柴芩温胆汤联合西药治疗胃食管反流病胆热犯胃证的临床研究

发布时间：2018-04-03 00:11

本文选题：柴芩温胆汤　切入点：胆热犯胃证　出处：《湖北中医药大学》2016年硕士论文

【摘要】：目的本研究旨在通过观察柴芩温胆汤联合西药(雷贝拉唑肠溶片、枸橼酸莫沙必利片)治疗胃食管反流病(GERD)胆热犯胃证的临床疗效,对比单纯应用西药治疗胃食管反流病的效果,并从理论和临床研究两个方面探讨柴芩温胆汤治疗胃食管反流病胆热犯胃证的作用机制,为治疗胃食管反流病提供更好的方案。方法本研究选取60例就诊于武汉市中医院消化内科住院部及门诊患者,其中男性33例,女性27例,年龄处于25-70岁。病例均符合胃食管反流病西医诊断标准以及中医胆热犯胃证标准,按就诊顺序随机将60例病例分为治疗组和对照组,治疗组30例,包括男性16例、女性14例,其中反流性食管炎(RE)21例,非糜烂性反流病(NERD)9例;对照组30人,包括男性17例、女性13例,其中RE 24例,NERD 6例。两组患者经统计学分析后,年龄、性别、病程、治疗前症状积分及胃镜下积分差异无统计学意义(p0.05),具有可比性。对照组予以雷贝拉唑钠肠溶片(20mg早晚饭前口服)、枸橼酸莫沙必利片(5mg于3餐前口服);治疗组在对照组的基础上加用柴芩温胆汤联合治疗。柴芩温胆汤是笔者导师杨康主任应用多年的经验方(其组成为柴胡10g黄芩10g黄连6g法半夏10g陈皮15g茯苓30g甘草6g枳壳15g竹茹15g厚朴15g生姜10g大枣10g),水煎服,日1剂,早晚饭后温服,每次200ml,服药时间均为4周。观察两组病例治疗前后临床症状、体征等变化,4周为一个疗程,分别于治疗前及治疗后4周将患者症状发作的程度及频率登记并予以相应评分,RE患者于治疗一个疗程后复查胃镜,评估并比较两组患者的了临床疗效及胃镜下疗效。一个疗程结束后,用SPSS20.0统计软件对数据进行分析,计量资料采用t检验,计数资料采用χ2检验,等级资料采用秩和检验。结果两组药物对GERD均有一定的疗效,治疗组临床疗效总有效率为93.33%,RE患者内镜下总有效率为75.00%;对照组总有效率为81.00%,RE患者内镜下总有效率为70.83%;两组比较,治疗组临床疗效总有效率高于对照组,差异有统计学意义(p0.05),治疗组内镜下总有效率高于对照组,差异无统计学意义(p0.05)。在证候积分方面,治疗前后临床证候、内镜下积分两组均有较显著性的差异(p0.05),治疗组证候积分改善明显优于对照组,差异有统计学意义(p0.05),治疗组内镜下积分改善优于对照组,但差异无统计学意义(p0.05)。对于病程1年的患者,治疗组的治疗效果优于对照组,差异有统计学意义(p0.05)。结论柴芩温胆汤联合西药治疗胃食管反流病胆热犯胃证,比单用西药疗效显著,能够在很大程度上改善患者的临床症状,提高生活质量,为临床治疗GERD提供了良好的方法,值得在临床应用和推广。
[Abstract]:Objective to observe the clinical effect of Chaiqin Wendan decoction combined with western medicine (rabeprazole enteric-coated tablet, mosapride citrate tablet) in treating gastroesophageal reflux disease (GERD) with gallbladder heat invading stomach syndrome.The therapeutic effect of western medicine on gastroesophageal reflux disease was compared, and the mechanism of Chaiqin Wendan decoction in treating gastroesophageal reflux disease was discussed from two aspects of theory and clinical study, which provided a better scheme for the treatment of gastroesophageal reflux disease.Methods A total of 60 inpatient and outpatient patients, 33 males and 27 females, aged 25 to 70 years, were selected from the Department of Digestive Medicine, Wuhan traditional Chinese Medicine Hospital.60 cases were randomly divided into treatment group (n = 30) and control group (n = 30), including 16 males and 14 females.There were 21 cases of reflux esophagitis and 9 cases of non-erosive reflux disease, and 30 cases of control group, including 17 males and 13 females, including 24 cases of RE and 6 cases of NERD.After statistical analysis, there was no significant difference in age, sex, course of disease, symptom score before treatment and score under gastroscope between the two groups.The control group was treated with rabeprazole sodium enteric-coated tablets 20mg before meals and mosapride citrate 5mg before meals, while the treatment group was treated with Chaiqin Wendan decoction on the basis of the control group.Chaiqin Wendan decoction is an experienced prescription used for many years by our tutor Yang Kang (its composition is 10g of Radix Bupleurum 10g Scutellaria 10g Rhizoma Coptidis 10g old skin 15g Poria cocos 15g Fructus Glycyrrhiza 6g Fructus Aurantii 15g Fructus Glycyrrhiza 15g Magnolia officinalis 15g Ginger 10g Jujube 10g, water decoction, 1 dose per day.Morning and evening after meal warm, each time 200 ml, the medicine time is 4 weeks.The changes of clinical symptoms and signs before and after treatment were observed for 4 weeks as a course of treatment.The degree and frequency of symptom attack were registered before and 4 weeks after treatment, and the patients with RE were evaluated and compared after a course of treatment with gastroscopy.After a course of treatment, the data were analyzed by SPSS20.0 statistical software. T test was used to measure the data, 蠂 2 test was used for counting data, and rank sum test was used for rank data.Results the total effective rate of the treatment group was 93.33%, the total effective rate of the control group was 81.00%, the total effective rate of the control group was 81.00%, the total effective rate of the two groups was 75.00%, the total effective rate of the two groups was 75.00%, the total effective rate of the treatment group was 75.00%, and the total effective rate of the control group was 81.00%.The total effective rate in the treatment group was higher than that in the control group, and the difference was statistically significant (P 0.05). The total effective rate under endoscopy in the treatment group was higher than that in the control group, but the difference was not statistically significant (P 0.05).In the aspect of syndromes integral, there was significant difference between the two groups before and after treatment. The improvement of syndrome integral in the treatment group was better than that in the control group, and the difference was statistically significant (P 0.05). The improvement of the endoscopic integral in the treatment group was better than that in the control group.But the difference was not statistically significant (P 0.05).The therapeutic effect of the treatment group was better than that of the control group, and the difference was statistically significant (P 0.05).Conclusion Chaiqin Wendan decoction combined with western medicine is more effective than western medicine in treating gastroesophageal reflux disease, which can improve the clinical symptoms and quality of life to a great extent, and provide a good method for clinical treatment of GERD.It is worth applying and popularizing in clinic.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R571

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