温中健脾方联合马来酸曲美布汀治疗腹泻型肠易激综合征脾阳虚证的临床研究

发布时间：2018-06-30 03:15

本文选题：温中健脾方 + 马来酸曲美布汀　；参考：《湖北中医药大学》2014年硕士论文

【摘要】：【目的】观察温中健脾方联合马来酸曲美布汀治疗腹泻型肠易激综合征脾阳虚证的临床疗效，，并从理论和临床两个方面来系统探讨温中健脾方联合马来酸曲美布汀的作用机制。【方法】 1.选取湖北省中医院脾胃科2012年2月至2013年12月门诊患者66例，西医诊断均为腹泻型肠易激综合征，中医诊断均为泄泻（脾阳虚证型），将全部患者随机分为两组:治疗组34例和对照组32例，所有患者均在湖北省中医院行电子结肠镜检查，结果均无明显病理改变，血、尿、粪等常规体检项目结果均正常，符合西医学罗马Ⅲ标准中腹泻型IBS诊断标准，两组患者在性别、年龄、病程、病情、症状积分等方面没有明显统计学差别，具有可比性(P0.O5)。 2.处理:对照组:餐前口服马来酸曲美布汀分散片(浙江昂利康制药有限公司生产，商品名为尼为孚)每天三次，每次2片（每片100mg）;治疗组:在对照组基础上加用温中健脾方，基本方为:党参、干姜、白术、茯苓、吴茱萸、黄连、山药、薏苡仁、陈皮、鸡内金、木香、砂仁、柴胡、枳壳、赤白芍、延胡索、炙甘草。水煎服，每日一剂，每天两次，于早餐和午餐后两小时左右服用。疗程均为4周。两组患者治疗期间停服其它药物，予以清淡饮食，并观察记录患者常规体检情况以及可能出现的其它不良反应等，疗程结束后统计疗效。 3.统计学处理:所有数据均应用SPSS19.0软件进行处理。计数资料采用X2检验，计量资料采用t检验，等级资料采用Ridit检验。【结果】1.治疗组:临床痊愈5例，显效16例，有效9例，无效4例，总有效率86.17%;对照组:临床痊愈1例，显效9例，有效13例，无效9例，总有效率71.87%。两组总疗效经过统计学分析有显著性差异(P0.O5)，治疗组疗效优于对照组。 2.对照组与治疗组在治疗前后总积分比较有显著性差异，具有统计学意义(P0.01），在总积分的改善方面治疗组效果明显优于对照组。 3.治疗组在改善患者临床症状、缓解焦虑抑郁情绪、降低复发率、巩固疗效方面的效果明显优于对照组(P0.05)。 4.与对照组相比，治疗组能够更加有效的改善患者整体生存质量。【结论】本课题研究发现温中健脾方联合马来酸曲美布汀治疗腹泻型肠易激综合证（脾阳虚证）在减轻患者临床症状、降低复发率、改善患者生存质量等方面均优于对照组，温中健脾方组方严谨，全方从经方化裁而来，以温中祛寒，益气健脾为原则，健脾燥湿，温中散寒，振奋脾阳。其现代药理作用可能为以下几个方面:1.有效调节胃肠运动，缓解腹痛腹胀等症状。2.调整紊乱的神经内分泌功能。3.调节机体免疫功能。4.平衡胃肠菌群。综上所述，温中健脾方联合马来酸曲美布汀治疗腹泻型肠易激综合证(脾阳虚证)有较好的临床疗效，值得更多更深入的去研究。
[Abstract]:[Objective]
To observe the clinical effect of warming spleen recipe combined with trimebutine maleic acid in treating diarrhea type irritable bowel syndrome spleen yang deficiency syndrome, and systematically explore the mechanism of the combination of the combination of warm and medium invigorating spleen prescription combined with trimebutine maleic from the two aspects of theory and clinical.
[method]
1. selected 66 outpatient patients from February 2012 to December 2013 of the Hubei Provincial Traditional Chinese Medical Hospital, all of which were diagnosed as diarrhea type irritable bowel syndrome, and all the patients were randomly divided into two groups: 34 cases in the treatment group and 32 cases in the control group. All the patients were examined by electronic colonoscopy in the hospital. There were no obvious pathological changes. The results of routine physical examination of blood, urine and feces were all normal. It was in line with the diagnostic standard of diarrhea type IBS in the Rome III standard of Western medicine. There was no significant difference between the two groups in sex, age, course of disease, condition and symptom score, and it was comparable (P0.O5).
2. treatment: control group: pre - meal oral Trimebutine Maleate Dispersible Tablets (Zhejiang Anlikang Pharmaceutical Co., Ltd. production, the name of NYF) three times a day, 2 tablets (100mg per tablet); treatment group: on the basis of the control group plus warm spleen prescription, the basic recipe is: Party ginseng, dried ginger, Atractylodes, Poria, Wu Zhuyu, Huanglian, yam, coix seed, Chen peel, chicken Internal gold, wood, Amomum, bupleurum, bupleurum, Fructus aurantii, Radix Paeoniae, Rhizoma Corydalis, roasted licorice. One dose a day, two times a day, about two hours after breakfast and lunch. The course of treatment is 4 weeks.
In the two groups of patients, other drugs were stopped during the treatment, a light diet was given, and the routine physical examination of the patients and other possible other adverse reactions were observed. After the course of treatment, the curative effect was statistically analyzed.
3. statistical processing: all data were processed by SPSS19.0 software. X2 test was used for counting data, t test was adopted for measurement data, and Ridit test was used for grading data.
[results] 1. treatment group: clinical recovery 5 cases, effective 16 cases, effective 9 cases, invalid 4 cases, total effective rate 86.17%; control group: clinical cure 1 cases, 9 cases, effective 13 cases, 9 cases, total effective 71.87%. two group total effect after statistical analysis has significant difference (P0.O5), treatment group effect is superior to the control group.
There was a significant difference between the 2. control groups and the treatment group before and after the treatment. The difference was statistically significant (P0.01). The effect of the treatment group was obviously better than the control group in the improvement of the total integral.
3. the treatment group was significantly better than the control group in improving clinical symptoms, relieving anxiety and depression, reducing relapse rate and consolidating curative effect (P0.05).
4. compared with the control group, the treatment group can improve the overall quality of life of patients.
[Conclusion]
The study found that Wen Zhong Jianpi Fang combined with maleic trimebutine is superior to the control group in the treatment of diarrhea type irritable bowel syndrome (spleen yang deficiency syndrome) in alleviating the clinical symptoms, reducing the recurrence rate and improving the quality of life of the patients. Wen Zhong is strict with the prescription of strengthening the spleen, and the whole prescription comes from the recipe, and the principle of Wen Zhong dispelling cold and invigorating qi and invigorating the spleen is the principle. Invigorating the spleen and drying the dampness, in the warm and cold, and exhilarating the spleen yang, its modern pharmacological action may be as follows: 1. effective regulation of gastrointestinal motility, relieving abdominal pain and abdominal distention and other symptoms of.2. adjusted neuroendocrine function.3. to regulate the body immune function.4. balance gastrointestinal bacteria group. The irritable bowel syndrome (spleen yang deficiency syndrome) has a good clinical curative effect and deserves more in-depth study.
【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】：R574

【参考文献】