加味补中益气汤联合西药治疗老年反流性食管炎的临床研究

发布时间：2018-05-01 02:09

本文选题：加味补中益气汤 + 老年人　；参考：《湖北中医药大学》2014年硕士论文

【摘要】：目的本临床研究旨在探讨加味补中益气汤联合西药治疗老年反流性食管炎的临床疗效及药物安全性，为临床治疗老年反流性食管炎提供理论依据，以便更好为老年患者健康服务。方法病例全部选自2012年8月至2013年10月在湖北省武汉市中西医结合医院消化内科及中医部名医堂门诊就诊的患者，符合反流性食管炎西医诊断标准，中医辨证为中虚气逆型患者共70例，依据患者就诊时间随机分为对照组及治疗组各35例。对照组，给予常规西药治疗：奥美拉唑肠溶胶囊（彼司克）20mg，口服，1/日，嗳气、腹胀或反流明显患者加服枸橼酸莫沙必利片(加斯清)，5mg，口服，3/日。治疗组：在对照组的基础上加服加味补中益气汤，1包（采用湖北省武汉市第一医院中药煎药室自制包装，每包中药药汁约200ml），口服，2/日。两组患者治疗总周期均为8周。观察两组患者治疗前后的临床综合疗效、临床表现改善情况、胃镜下食管粘膜改善情况、生活质量表各维度积分改善情况、3个月随访复发率及药物安全性。结果两组患者均进行8周的临床治疗后其临床试验结果： 1.治疗组临床综合疗效优于对照组：对照组患者痊愈7例，显效10例，有效11例，无效7例，总有效率为80.00%；而治疗组患者痊愈13例，显效12例，有效7例，无效3例，总有效率为91.43%。两组临床综合疗效比较经统计学处理，P＜0.05，差异有统计学意义。 2.中医证候积分情况：两组患者治疗后反酸、胃脘隐痛症候积分改善无显著差异，P＞0.05；其他中医证候积分改善情况治疗组优于对照组，P＜0.05，，有显著性差异，有统计学意义。 3.主要临床表现改善情况：两组患者在反酸、烧心及非心性胸痛三个方面治疗效果基本相当，P＞0.05；而在改善泛吐清涎、嗳气及呃逆症状方面，治疗组效果优于对照组，P＜0.05，有统计学意义。 4.胃镜下食管粘膜改善情况：对照组食管粘膜正常7例，Ⅰa级5例，Ⅰb级9例，Ⅱ级11例，Ⅲ级4例，痊愈率为20.00%；治疗组食管粘膜正常13例，Ⅰa级8例，Ⅰb级6例，Ⅱ级6例，Ⅲ级2例，痊愈率为37.14%。经统计学分析，P＜0.05，治疗组治愈率优于对照组，有统计学意义。 5.生活质量改善情况：采用SF-36生活质量调查表评分比较，治疗后两组生理功能、躯体疼痛评分比较，P＞0.05，两组治疗效果无明显差异，无统计学意义。而其他各维度积分比较P＜0.05，差异有统计学意义。 6.随访3个月复发率及药物安全性评价情况：对照组的复发率63.33%，治疗组为41.94%，两者之间比较经统计学处理：P＞0.05，但治疗组复发率低于对照组；药物安全性评价：对照组有7例出现恶心、头晕，排除其他危险因素后继续予以服药至治疗周期结束，停药后上述症状未再出现。治疗组有4名出现轻度呕吐，予以对症处理症状消失后继续服用未出现其他不适。结论加味补中益气汤治疗老年反流性食管炎（中虚气逆型）的临床疗效满意，能有效改善老年患者的临床症状，提高其生活质量，降低复发率。本次临床试验证实在改善患者临床表现、食管粘膜及复发率等方面上，加味补中益气汤联合西药治疗老年反流性食管炎效果优于单纯西药治疗，且不良反应少，临床安全性较高，值得临床参考运用。
[Abstract]:objective
This clinical study aims to explore the clinical efficacy and drug safety of Jiawei Bu Zhong Yiqi Decoction Combined with western medicine in the treatment of reflux esophagitis in the elderly, and to provide a theoretical basis for the treatment of reflux esophagitis in the elderly so as to better serve the health of the elderly.
Method
All cases were selected from August 2012 to October 2013 in the outpatient of the Department of Gastroenterology and the famous medical Hall of the Ministry of traditional Chinese medicine in Wuhan, Hubei province. The patients were in accordance with the standard of Western medicine for reflux esophagitis. The TCM syndrome was divided into 70 patients with middle asthenia gas inverse type. The patients were randomly divided into the control group and the treatment group (35 cases each) according to the patient's time. Group, give routine western medicine treatment: Omeprazole Enteric-coated Capsules (Peter) 20mg, oral, 1/ day, belching, abdominal distention or reflux patients with Mosapride Citrate Tablets (Garth Qing), 5mg, orally, 3/ day. Treatment group: on the basis of the control group, add flavored Tonifying Qi Yiqi Decoction, 1 packets (using Chinese medicine in Wuhan No.1 Hospital of Hubei province decoction medicine) Room self-made packaging, each package of Chinese medicine juice about 200ml), oral, 2/ day, two groups of patients with a total period of 8 weeks of treatment, observe the clinical comprehensive efficacy of the two groups of patients before and after treatment, the improvement of clinical manifestation, the improvement of the esophagus mucosa under gastroscope, the improvement of the quality of life scales in all dimensions, the recurrence rate of 3 months and the safety of medicine.
Result
Two groups of patients were treated for 8 weeks after clinical treatment.
1. in the treatment group, the clinical comprehensive effect was better than the control group: the patients in the control group were cured 7 cases, effective 10 cases, effective 11 cases, invalid 7 cases, the total effective rate was 80%, and the treatment group cured 13 cases, 12 cases, effective 7 cases, 3 cases invalid, the total effective rate was 91.43%. two clinical comprehensive therapeutic effect comparison after statistical treatment, P < 0.05, the difference has statistical significance. Righteousness.
2. TCM syndrome score: two groups of patients after treatment anti acid, gastric epigastric pain syndrome score improvement no significant difference, P > 0.05; other TCM syndrome score improvement treatment group is better than the control group, P < 0.05, there are significant differences, there is statistical significance.
3. the main clinical manifestations of improvement: two groups of patients in the treatment of acid, heart and non heart pain three aspects of the basic treatment effect is basically equal, P > 0.05; and in improving the puke saliva, belching and hiccup symptoms, the effect of the treatment group is better than the control group, P < 0.05, there is statistical significance.
4. the improvement of esophagus mucosa under Gastroscope: 7 cases of normal esophageal mucosa, 5 cases of grade I, grade I 5, grade I B 9 cases, 11 cases of grade II, 4 cases of grade III, 20% of cure rate, 13 cases of normal esophagus mucosa, 8 cases of grade I, 6 cases of grade I, 6 cases of grade I, 2 cases of grade III, P < 13, cure rate of treatment group is superior to control group. There is a statistical significance.
5. improvement of quality of life: compared with the SF-36 quality of life questionnaire, two groups of physiological functions and somatic pain scores were compared, P > 0.05, and there was no significant difference in the treatment effect between the two groups, and the scores of other dimensions were compared to P < 0.05, the difference had statistical significance.
6. the recurrence rate of 3 months and the evaluation of drug safety: the recurrence rate of the control group was 63.33% and the treatment group was 41.94%. The comparison between the two groups was statistically treated: P > 0.05, but the recurrence rate of the treatment group was lower than that of the control group; the safety evaluation of the treatment group: the control group had 7 cases of nausea and dizziness, and the other risk factors were excluded and continued taking the medicine after excluding the other risk factors. At the end of the treatment cycle, the symptoms were not reappeared after the withdrawal of the drug. In the treatment group, 4 had mild vomiting.
conclusion
The clinical efficacy of Jiawei Bu Zhong Yiqi Decoction in the treatment of reflux esophagitis (middle Asthenia Type) is satisfactory. It can effectively improve the clinical symptoms of the elderly, improve the quality of life and reduce the recurrence rate. This clinical trial verifies that the clinical manifestations of the patients, the esophageal mucosa and the recurrence rate are improved, and the combination of Tonifying Qi and replenishing qi and Western medicine is added to the treatment of the patients. The effect of elderly reflux esophagitis is better than that of Western medicine alone, with fewer adverse reactions and higher clinical safety. It is worthy of clinical reference.

【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】：2014
【分类号】：R571

【参考文献】