护膜生肌散联合质子泵抑制剂治疗消化性溃疡的临床疗效观察

发布时间：2018-05-31 13:18

本文选题：护膜生肌散 + 泮托拉唑　；参考：《南京中医药大学》2014年硕士论文

【摘要】：目的：观察护膜生肌散联合质子泵抑制剂治疗消化性溃疡的临床治疗效果,并从理论与临床研究两方面系统的探讨护膜生肌散的作用机理。方法：选择2013年1月-2013年7月江苏省第二中医院消化内科门诊治疗的59例消化性溃疡病例,所有病例在我院确诊为消化性溃疡,按照患者就诊顺序随机分为观察组和对照组,观察组30例,对照组29例。其中对照组患者给予泮托拉唑40mg静滴BID 10天,后改雷贝拉唑 10mg BID口服6周。观察组在对照组基础上给予导师经验方护膜生肌散治疗,五味子粉、三七粉、白芨粉、山药粉、煅乌贼骨粉,上方每药2g共l0g研粉后每次10g每天服用3次。所有测量结果采用SPSS17.0进行统计分析。比较两组治疗前后综合治疗效果,胃镜治疗效果,中医症候总积分和溃疡面积大小变化情况,比较治疗前后两组中医症候各项积分变化情况,对两组患者进行随访1年,观察两组6个月和12个月溃疡复发情况。观察治疗期间两组患者出现的服药不良反应和安全性评价。结果：(1)观察组中医证候疗效总有效率为93.33%,对照组为65.52%,组间对比差异有统计学意义(P0.05)。(2)观察组胃镜治疗总有效率为86.67%；对照组治疗总有效率为62.07%,组间对比差异有统计学意义(P0.05)。(3)观察组治疗后中医证候评分(7.43±1.24)分,溃疡面积大小(19.89±6.75)mm2；对照组治疗后中医证候评分(9.89±2.31)分,溃疡面积大小(34.03±10.95)mm2,组间对比差异有统计学意义(P0.05)。(4)对中医症状从胃脘部疼痛、脘腹胀满、暖气呃逆、纳差食少、情绪抑郁或者烦躁易怒、胸闷、乏力倦怠和大便溏薄8个项目进行观察,两组治疗后各项症状评分均低于治疗前,经统计学分析差异有统计学意义(P0.05)。观察组治疗后中医症状各项评分低于对照组,组间对比差异有统计学意义(P0.05)。(5)对两组患者随访1年,采用胃镜评定患者治疗后复发情况,其中观察组6个月复发率为6.67%,对照组6个月复发率为27.59%；观察组12个月复发率为26.67%,对照组12个月复发率为51.72%,组间对比差异有统计学意义(P0.05)。(6)两组患者治疗期间均未发生不良反应。结论：本课题研究提示了中西医结合治疗消化性溃疡的效果优于单纯西药治疗,护膜生肌散可以明显的改善消化性溃疡患者各项临床体征,减轻患者的痛苦,提高患者生活质量；该方的作用机制可能是通过提高消化性溃疡患者免疫功能,增强胃黏膜屏障保护能力与上皮细胞再生功能；根除幽门螺旋杆菌增加了胃黏膜前列腺素合成保护胃黏膜受到胃酸的侵蚀,能够增加胃黏膜循环、灌注促进了患者机体的能量代谢,保证粘膜上皮与溃疡的底部及边缘迅速增生保证粘膜微循环酸碱平衡,提高了溃疡的愈合效果,降低了溃疡的复发情况。通过中医药优势更好地开展中西医结合治疗,优化临床消化性溃疡治疗方案,降低了临床复发率,促进了中医药学术水平发展并改善国人健康卫生水平。
[Abstract]:Objective: to observe the clinical effect of HuimenshengmySan combined with proton pump inhibitor in the treatment of peptic ulcer. Methods: 59 cases of peptic ulcer were selected from the outpatient department of Department of peptic Medicine, second traditional Chinese Medicine Hospital of Jiangsu Province from January 2013 to July 2013. All the cases were diagnosed as peptic ulcer in our hospital. The patients were randomly divided into observation group and control group. There were 30 cases in the observation group and 29 cases in the control group. Patients in the control group were given pantazol 40mg intravenously for 10 days and then treated with rabeprazole 10mg BID for 6 weeks. The observation group was treated with Schisandra powder, Panax notoginseng powder, Bletilla striata powder, mountain medicine powder and calcined squid bone powder on the basis of experimental group. All the measured results were analyzed by SPSS17.0. The effects of comprehensive treatment, gastroscopy, the total score of TCM symptom and the area of ulcer were compared between the two groups before and after treatment. The patients in the two groups were followed up for 1 year. The recurrence of ulcer was observed at 6 and 12 months in both groups. Adverse drug reactions and safety evaluation were observed in the two groups during treatment. Results the total effective rate of TCM syndromes in the observation group was 93.33 and that in the control group was 65.52. The difference between the two groups was statistically significant (P 0.05). The total effective rate of the observation group was 86.677.The total effective rate of the control group was 62.07, and the difference between the two groups was statistically significant. Significance: P0.05A) after treatment, the TCM syndrome score of the observation group was 7.43 卤1.24). The area of ulcer was 19.89 卤6.75 mm ~ 2, the score of TCM syndromes was 9.89 卤2.31) and the area of ulcer was 34.03 卤10.95 mm ~ (2) in the control group. The difference between the two groups was statistically significant (P < 0.05). Eight items of depression or irritability, chest tightness, fatigue, fatigue and loose stool were observed. After treatment, the scores of symptoms in the two groups were lower than those before treatment, and the difference was statistically significant (P 0.05). After treatment, the scores of TCM symptoms in the observation group were lower than those in the control group, and the difference between the two groups was statistically significant (P 0.05). The patients in the two groups were followed up for one year. The recurrence of the patients after treatment was assessed by gastroscopy. The recurrence rate was 6.67 in the observation group and 27.59in the control group, 26.67 in the observation group and 51.72 in the control group. Conclusion: this study indicates that the effect of integrated traditional Chinese and western medicine in the treatment of peptic ulcer is better than that of western medicine alone, and the clinical signs of peptic ulcer patients can be obviously improved and the pain of peptic ulcer can be alleviated. The mechanism of the prescription may be to improve the immune function of patients with peptic ulcer and enhance the ability of gastric mucosal barrier protection and epithelial cell regeneration. Eradication of Helicobacter pylori increased prostaglandin synthesis in the gastric mucosa to protect gastric mucosa from gastric acid erosion, increased gastric mucosal circulation, and increased energy metabolism in the patient's body. To ensure the rapid proliferation of mucosal epithelium and the bottom and edge of ulcer, to ensure the mucosal microcirculation acid-base balance, to improve the healing effect of ulcer, and to reduce the recurrence of ulcer. Through the advantage of traditional Chinese medicine, the combination of traditional Chinese medicine and western medicine can improve the treatment of peptic ulcer, reduce the rate of clinical recurrence, promote the development of academic level of traditional Chinese medicine and improve the health level of Chinese people.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R573.1

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