疏肝理气清热法联合奥美拉唑治疗肝胃郁热型非糜烂性胃食管反流病的临床观察

发布时间：2018-06-23 10:58

本文选题：非糜烂性胃食管反流病 + 肝胃郁热　；参考：《南京中医药大学》2017年硕士论文

【摘要】：研究目的探索总结导师治疗非糜烂性胃食管反流病(NERD)的经验,观察疏肝理气清热法联合奥美拉唑治疗肝胃郁热型NERD的临床疗效,证实中医辨证联合西药可短期内迅速改善NERD临床症状,并降低复发率,为推广中医治疗NERD提供临床依据,以推广其临床应用。研究方法选择60例符合纳入标准的NERD患者,随机分为中西医结合组20例、中药组20例和西药组20例,疗程4周,共两个疗程,中药组予中药协定方,西药组予奥美拉唑20mg口服bid,中西医结合组予中药协定方(同中药组)并予奥美拉唑(服用方法同西药组)。采取问卷方式,分别在治疗前、治疗4周后、治疗8周后填写耐信量表及中医证侯积分量表,通过SPSS软件分析比较三组疗效,并于停药8周时观察停药后复发情况,评价疏肝理气清热法治疗NERD的临床疗效。研究结果1.综合疗效比较:三组治疗4周后中西医结合组和西药组综合疗效明显好于中药组(P0.05),8周后三组综合疗效无明显差异(P0.05)。2.在改善临床症状方面:中西医结合组及中药组均可有效改善NERD各临床症状(P0.01);西药组对胃脘痞胀、心烦易怒、大便秘结改善不明显(P0.05),对反酸、烧心、暖气、咽部异物感、胸闷胸痛、口干口苦、两胁胀满可显著改善(P0.01)。三组在用药4、8周后,嗳气、咽部异物感、胸闷胸痛、两胁胀满症状积分无明显差异,疗效相当(P0.05);对于反流、烧心症状,中西医结合组、西药组在治疗4周后和中药组比较,症状积分明显下降,有统计学差异(P＜0.05),而在治疗第8周后,三组间症状积分比较无统计学意义(P0.05);在口干口苦、大便秘结方面,中西医结合组、中药组在用药4、8周后疗效均较优于西药组(P＜0.05);在胃脘痞胀、心烦易怒症状上,中西医结合组在用药第4、8周时疗效均优于另外两组(P＜0.05)。3.在改善耐信量表积分方面:三组治疗4、8周后积分均显著降低(P0.01);治疗4周后中西医结合组与西药组反流、烧心积分均较中药组低(P0.05),胸骨后疼痛、反食积分三组疗效无差异(P0.05)。治疗8周后三组疗效相当(P0.05)。4.远期疗效比较:中西医结合组有2例复发,中药组有2例复发,西药组有9例复发,中西医结合组及中药组复发率较西药组低,远期疗效好,有统计学差异(P0.05)。研究结论疏肝理气清热法联合奥美拉唑治疗NERD的综合疗效及远期疗效确切,值得进一步推广应用。
[Abstract]:Objective to explore the experience of tutor in the treatment of non-erosive gastroesophageal reflux disease (NERD), and to observe the clinical effect of soothing liver, regulating qi and clearing heat combined with omeprazole in the treatment of NERD with dampness of liver and stomach. It is proved that TCM syndrome differentiation combined with western medicine can quickly improve the clinical symptoms of NERD and reduce the recurrence rate in a short period of time. It provides a clinical basis for popularizing the treatment of NERD and popularizes its clinical application. Methods Sixty NERD patients who met the inclusion criteria were randomly divided into three groups: traditional Chinese medicine group (n = 20), traditional Chinese medicine group (n = 20) and western medicine group (n = 20). The western medicine group was given omeprazole 20mg orally, the traditional Chinese medicine agreement prescription (the same Chinese medicine group) and the omeprazole group (taking the method with the western medicine group). Questionnaires were used to fill out the credit tolerance scale and TCM syndromes integral scale before treatment, 4 weeks after treatment and 8 weeks after treatment respectively. The efficacy of the three groups was analyzed and compared by SPSS software, and the relapse after 8 weeks of withdrawal was observed. To evaluate the clinical effect of soothing liver, regulating qi and clearing heat on NERD. Results 1. Comprehensive efficacy comparison: the three groups after 4 weeks of treatment of integrated traditional Chinese and Western medicine group comprehensive efficacy was significantly better than the traditional Chinese medicine group (P0.05) 8 weeks after the three groups after the comprehensive efficacy of no significant difference (P0.05). 2. In terms of improving clinical symptoms: both the integrated Chinese and western medicine group and the traditional Chinese medicine group can effectively improve the clinical symptoms of NERD (P0.01); the western medicine group can effectively improve the symptoms of epigastric distension, irritability and irritability, and the improvement of the big constipation is not obvious (P0.05), and the foreign body sensation of regurgitation, heartburn, warm air and pharynx is not obvious in the western medicine group. Chest tightness and chest pain, dry mouth and bitter mouth, both side swelling can be significantly improved (P 0.01). After 4 weeks of medication, belching, foreign body sensation in pharynx, chest tightness and chest pain, and the integral score of the two hypochondriac fullness symptoms were not significantly different in the three groups (P0.05); for reflux, heartburn symptoms, the combination of traditional Chinese and western medicine group, western medicine group and traditional Chinese medicine group after 4 weeks of treatment compared with the traditional Chinese medicine group, The symptom score decreased significantly (P < 0.05), but after the 8th week of treatment, there was no significant difference between the three groups (P0.05), in the dry mouth bitter, big constipation, the combination of traditional Chinese and Western medicine group, The curative effect of the traditional Chinese medicine group was better than that of the western medicine group after 4 weeks (P < 0.05), and that of the traditional Chinese medicine group was better than that of the other two groups at the 8th week (P < 0.05), and the symptoms of stomach distension and irritability were better in the traditional Chinese medicine group than in the western medicine group at the 8th week (P < 0.05). After 4 weeks of treatment, the scores of the three groups were significantly lower than those of the traditional Chinese medicine group (P0.05), and the score of heartburn was lower than that of the traditional Chinese medicine group (P0.05). There was no difference in the curative effect among the three groups (P0.05). After 8 weeks of treatment, the efficacy of the three groups was similar (P0.05). 4. Comparison of long-term curative effect: there were 2 cases of recurrence in TCM group, 2 cases in TCM group and 9 cases in western medicine group. The recurrence rate of TCM group and TCM group was lower than that of western medicine group, and the long-term curative effect was better than that of western medicine group (P0.05). Conclusion the comprehensive and long-term curative effect of omeprazole combined with the method of soothing liver, regulating qi and clearing heat is definite and worthy of further application.
【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】：2017
【分类号】：R571

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