中药分阶段论治慢性乙型重型肝炎的临床研究

发布时间：2019-03-27 19:58

【摘要】：目的：观察分析中药分阶段论治慢性乙型重型肝炎的临床疗效。方法：选取符合标准的慢性乙型重型肝炎患者44例(早、中期),随机分为对照组22例(脱落2例),治疗组22例。对照组采用西医治疗,而治疗组在西医治疗的基础上加用中药治疗。中药治疗组采用分阶段论治法：前期着重“攻邪”,后期着重“扶正”并兼以“祛邪”。中药均采用口服、灌肠、静滴3个途径给药。前阶段(一般为2周)重用清热解毒凉血化瘀中药,口服方以本院的肝毒清颗粒为基础方加减,灌肠方为大承气汤,静滴方为丹参及清开灵注射液。后阶段采用扶正补虚方法治疗。补虚时重视温阳扶正法的运用。①阴虚患者：口服方为六味地黄丸合增液汤加减,灌肠方为增液承气汤,静滴方为生脉注射液和丹参注射液,②阳虚患者：茵陈术附汤加入肉桂、干姜、黄芪、白术等温补重剂,灌肠方为温脾汤加减,静滴方为参附注射液,③中间组(未表现出明显的阴虚或阳虚的患者),口服方以肝毒清为基础方减少清热凉血药加入桂枝、茴香、白术、淫羊藿、巴戟天等温补平剂,灌肠方采用小承气汤加入附片(少量)、干姜、当归,而静滴方为参麦注射液。疗程为4周,疗程结束后,对比治疗组和对照组的生化指标变化情况(如总胆红素、凝血酶原活动度、白蛋白等)、总有效率和症状改善情况,对临床疗效做出分析和评价。结果：①疗程结束后,治疗组显效7例,有效11例,无效4例,无效包括病死1例,总有效率81.8%,总体生存率95.5%。对照组显效4例,有效7例,无效9例,无效包括病死1例,总有效率55.0%,总体生存率95.0%。两组综合有效率对比差异无统计学意义(P0.05)。②疗程结束后,治疗组凝血酶原活动度(PTA)、总胆红素(TBIL)的改善程度优于对照组,差异具有统计学意义(P0.05)；而白蛋白(ALB)、谷丙转氨酶(ALT)、谷草转氨酶(AST)的改善对比无明显差异(P0.05)。③疗程结束后,治疗组中身软乏力、饮食减少、便溏或便干结症状好转率高于对照组,差异具有统计学意义(P0.05)。而口干口苦、恶心呕吐、脘腹胀满的症状改善差异无统计学意义。结论：分阶段中西结合论治慢性乙型重型肝炎是有效治疗慢性乙型重肝炎的方法,治疗该病时应注重病人之虚,不必担心闭门留寇,越补而毒邪越炽。补中应重视温补。
[Abstract]:Objective: to observe and analyze the clinical efficacy of traditional Chinese medicine (TCM) in treating chronic severe hepatitis B in stages. Methods: 44 patients with chronic severe hepatitis B (early and middle stage) were randomly divided into control group (n = 22) and treatment group (n = 22). The control group was treated with western medicine, while the treatment group was treated with traditional Chinese medicine on the basis of western medicine treatment. The treatment group was divided into two groups: "attacking evil spirits" in the early stage and "strengthening the positive" in the later stage and "removing evil spirits" at the same time. All of them were given orally, enema and intravenous drip. The former stage (usually 2 weeks) reused the traditional Chinese medicine of clearing heat, detoxification, cooling blood circulation and removing blood stasis. The oral prescription was based on the Gan du Qing granule of our hospital, the enema prescription was Dachengqi decoction, and the intravenous drip prescription was Danshen and Qingkailing injection. The later stage was treated with Fuzheng tonifying deficiency method. 1 Yin deficiency patients: the oral prescription for Liuwei Dihuang pill combined with Zengye decoction, enema for the liquid Chengqi decoction, intravenous drip for Shengmai injection and salvia miltiorrhiza injection, the patient with Yin deficiency: oral prescription for Liuwei Dihuang pills combined with Zengye decoction, enema prescription for Zengliu Chengqi decoction, (2) Yang deficiency patients: Yin Chen Shu Fu Tang added cinnamon, dried ginger, astragalus membranaceus, and Atractylodes et al., the enema prescription was Wenpi decoction, the intravenous drip prescription was Shenfu injection, and the middle group (the patients without obvious deficiency of yin or yang), the middle group (without obvious deficiency of yin or yang). Oral prescription is based on Gan du Qing to reduce heat and cool blood by adding Guizhi, fennel, Atractylodes, Herba Epimedium, Euphorbia officinalis Isothermal tonifying Agent, enema recipe with Xiaochengqi decoction (small amount), dried ginger, Angelica sinensis, and intravenous drip prescription for Shenmai injection. After the course of treatment was 4 weeks, the changes of biochemical indexes (such as total bilirubin, prothrombin activity, albumin, etc.), total effective rate and symptom improvement were compared between the treatment group and the control group, and the clinical efficacy was analyzed and evaluated. Results: after 1 course of treatment, the treatment group was effective in 7 cases, effective in 11 cases, ineffective in 4 cases, including 1 case died of disease, the total effective rate was 81.8%, the overall survival rate was 95.5%. In the control group, 4 cases were effective, 7 cases were effective, 9 cases were ineffective, including 1 case died of disease, the total effective rate was 55.0%, and the overall survival rate was 95.0%. There was no significant difference in the comprehensive effective rate between the two groups (P0.05). After the end of the course of treatment, the improvement of prothrombin activity (PTA), total bilirubin (TBIL) in the treatment group was better than that in the control group, and the difference was statistically significant (P0.05). There was no significant difference in the improvement of albumin (ALB), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST) (P0.05). After 3 courses of treatment, the body weakness and diet decreased in the treatment group. Loose stool or stool dry knot symptom improvement rate was higher than the control group, the difference was statistically significant (P0.05). But dry mouth bitter, nausea and vomiting, abdominal distension symptom improvement has no statistical significance. Conclusion: the treatment of chronic severe hepatitis B by combination of Chinese and western medicine in stages is an effective method for treating chronic severe hepatitis B. in the treatment of this disease, we should pay attention to the deficiency of the patient, do not have to worry about leaving invaders behind closed doors, and the more replenishing the poison and evil, the more incandescent the toxin and evil. Attention should be paid to warming up in the process of tonifying.
【学位授予单位】：泸州医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.62

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