涤肠愈疡汤灌肠联合西药治疗溃疡性结肠炎（大肠湿热证）的临床观察

发布时间：2018-07-05 12:18

本文选题：溃疡性结肠炎 + 大肠湿热　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:该临床研究主要旨在观察应用中药灌肠方法联合西药治疗慢性溃疡性结肠炎活动期(大肠湿热证)的临床疗效,观察并记录患者在本治疗过程中的症状、体征、实验室检查结果及复发次数,将之与对照组进行比较。比较二者在接受相应治疗后的近期及远期疗效,以此来评价该治疗方法的有效性及安全性,为以后临床使用涤肠愈疡汤灌肠治疗溃疡性结肠炎提供依据。研究方法:该观察中的64例病例,均来自于自2015年10月至2016年10月就诊于湖北省中医院光谷院区脾胃科住院病房,将患者随机分成实验组32例,对照组32例。依据随机分组法将病人列为实验组32例,对照组32例。西药组吩咐病人口服西药美沙拉嗪肠溶片治疗,1.0g/次,3次/天,疗程为2个月。以西药组为基础,治疗组则加用自拟方涤肠愈疡汤(方剂组成:白头翁10g,青黛10g,川连10g,川柏炭10g,败酱草10g,白及15g,三七5g,炒蒲黄10g,槐花炭10g)水煎300ml,分成两份,早晚各取150ml保留灌肠,连续使用2个月。治疗结束后对比两组患者总疗效、中医证候积分、肠镜黏膜评级表现、中医证候疗效、疾病活动指数及C-反应蛋白(CRP)、大便潜血(OB)评分结果的变化。结果:(1)治疗组的总有效率为87.5%,对照组的总有效率为62.5%,两组结果经统计学比较,差异具有显著性(P0.05);在改善中医证候积分、降低DAI指数、中医证候改善、内镜下黏膜评级改善情况、改善OB评分指标方面,两组具有统计学意义,治疗组均优于对照组(P0.05);在改善两组CRP值方面,两组无统计学差异(P0.05);(2)治疗过程中两组患者均偶见头痛现象,初期偶见患者腹泻症状加重,几天后症状减轻,该现象考虑与美沙拉嗪副作用及药物耐受有关;治疗结束3个月后随访,治疗组复发2人,对照组复发10人,治疗组的复发率低于对照组。结论:涤肠愈疡汤灌肠联合美沙拉嗪肠溶片口服能有效的治疗慢性溃疡性结肠炎活动期(大肠湿热证)患者,能明显改善患者临床症状、降低DAI指数、修复患者肠道黏膜,并且复发率低,在临床运用安全有效,值得推广使用。
[Abstract]:Objective: to observe the clinical effect of traditional Chinese medicine enema combined with western medicine in treating active stage of chronic ulcerative colitis (large intestine damp-heat syndrome), and to observe and record the symptoms and signs of the patients. The results of laboratory examination and the times of recurrence were compared with those of the control group. In order to evaluate the efficacy and safety of the two methods, the short-term and long-term effects of the two treatments were compared, which provided the basis for the treatment of ulcerative colitis with Ditan Changyu decoction (DYYTang). Methods: from October 2015 to October 2016, 64 cases were admitted to the inpatient ward of Department of spleen and stomach of Guanggu Hospital of Hubei traditional Chinese Medicine Hospital. The patients were randomly divided into experimental group (n = 32) and control group (n = 32). The patients were divided into experimental group (32 cases) and control group (32 cases). The western medicine group ordered the patients to take orally the western medicine mesalazine enteric-coated tablets for 3 times a day for 2 months. On the basis of the western medicine group, the treatment group was added with the decoction of self-made formula Ditan Chang Yu Yang Tang (the composition of the prescription: Weng 10g, Qing Dai 10g, Chuan Lian 10g, Chuan Pai Tan 10g, paussurea 10g, White and 15g, panax notoginseng 5g, fried fuhuang 10g, Sophora japonica 10g), and divided into two parts. Take 150ml to retain enema in the morning and evening and use continuously for 2 months. After treatment, the changes of total curative effect, TCM syndromes score, mucosal grading, TCM syndromes efficacy, disease activity index, C-reactive protein (CRP) and occult blood (OB) score were compared between the two groups. Results: (1) the total effective rate was 87.5 in the treatment group and 62.5 in the control group. The difference between the two groups was statistically significant (P0.05). In improving the OB score, the two groups have statistical significance, the treatment group is better than the control group (P0.05); in improving the value of); (in the two groups, there is no statistical difference (P0.05) in the treatment process of the two groups of patients have occasional headache phenomenon, The symptoms of diarrhea were aggravated in the early stage and relieved a few days later, which was related to the side effects of mesalazine and drug tolerance. After 3 months of treatment, there were 2 relapses in the treatment group and 10 in the control group. The recurrence rate in the treatment group was lower than that in the control group. Conclusion: Dishangyu decoction enema combined with mesalazine enteric-coated tablets can effectively treat patients with active stage of chronic ulcerative colitis (large intestine damp-heat syndrome), can significantly improve the clinical symptoms of patients, reduce the Dai index, repair the intestinal mucosa of patients. And the recurrence rate is low, safe and effective in clinical use, worth popularizing.
【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】：2017
【分类号】：R574.62

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