疏肝和胃法治疗慢性非萎缩性胃炎的临床研究

发布时间：2018-01-19 06:25

本文关键词： 慢性非萎缩性胃炎肝胃不和痞满临床疗效　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：慢性非萎缩性胃炎是指由多种病因所引起的胃黏膜的慢性炎症,具有发病率高、病情缠绵难愈的特点,临床多表现为上腹部隐痛和(或)饱胀不适、暖气、反酸、呃逆、恶心、消瘦等症状。当今社会生活、工作压力大,多数患者常因情绪刺激导致病情反复,影响生活质量,在疾病进展的后期,随着胃粘膜固有腺体萎缩及肠腺的化生,少数可进一步发展成慢性萎缩性胃炎,甚至发生癌变。可见该病不仅长期困扰患者日常生活,在疾病进展后期也会对患者的生命安全构成严重的危害,因此如何改善患者临床症状,提高生活质量是治疗该病的重中之重,中医药特色疗法在治疗该病上优势明显,疗效显著,本研究旨在探索疏肝和胃法治疗此类疾病的临床价值。目的:通过治疗前后患者中医证候积分及慢性胃炎PRO量表各领域积分的变化,探讨疏肝和胃法治疗慢性非萎缩性胃炎的临床疗效,为进一步的临床应用及推广提供依据。方法:选择2016年2月一 2017年1月间在广东省中西医结合医院门诊及住院部就诊,经胃镜检查确诊为慢性非萎缩性胃炎,中医辨证为痞满肝胃不和型,符合入选标准及排除标准的患者70例。随机分为治疗组(疏肝和胃法组)和对照组(多潘立酮组),每组各35例。治疗组:以柴枳和胃汤口服治疗,每日1剂,分早餐后和晚餐后两次温服;对照组:多潘立酮,10mg 口服每日3次,治疗疗程均为2周。分别记录所有入组人员治疗前后中医证候积分、慢性胃炎PRO量表评分。对所有资料作详细记录并分析其临床疗效。结果:1.研究开始前对两组患者在入组年龄、性别、受教育程度等一般情况、中医证候积分、生存质量各领域积分进行比较,两组间的差异无统计学意义(P0.05),说明治疗前两组一般情况具有可比性。2.临床总疗效评价:疗程结束后,治疗组共纳入34例,痊愈10例,显效12例,有效8例,无效4例,总有效率88.24%;对照组共纳入33例,痊愈5例,显效4例,有效13例,无效11例,总有效率66.67%。经治疗后两组患者疗效分级经两独立样本非参数检验(秩和检验)及Fisher卡方检验,差异均有统计学意义(P0.05),治疗组疗效优于对照组。3.中医证候积分:通过治疗后,治疗组和对照组中医证候积分均有改善(P0.01),对两组治疗后中医证候积分和治疗前后积分差值进行比较,治疗组对肝胃不和型中医证候改善优于对照组,差异具有统计学意义(P0.05)。4.PRO量表积分:治疗组和对照组经治疗后在生存质量生理领域、独立性领域、心理领域、环境领域四个领域方面均较治疗前有缓解(P0.01),对生理领域及心理领域治疗后评分、治疗前后评分差值进行比较,两组差异具有统计学意义(P0.05),而在独立性领域及环境领域方面,治疗后的评分及治疗前后的评分差值比较无统计学意义(P0.05)。5.两组患者服药期间均未发生不良事件。结论:运用疏肝和胃法治疗肝胃不和型慢性非萎缩性胃炎疗效满意,改善临床证候疗效优于多潘立酮,该方可以改善患者的生存质量,其中在生理领域及心理领域方面治疗作用优于多潘立酮。两组患者在治疗过程未发生不良事件,提示疗效安全、显著,可供临床参考。
[Abstract]:Chronic non atrophic gastritis is a chronic inflammation caused by various etiological factors of gastric mucosa, with a high incidence, characteristics of disease lingering, clinical symptoms were abdominal pain and (or) distention, heating, acid reflux, hiccups, nausea, weight loss and other symptoms. In today's social life, work pressure a large majority of patients, often due to emotional stimuli leading to repeated illness, affecting the quality of life, in the late stage of disease progression, with gastric mucosa gland atrophy and intestinal gland metaplasia, few can further develop into chronic atrophic gastritis, and even cancer. The disease is not only long plagued the daily life of patients with disease progression, in the late stage may constitute a serious harm to the life safety of patients, so how to improve clinical symptoms, improve the quality of life is the priority among priorities of the treatment of the disease, the characteristics of traditional Chinese medicine therapy in the treatment of the disease have obvious advantages, curative effect, The purpose of this study was to explore the clinical value of Shuganhewei therapy for this disease. Objective: through changes before and after treatment of TCM syndrome in patients with chronic gastritis score and PRO scale in all areas of integration, to explore the clinical effect of Shuganhewei therapy for chronic non atrophic gastritis, provide the basis for further clinical application and promotion. Methods: a February 2016 January 2017 in Guangdong Province Traditional Chinese medicine hospital outpatient and inpatient treatment, diagnosed by endoscopy for chronic non atrophic gastritis, syndrome of incoordination between the liver and stomach fullness, met the inclusion criteria and 70 patients. In addition to the standard were randomly divided into treatment group (Shuganhewei group) and the control group (domperidone group), 35 cases in each group. The treatment group were treated with CHAIZHI and Stomach Decoction, 1 dose daily, divided after breakfast and after dinner two times / day; control group: domperidone, 10mg orally 3 times a day, treatment The process for 2 weeks. All subjects were recorded before and after treatment of TCM syndrome, chronic gastritis PRO scale. To make a detailed record of all data and analyze its clinical curative effect. Results: 1. study before the start of the two groups of patients in the group of age, gender, education level, general situation of traditional Chinese medicine the syndrome integral, the integral quality of life in all areas were compared, there was no significant difference between the two groups (P0.05), indicating the two groups before treatment, generally comparable.2. total clinical efficacy evaluation: after the end of treatment, the treatment group included 34 cases, 10 cases were cured, 12 cases markedly effective, effective in 8 cases, 4 cases were invalid, the total efficiency of 88.24%; the control group included 33 cases, 5 cases were cured, 4 cases were cured, 13 cases effective, 11 cases ineffective, the total efficiency of 66.67%. after treatment in patients with grade two groups by two independent samples nonparametric test (Wilcoxon test) and Fisher chi square test, have statistical difference The significance of.3. (P0.05), the control group of TCM syndromes curative effect in treatment group than: after the treatment, the treatment group and the control group of TCM syndrome score were improved (P0.01), comparison of the two groups after treatment before and after treatment of TCM syndrome integral and the integral of the treatment group than the control group of Chinese medicine liver stomach disharmony the improvement in the symptoms, the difference was statistically significant (P0.05).4.PRO scores: treatment group and control group after treatment in the quality of life in the physiological field, psychological field independence, field, four field of environmental field was significantly higher than before treatment (P0.01), alleviate the score in the treatment of physical and psychological domain after treatment after the score difference comparison, with significant difference between two groups (P0.05), and independence in the field and environment field, score difference scores before and after treatment and after treatment, there is no statistical significance (P0.05).5. two group service There were no adverse events during the treatment. Conclusion: the curative effect of Shuganhewei Decoction in treating liver stomach disharmony chronic non atrophic gastritis, improve clinical syndromes curative effect is better than domperidone, the prescription can improve the quality of life of patients, the treatment in the physical domain and psychological effect is better than domperidone. Two groups of patients in the treatment process no adverse events, clinical safety tips, significantly, for clinical reference.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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