【目的】观察基于通降法运用大黄附子汤加减治疗寒邪积滞型急性胰腺炎的临床疗效。 【方法】将78例寒邪积滞型急性 胰腺炎患者随机分为研究组和对照组，每组各39例。对照组给予常规西医治疗，研究组在对照组的基础上给予口服或鼻饲 大黄附子汤加减治疗，疗程为7 d。观察2组患者治疗前后血清胰腺酶学指标 （血清淀粉酶和脂肪酶） 、炎症因子[C反应蛋白 （CRP） 、降钙素原 （PCT） 、白细胞介素6 （IL-6） 、白细胞介素8 （IL-8） ]水平及急性生理与慢性健康状况Ⅱ （APACHEⅡ） 评分、 改良CT严重指数 （MCTSI） 评分的变化情况，比较2组患者的腹痛改善时间、腹胀改善时间、肛门排便时间，评价2组患者的 临床疗效和用药安全性。 【结果】（1） 脱落情况方面，研究过程中，研究组和对照组各有1例患者脱落，最终各有38例纳入疗 效统计。 （2） 疗效方面，治疗7 d后，研究组的总有效率为86.84% （33/38） ，对照组为78.95% （30/38） ，组间比较 （秩和检验） ， 研究组的疗效明显优于对照组 （P＜0.05） 。 （3） 胰腺酶学指标方面，治疗后，2组患者的血清淀粉酶、脂肪酶水平均较治疗前 下降 （P＜0.05） ，且研究组对血清淀粉酶、脂肪酶水平的下降幅度均明显优于对照组 （P＜0.05） 。 （4） 炎症因子方面，治疗后， 2组患者血清CRP、PCT、IL-6、IL-8水平均较治疗前下降 （P＜0.05） ，且研究组对血清CRP、PCT、IL-6、IL-8水平的下降 幅度均明显优于对照组 （P＜0.05） 。 （5） 量表评分方面，治疗后，2组患者的APACHEⅡ、MCTSI评分均较治疗前下降 （P＜ 0.05） ，且研究组对APACHEⅡ、MCTSI评分的下降幅度均明显优于对照组 （P＜0.05） 。 （6） 症状改善时间方面，研究组的腹痛 改善时间、腹胀改善时间、肛门排便时间均较对照组明显缩短，差异均有统计学意义 （P＜0.05） 。 （7） 安全性方面，治疗过 程中，2组患者均未发生明显不良反应，具有较高的安全性。 【结论】在常规治疗的基础上，基于通腑法运用大黄附子汤加减 治疗寒邪积滞型急性胰腺炎患者疗效确切，能有效改善患者的症状、体征，降低血清胰腺酶学指标和炎症因子水平。

Objective To observe the clinical efficacy of modified Dahuang Fuzi Decoction following the therapy of unblocking bowels for the treatment of acute pancreatitis of pathogenic-cold accumulation and retention type. Methods A total of 78 patients with acute pancreatitis of pathogenic-cold accumulation and retention type were randomly divided into a study group and a control group，39 cases in each group. The control group was treated with conventional western medicine，and the study group was treated with oral use or nasogastric feeding of Dahuang Fuzi Decoction on the basis of treatment for the control group. The course of treatment covered seven days. The two groups were observed in the changes of serum pancreatic enzyme indicators of serum amylase and lipase， inflammatory factors of C-reactive protein （CRP） ，procalcitonin （PCT） ，interleukin-6 （IL-6） and interleukin-8 （IL-8） ，acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score，and modified CT severity index （MCTSI） score before and after treatment. The time for abdominal pain relief，time for abdominal distension relief， and time for anal defecation were compared between the two groups. After treatment，the clinical efficacy and safety of the two groups were evaluated. Results （1）During the trial，there was one patient falling off separately from the study group and the control group，and 38 patients in each group were eventually included in the efficacy statistics. （2） After seven days of treatment，the total effective rate of the study group was 86.84% （33/38） ，and that of the control group was 78.95% （30/38） . The intergroup comparison （tested by rank sum test） showed that the efficacy of the study group was significantly superior to that of the control group （P＜0.05） . （3） After treatment， the serum levels of pancreatic enzyme indicators of amylase and lipase in the two groups were decreased compared with those before treatment （P＜0.05） ，and the decrease of serum amylase and lipase levels in the study group was significantly superior to that in the control group （P＜0.05） . （4） After treatment，the serum levels of inflammatory factors of CRP，PCT，IL-6 and IL-8 in the two groups were decreased compared with those before treatment （P＜ 0.05） ，and the decrease of serum CRP，PCT，IL-6 and IL-8 levels in the study group was significantly superior to that in the control group （P＜0.05） . （5） After treatment，the APACHE II and MCTSI scores of the two groups were decreased compared with those before treatment （P＜0.05），and the decrease of APACHE II and MCTSI scores in the study group was significantly superior to that in the control group （P＜0.05） . （6） For the time of symptom relief，the time for abdominal pain relief，time for abdominal distension relief，and time for anal defecation in the study group were significantly shortened compared with those in the control group，and the differences were statistically significant （P＜0.05） . （7） No obvious adverse reactions occurred in the two groups during the treatment，indicating high safety. Conclusion On the basis of conventional treatment，the use of modified Dahuang Fuzi Decoction following the therapy of unblocking bowels exerts certain efficacy for the treatment of patients with acute pancreatitis of pathogenic-cold accumulation and retention type. The therapy is effective on relieving the symptoms and signs of patients，and decreasing the level of serum pancreatic enzyme indicators and inflammatory factors.

R259.76

东莞市科技计划医疗卫生类科研项目 （编号：2011021500261）；东莞市社会发展科技项目 （编号：20221800900032）；东莞市 卫健局“周正东莞市名中医药专家传承工作室”建设项目 （东卫函[2020]136号）