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Objective::To explore the effect of modified Qingyitang combined with continuous blood purification in the adjuvant treatment of severe acute pancreatitis (SAP) complicated with multiple organ dysfunction (MODS) caused by heat accumulation of viscera. Method::Totally 100 cases of patients of SAP complicated with MODS, who were diagnosed as heat accumulation of viscera by traditional Chinese medicine(TCM) and treated in ICU of the First Affiliated Hospital of Hunan University of Chinese Medicine during May 2015 and May 2019, were randomly divided into two groups, namely control group and observation group, with 50 cases in each group. The patients in control group were treated with fasting and abstinence, gastrointestinal decompression, inhibition of trypsin secretion, gastric mucosal protection, early jejunal nutrition, reduction of inflammatory reaction, continuous blood purification (CBP), mechanical ventilation and circulatory support. The patients in observation group were treated by nasojejunal tube according to syndrome differentiation in addition to routine comprehensive therapy. Modified Qingyitang was injected for 7 days. The remission time of abdominal pain and distention, the time of first exhaust and defecation, the time of ICU residence, the number of samples falling off, the cause of death and the number of cases were recorded. Relevant indexes were measured before treatment, on the 3rd and 7th day of treatment, including the evaluation indexes of pancreatitis: blood amylase (AMS), blood lipase (LPS), and modified computed tomography severity index (MCTSI), inflammatory response indexes were interleukin-6 (IL-6) and hypersensitive C-reactive protein (hs-CRP). Organ function indexes included APACHE-Ⅱ, arterial partial pressure of oxygen (PaO2), oxygenation index (PaO2/FiO2), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), glutamyltransferase (γ-GGT), urine volume, creatinine (CREA), urea nitrogen (UREA), glomerular filtration rate (GFR), creatine kinase (CK), creatine kinase isoenzymes (CKMB), lactate dehydrogenase (LDH), myoglobin (Mb). Tissue perfusion evaluation indexes included acute physiology and chronic health score, serum lactic acid (Lac) and central venous pressure (CVP). TCM treatment score was based on the syndrome score of acute pancreatitis with heat accumulation of viscera syndrome. Result::The total effective rate of TCM syndromes was 86.67%(39/45) in observation group and 73.91%(34/46) in control group (χ2 =13.524, P<0.01). On the 7th day of treatment, the symptoms and indicators of the two groups were improved. Compared with before treatment, AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT and AST were improved on the 3rd and 7th day after treatment in observation group and control group. The levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). Compared with control group on the 3rd and 7th day, the levels of AMS, LPS, IL-6, hs-CRP, MCTSI, APACHE-Ⅱ, Lac, CVP, PaO2, PaO2/FiO2, ALT, AST, ALP, γ-GGT, urine volume were significantly improved (P<0.05). CREA, UREA, GFR, CK, CKMB, LDH and Mb were significantly improved (P<0.05). Compared with control group, the abdominal pain, abdominal distension relief time, first exhaust/defecation time, ICU stay time in observation group were significantly shortened (P<0.05), and the mortality rate in observation group was significantly reduced (P<0.05). Conclusion::Patients of SAP accompanied with MODS can be treated with blood purification combined with modified Qingyitang by promoting pancreas repair, inhibiting inflammation and improving organ function. It plays an important role in improving symptoms, alleviating TCM syndromes, delaying progression of disease, reducing hospital stay and reducing mortality.
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Objective To investigate the changes of serum concentration of amylase(AMY) and pathological of pancreas in severe acute pancreatitis of SD-rats treated with Ulinastatin combined with qingyitang and to provide the basis for clinical application.Methods Ninty male SD-rats with average weight of(271.59±11.13) g were conventional feeding for a week.Twelve hours before experiment,they were forbidden to take food.They were randomly divided into five groups(with 18 in every group):sham operation group,severe acute pancreatitis group,Ulinastatin treated group,qingyitang treated group,Ulinastatin combined with qingyitang treated group.Then eighteen rats in every group were divided randomly into 6 h,12 h and 24 h groups with six rats in each group.Severe acute pancreatitis model was created by retrograde injection of 5％ sodium taurocholate (0.1 ml/100 g) through pancreatic duct,in sham operation group,only pancreas were flipped.The three treated groups were treated with vein injection of Ulinastatin(20 000 U/kg)or qingyitang perfusion(1 ml/100 g)or Ulinastatin combined with qingyitangat 0 h,5 h and 11 h after severe acute pancreatitis model successfully created.AMY and patholigical changes of pancreas were measured.Results There was significant difference on AMY level at 6 h,12 h and 24.h between severe acute pancreatitis group and sham operation group[6 h:(16 518±327)U/L vs(1671±175)U/L,F =3296.24,P ＜0.01;12 h:(16 796±338) U/L vs(1751±223)U/L,F =3802.44,P ＜0.01;24 h:(1554±373) U/L vs(1724±187) U/L,F =2382.54,P ＜0.01].Compared with severe acute pancreatitis group,the AMY level and pathologic score both decreased significantly in Ulinastatin treated group,qingyitang treated group and Ulinastatin combined with qingyitang treated group(P ＜0.05 or P ＜ 0.01).At the same time,the AMY level and pathologic score both decreased more in Ulinastatin combined with qingyitang treated group than Ulinastatin treated group and qingyitang treated group(P ＜0.05 or P ＜ 0.01).Conclusion Combination of Ulinastatin with qingyitang in treatment of severe acute pancreatitis of rats is superior to treatment with single medicine.
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Objective To study the use on curative effect of Chinese medicine Qingyitang in severe acute pancreatitis.Methods 132 cases of severe acute pancreatitis were randomly divided into 2 groups,The control group(n=62) and the treatment group(n=70).Routine treatment were given in both,otherwise,the Chinese medicine Qingyitang was used in the treatment group.The operation rate,the infection rate,the time of abdominal distension removing and fasting and being hospitalized were observed and compared between two groups.Results Every index of the treatment group was finer than the control group.Conclusions The Chinese medicine Qingyitang showes their protective effects on gut barrier function by alleviating the damage of intestinal mucosa and microecologic disturbance following acute pancreatitis.As a result,the chances of bacterial translocation and enterogenic infection declines.These preparation might raise the treatment effects,as a well,shorten the course of treatment.
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Objective:To establish a method for the determination of jasminoidin and paeoniflorin in Qiyitang Granules.Methods:The analytical column was a Agilent Eclipse XDB-C18 column(4.5?150mm,5?m).The mobile phase consisted of acetonitrile-0.1%H3PO4(12:88,V/V),flow rate was 1.0ml/min.The detection wavelength was 230 nm.Rusults:Jasminoidin and paeoniflorin were separated utterly and the linear correlation was good. The average recoveries of high,middle and low concentration of jasminoidin were 106.2%,97.5% and 98.1% respectively with RSD of 0.96%,1.23% and 1.62%(n=3)respectively.The average recoveries from paeoniflorin were 101.3%,99.5% and 98.2% respectively with RSD being 1.19%,1.33% and 1.58%(n=3),respectively. Conclusions:The method is simple,reproducible,accurate and reliable.It may be used for the quality control of this granules.