Effects Of Traditional Chinese Medicine For Severe Acute Pancreatitis: A System Review And Clinical Research

Acute pancreatitis (AP) is a common acute abdomen,of which 10%-20% can develop into severe acute pancreatitis (SAP), seriously harm to human life and health. At present, integrated traditional Chinese medicine with Western medicine (ITCWM) in treating SAP has made great progress, causing the medical professional attention. Many articles also had indicated that the efficacy of ITCWM is much better than that of Western medicine alone (WM).The rhubarb which has a long history in treating AP has more extensive clinical application in past time.This study was designed to have a system review to evaluate the effects of traditional Chinese medicine for SAP on the base of retrospective studies with rhubarb in treating AP.AIM:To observe the epidemiologic feature of acute pancreatitis with retrospective studies and evaluate the efficacy to the acute pancreatitis with rhubarb.Further more, to compare the effects of integrated traditional Chinese with Western medicine (ITCWM) and Western medicine alone (WM) for severe acute pancreatitis with System Review,and to sum up the main method and composition of traditional Chinese medicine in treating SAP.METHODS:part 1:174 patients were divided into rhubarb group and control group during 01-2005 to 12-2008 in Nanjing DrumTower Hospital. All the patients were treated with common western medicine. Rhubarb were applied to rhubarb group. Then the two groups were compared with clinical efficacy and the quantity of platelets.Part 2:We searched the electronic biological databases:Medline(1966 to June 2009), Chinese biological medical database (CBMdisk,1978 to June 2009).CNKI(1994 to June 2009) and CQVIP(1989 to June 2009). We also hand searched relevant journals and conference proceedings. Randomized controlled trials (RCT) in which ITCWM was used to treat severe acute pancreatitis were collected. Then we screened the retrieved studies according to predefined inclusion and exclusion criteria, evaluated the quality of included studies, then meta-analysis were performed by using RevMan 4.2software.RESULTS:part 1:The rhubarb group is more effective than the control group and the quantity of platelets in rhubarb group increased with statistical significance compared with the control group.part 2:A total of 57 studies were enrolled into the analysis.Compared with the control group, patients treated with ITCWM had significantly quicker stomachache relief and abdominal distention relief, shorter period of bowel functional recovery (WMD=-2.01, 95%CI:-2.41～-1.61,P<0.01),less hospital stay(days) (WMD=-9.47,95%CI:-11.46～-7.49, P<0.01),lower sequelae of surgery (RR= 0.38,95%CI:0.29～0.51,P<0.01),lower incidence of complications (RR=0.47,95%CI:0.40～0.55,P<0.01)and lower in hospital mortality (RR=0.40,95%CI:0.32～0.50,P<0.01).CONCLUSION:The adjunctive therapy with rhubarb in severe acute pancreatitis can decrease the time ot stomachache relief,abdominal distention relief,period of bowel functional,sequelae of surgery,the incidence of complications and in hospital mortality and also can shorten hospital stay.The routine adjunctive therapy with traditional Chinese medicine in severe acute pancreatitis should be recommended.The efficacy of routine treatment added rhubarb is much better than that of routine treatment, it had significantly quicker stomachache and abdominal distension relief, lower incidence of complications and in hospital mortality. Further more, the rhubarb group may can improve the microcirculation of pancreas with raising the number of platelets compared with the control group.