Severe acute pancreatitis (SAP) still remains an important surgical problem with high morbidity and mortality. The utilization of Traditional Chinese Medicine shows good prospects in therapy of SAP since it has advantages of more extensive pharmacological effects and fewer adverse effects. In this retrospective study, 38 patients received standardized treatment (control group) and 37 patients received Chinese herbal decoction, Huoxue Qingyi Decoction (HQD group), in addition to standard treatment for SAP. We found that the HQD group had a shorter hospital stay and lower initial expense than the control group (
Severe acute pancreatitis (SAP) is a common cause of emergency hospital admission, with an increase in the incidence rate during the past 30 years. It can induce vascular leakage, shock, systemic inflammatory response syndrome, and even organ dysfunctions [
In contrast to western medicine, there is accumulating evidence suggestive of beneficial effects of plants used in Traditional Chinese Medicine (TCM) and compounds isolated from medicinal plants [
Between June 2010 and June 2014, 75 patients with a clinical diagnosis of SAP of whom 49 were men and 26 were women with a mean age of 45 years (range: 22 to 69 years) were admitted to the Department of Emergency Intensive Care Unit at First People’s Hospital affiliated to Huzhou University Medical College (Zhejiang Province, China) within 3 days of disease onset. 38 patients received standardized medical therapy for SAP (control group) and 37 patients received additional HQD therapy (HQD group). Medical records were retrospectively reviewed.
The diagnostic and classification criteria for SAP were in accordance with the revised Atlanta criteria of 2013 [
This study was conducted in accordance with the principles of the Declaration of Helsinki and “Good Clinical Practice” guidelines. Written informed consent was obtained from all patients. Approval of the study was obtained from the institutional review board.
All of the patients received standardized medical therapy for SAP according to the United Kingdom, Chinese Medical Association, and International Association of Pancreatology guidelines [
The composition of HQD (shown in Table
Components of Huoxue Qingyi Decoction with Latin and English names.
Name in Latin | Name in English | Dose |
---|---|---|
Salviae Miltiorrhizae | Danshen root | 30 g |
|
Snowbell leaf tick clover herb | 30 g |
|
|
10 g |
Natrii Sulfas | Glauber salt | 9 g |
|
Magnolia bark | 10 g |
Radix Paeoniae Alba | White peony root | 10 g |
Radix Bupleuri | Bupleurum root | 10 g |
Fructus Aurantii Immaturus | Immature bitter orange | 10 g |
|
Scutellaria root | 10 g |
Clinical factors such as gender, age, body mass index (BMI), body weight, underlying comorbidity, etiological factor, severity of pancreatitis (Ranson’s signs and Balthazar CT index), operability, hyperamylasemia duration, mechanical ventilation, mortality rate, hospital stay, initial hospitalization cost, and adverse effects were compared. All complications such as acute respiratory distress syndrome (ARDS), renal failure, hemorrhage, sepsis, pancreatic pseudocyst, and pancreatic abscess from admission to discharge from hospital were retrospectively analyzed. Respiratory failure was defined as the requirement for mechanical ventilation beyond 24 hours after surgery. ARDS and multiple organ failure were defined as per Bone et al. [
All measurements were expressed as mean ± SD. The statistical analyses were performed using the two-sample
There were no statistically significant differences between two groups in patient characteristics, in terms of gender, age, body mass index (BMI), severity of pancreatitis (Ranson’s signs and Balthazar CT index), body weight, underlying comorbidity, and etiological factor (Table
Patient characteristics.
Control group ( |
HQD group ( |
|
|
---|---|---|---|
Gender | 0.7438 | ||
Male | 26 | 23 | |
Female | 12 | 14 | |
Underlying comorbidity | |||
Hypertension | 11 | 12 | 0.9388 |
Heart disease | 3 | 2 | 0.9754 |
Diabetes mellitus | 9 | 7 | 0.8245 |
Fatty liver | 6 | 7 | 0.9578 |
Chronic obstructive pulmonary disease | 3 | 4 | 0.9704 |
Etiological factor | 0.8336 | ||
Biliary tract stone | 17 | 20 | |
Hyperlipidemia | 9 | 7 | |
Alcohol intake | 10 | 9 | |
Other | 2 | 1 | |
Age (year) |
|
|
0.3667 |
Ranson’s signs (score in 48 h) |
|
|
0.4546 |
CT index (score in 48 h) |
|
|
0.1115 |
BMI (kg/m2) |
|
|
0.5263 |
Body weight (kg) |
|
|
0.6008 |
Clinical outcomes were shown in Table
Clinical outcomes.
Control group ( |
HQD group ( |
|
|
---|---|---|---|
Hyperamylasemia duration (day) |
|
|
0.0001 |
Hospital stay (day) |
|
|
0.0220 |
Mechanical ventilation | 4 | 2 | 0.6953 |
Operability | 2 | 1 | 0.9812 |
In-hospital mortality | 1 | 0 | 0.9893 |
SIRS duration (day) |
|
|
0.0004 |
Initial hospitalization cost (Chinese yuan) |
|
|
0.0000 |
The percentage of patients having any complication was much higher in control group than HQD group (27/38 versus 17/37,
Complications.
Control group ( |
HQD group ( |
|
|
---|---|---|---|
Complication (%) | 27 (71.1%) | 17 (45.9%) | 0.0485 |
Hemorrhage | 3 | 1 | 0.6266 |
Pancreatic pseudocyst | 10 | 2 | 0.0312 |
Pancreatic abscess | 3 | 2 | 0.9514 |
Renal failure | 7 | 4 | 0.5452 |
Heart failure | 4 | 4 | 0.7382 |
Sepsis | 12 | 8 | 0.9254 |
Acute respiratory distress syndrome | 8 | 5 | 0.5773 |
Severe acute pancreatitis (SAP), a life-threatening condition characterized by edema, inflammation, hemorrhage, and necrosis of the pancreas, still remains an important surgical problem with high morbidity and mortality [
Evidences in basic and clinical research suggest that it not only is an injury caused by the activated pancreatic enzymes but also involves pancreatic ischemia which leads to disturbance of pancreatic microcirculation that plays an important role in its pathophysiological processes [
In this study, we found the patients of the HQD group showed a significantly shorter hospital stay, lower initial hospitalization cost, and shorter duration of SIRS and hyperamylasemia than control group. Though there was no significant difference in in-hospital morbidity between two groups, fewer complications especially pancreatic pseudocyst were found in HQD group than in control group. Notably, hemorrhage was not significantly alleviated in spite of antithrombotic properties of Salviae Miltiorrhizae.
Although Chinese herbal medicine is now widely used throughout the world, some herbal medicines have been associated with adverse effects and toxic effects [
In conclusion, HQD administrated per rectum and intragastrically or orally was well tolerable and did not increase the frequency of hemorrhage or adverse effects, at least in the short term. Therefore, application of HQD was effective, safe, and economic for reduction of complication, for early recovery from systemic inflammation, and for promoting earlier rehabilitation from SAP, though the precise mechanisms of therapeutic effects of HQD on patients required further exploration. Because of the retrospective nature and the small sample size, further prospective study with large sample size is needed to confirm the results of our study.
The authors declare that they have no conflict of interests.
Chao Hui Ji and Li Qin Yao designed the study and wrote the paper; Wen Ming Feng and Cheng Wu Tang conducted patients’ management and monitoring; Ying Bao provided the collection of all of the human material in addition to providing financial support for this work.