新加坡胃食管反流病的证候规律和辨证治疗临床研究

发布时间：2018-02-28 09:59

本文关键词： 胃食管反流病新加坡中医证候相关因素辨证治疗临床疗效　出处：《南京中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:通过回顾性病例分析,进行新加坡流行病学调查,归纳胃食管反流病的证候分布规律,并找出与证候的相关因素,探讨发病的病因病机和病程的演变,为中医的临床辨证治疗提供参考。通过临床病例资料的收集,观察中医辨证分型治疗胃食管反流病的有效性,研究中医药的临床思路,探讨新加坡病人群的规范化与个体化的治疗方案。方法:收集505例胃食管反流病患者的病例资料,根据中医四诊信息辨证分型,建立数据库,运用SPSS统计方法,总结胃食管反流病的证候规律,分析其与多种因素之间的相关性;分析结果运用于临床治疗44例患者,入选患者已经PPI治疗3个月以上并停药后再复发者,主要症状烧心、胸痛、反酸、反食症状以RDQ问卷症状积分,其他与反流相关的症状用中医证候积分,进行治疗前与治疗后比较,口服中医颗粒8周,1天14-16克,日2次服用,观测点分别为0周、2周、4周、8周,在完成8周治疗后,评价临床疗效。治疗结束,进行停药1月、3月的随访,观察远期疗效。结果:本组研究资料的发病年龄以50-69岁为最多,病程在1年内最多,发病因素以饮食因素、情志因素最常见,常见的前10位症状包括反酸、嗳气、上腹部胀满、咽部症状、口干、烧心、胸骨后疼痛、嘈杂、上腹部灼热感、口苦,常见的舌象为舌淡红,薄白苔,常见脉象为弦脉或细脉。证型比例肝胃郁热证肝胃不和证中虚气逆证痰湿内阻证阴虚胃热证气滞血瘀证。证型进行了多元逐步Logisitic回归分析显示,肝胃不和证与病程相关;肝胃郁热证与情志因素有关;中虚气逆证的相关因素有病程、情志因素;痰湿内阻证的相关因素也是与情志因素相关。在临床治疗的44病例中,临床痊愈1例(2.27%)显效21例(47.73%),有效18例(40.91%),无效4例(9.09%),。总有效率为90.91%。针对症状为烧心、反酸、胸骨后疼痛、胃内容物上涌以RDQ问卷进行症状积分计算,治疗后明显下降,非典型的反流症状和其他全身症状中医证候积分,治疗后也明显下降,差异具有统计学意义(P0.01)。停药后进行远期疗效的观察,症状积分较治疗前降低不到50%者,或RDQ量表问卷12分者定为复发,在44病例中,停药1月复发有3例,3月后复发有8例,共有11例,复发率为27.50%,无复发为72.50%,远期疗效理想。结论:胃食管反流病以胃失通降,脾失升清,气机升降失常为主要病机,涉及脏腑与脾胃、肝胆、肺相关,与肝最为密切,病理因素以气滞、郁热、痰湿、血瘀等为标,初病多以气病为主,实证多见,久病脾胃虚损,中虚气逆而发病,因虚致实虚实夹杂的病理演变,临床以辨证分型治疗,辨证与辨病相结合,疗效良好,远期疗效理想,是适合新加坡病人群的治疗方案。
[Abstract]:Objective: to investigate the epidemiology of gastroesophageal reflux disease (GERD) in Singapore by retrospective case analysis, and to find out the related factors of GERD, and to explore the etiology, pathogenesis and evolution of disease course. To provide a reference for the clinical treatment of TCM. Through the collection of clinical case data, to observe the effectiveness of TCM syndrome differentiation in the treatment of gastroesophageal reflux disease, and to study the clinical thinking of TCM. Methods: the data of 505 patients with gastroesophageal reflux disease were collected. According to the information of four diagnosis of TCM, the database was established and the SPSS statistical method was used. The syndromes of gastroesophageal reflux disease (GERD) were summarized, and the correlation between GERD and various factors was analyzed. The results were applied to 44 patients who had been treated with PPI for more than 3 months. The symptoms of chest pain, acid regurgitation and regurgitation were scored by RDQ questionnaire, and other symptoms related to reflux were treated with TCM syndromes score. Before and after treatment, oral TCM granules were taken 14 to 16 grams per day for 8 weeks, twice a day. The observation points were 0 weeks, 2 weeks, 4 weeks and 8 weeks, respectively. After 8 weeks of treatment, the clinical efficacy was evaluated. After the treatment, the patients were followed up on January and March to observe the long-term effects. Results: the age of onset of this study was 50-69 years old. The first 10 common symptoms include acid regurgitation, belching, upper abdominal bloating, pharynx, dry mouth, heartburn, back sternum pain, noise, upper abdominal burning. Bitter mouth, common tongue for the tongue red, thin white fur, The common pulse pattern was chord pulse or vein.Syndromes proportion of liver and stomach stagnation heat syndrome liver stomach stagnation syndrome liver stomach disharmony syndrome phlegm dampness internal obstruction syndrome yin deficiency stomach heat syndrome qi stagnation blood stasis syndrome. Multiple stepwise Logisitic regression analysis showed that liver and stomach disharmony syndrome was related to the course of disease. The related factors of syndrome of stagnation of heat of liver and stomach were related to emotion factors; the related factors of syndrome of deficiency of qi and inverses of qi were course of disease, factors of emotion, and factors of internal obstruction of phlegm and dampness were also related to factors of emotion. In 44 cases of clinical treatment, 44 cases were treated with phlegm and dampness. The total effective rate was 90.91.The total effective rate was 90.91.The total effective rate was 90.91.The total effective rate was 90.91.The symptoms were heartburn, acid regurgitation, poststernal pain, stomach contents upwelling with RDQ questionnaire to calculate the symptom score, which was significantly decreased after treatment. The scores of TCM syndromes of atypical reflux symptoms and other systemic symptoms also decreased significantly after treatment, and the difference was statistically significant (P 0.01). In 44 cases, there were 3 cases of recurrence in January and 8 cases of recurrence after March, with a recurrence rate of 27.50 and no recurrence rate of 72.50. Conclusion: gastroesophageal reflux disease is reduced by gastric loss. The main pathogenesis of spleen lost clear, Qi Qi ascending and descending disorder is the main pathogenesis, involving viscera and spleen and stomach, liver and gallbladder, lung, and liver are most closely related, pathological factors are Qi stagnation, stagnation of heat, phlegm and dampness, blood stasis, etc., the primary diseases are mainly qi diseases, and empirical evidence is more common. Because of the pathological evolution of deficiency caused by deficiency of deficiency and deficiency of qi, clinical treatment with syndrome differentiation and syndrome differentiation combined with disease differentiation has good curative effect and ideal long-term curative effect, which is suitable for the treatment of Singaporean disease.
【学位授予单位】：南京中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R259

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