu syndrome, the markedly effective rate was 48.9% (43/88) and 53.3% (23/43) respectively in the trial and control groups. No statistically significant difference was tested between the two groups (Pgt;0.05). Mild adverse effects occurred in two groups. When a smaller dose or termination of the drug were applied, the symptoms went. The tolerance was good when the patients took the medicine regularly. Conclusions Fushenqudu capsules have the same clinical effect as Shenshuaining capsule with a little toxic adverse effects.