旋覆代赭汤合左金丸联合奥美拉唑治疗胃食管反流病痰湿内阻证的临床研究

发布时间：2018-12-13 08:27

【摘要】：目的： 1.观察旋覆代赭汤合左金丸联合奥美拉唑治疗胃食管反流病痰湿内阻证的临床疗效。 2.从理论上分析旋覆代赭汤合左金丸联合奥美拉唑治疗胃食管反流病痰湿内阻证的作用机理。方法：收集2012年6月～2013年12月湖北省中医院消化内科专家门诊就诊的60例患者，均符合胃食管反流病西医诊断标准和中医痰湿内阻证标准。随机将患者分为治疗组和对照组，每组各为30人。统计学分析后，两组病人在年龄、病程、病情程度、性别、证候总积分等方面具有可比性，不存在统计学意义（P0.05）。两组患者均予以奥美拉唑胶囊口服。在此基础上，治疗组加用旋覆代赭汤合左金丸。旋覆代赭汤合左金丸是导师胡运莲教授应用多年的经验方（其组成为旋覆花15g,代赭石30g,法半夏10g,吴茱萸5g,黄连18g,人参15g,生甘草5g,生姜10g,大枣6枚），水煎服，每日1剂，早晚饭后半小时各1次，每次200ml；奥美拉唑胶囊口服，每次20mg,每日2次，早晚饭前服用。两组患者均连续服药一疗程（八周）。观察两组患者治疗前后反酸、烧心、口苦等症状、体征及临床总积分的变化，并且对血尿粪常规、肝功能、肾功能、心电图及其它可能出现的不良反应进行安全性评价。疗程结束后，予以统计学分析：数据应用SPSS16.0统计软件统计，等级资料用Ridit检验（秩和检验），计量资料采用t检验，计数资料采用χ2检验。结果： 1.两组患者疗程结束后临床综合疗效的比较：治疗组总有效率96.66%，痊愈7例，显效12例，有效10例，无效1例，对照组总有效率76.67%，痊愈3例，显效8例，有效12例，无效7例。治疗组总有效率、临床治愈率均高于对照组（P0.05）。 2.对反酸、烧心、咽部异物感等症状，治疗组明显优于对照组，改善明显；对早饱、嗳气等症状的改善，两组相当。对于临床症状总积分的改善，治疗组明显优于对照组（P0.05）,且治疗前后两组患者临床症状总积分均有显著差异（P0.05）。结论：本临床研究表明，中西医结合治疗胃食管反流病痰湿内阻证明显优于单纯西药组，主要表现在可以明显减少反酸、烧心、咽部异物感的发生频率，能缩短患者的治疗时间，不仅能减轻患者的痛苦，而且能减轻患者的经济负担。依现代药理理论分析，，旋覆代赭汤合左金丸有抑制胃酸分泌，从而促进粘膜修复、抑制溃疡形成的功能；可增强食管收缩幅度收缩频率，增加胃肠蠕动节律，从而起到加快胃肠排空的作用，可刺激或调节免疫系统，调整胃肠功能，有解痉止痛的作用。此外还有显著抑菌、消炎的作用。结合相关西药联合治疗可增强治疗效果。说明旋覆代赭汤合左金丸汤的组方切合临床实际，在治疗胃食管反流病痰湿内阻证方面有确切的疗效，值得在临床应用及推广。
[Abstract]:Objective: 1. To observe the clinical effect of Xuanhudezhe decoction combined with omeprazole in treating phlegm dampness and internal obstruction of gastroesophageal reflux disease. 2. The mechanism of Xuanhudezhe decoction combined with omeprazole in treating phlegm dampness and internal obstruction of gastroesophageal reflux disease was analyzed theoretically. Methods: from June 2012 to December 2013, 60 patients with gastroesophageal reflux disease were collected from the department of internal medicine, Department of Digestive Medicine, Hubei traditional Chinese Medicine Hospital. All the patients met the criteria of western medicine diagnosis of gastroesophageal reflux disease and internal obstruction of phlegm and dampness in traditional Chinese medicine. Patients were randomly divided into treatment group and control group, each group was 30 people. After statistical analysis, the two groups of patients in age, course of disease, degree of illness, gender, syndromes total score and other aspects are comparable, there is no statistical significance (P0.05). Both groups were given omeprazole capsule orally. On this basis, the treatment group plus Zuo Jin Pill with Zuo Jin Pill. Xianfu Daochhe Tang he Zuo Jin Pill is an experienced prescription used by Professor Hu Yunlian for many years (its composition is 15g, 30g, 10g, 5g, 18g, 15g, 5g, 5g, 10g, 10g, 6g, respectively). 1 dose daily, half an hour after morning and evening, every time 200ml; Omeprazole capsule oral, 20 mg each time, 2 times a day, morning and evening before meals. The patients in both groups were treated with a course of treatment (8 weeks). The changes of regurgitation, heartburn, bitter mouth and other symptoms, signs and total clinical scores were observed before and after treatment, and the safety of hematuria and fecal routine, liver function, renal function, electrocardiogram and other possible adverse reactions were evaluated. After the course of treatment, statistical analysis was performed: the data were analyzed by SPSS16.0 statistical software, Ridit test was used for grade data, t test was used for measurement data, 蠂 2 test was used for counting data. Results: 1. Comparison of the clinical comprehensive efficacy of the two groups after the end of the course of treatment: the total effective rate of the treatment group was 96.666.The total effective rate was 96.666,7 cases cured, 12 cases effective, 10 cases effective, and 1 case ineffective. In the control group, the total effective rate was 76.67%, 3 cases were cured, and 8 cases were remarkable effect. 12 cases were effective and 7 cases were ineffective. The total effective rate and clinical cure rate in the treatment group were higher than those in the control group (P0.05). 2. For the symptoms of regurgitation, heartburn and pharynx, the treatment group was obviously better than the control group, and the improvement of the symptoms such as early satiety and belching was similar between the two groups. For the improvement of the total score of clinical symptoms, the treatment group was significantly better than the control group (P0.05), and the two groups of patients before and after treatment were significantly different in the total score of clinical symptoms (P0.05). Conclusion: this clinical study shows that the treatment of internal obstruction of phlegm and dampness in patients with gastroesophageal reflux disease is better than that in western medicine group, which mainly shows that the frequency of foreign body sensation in reflux, heartburn and pharynx can be significantly reduced. It can shorten the time of treatment, not only alleviate the patient's pain, but also reduce the patient's economic burden. According to the modern pharmacological theory, Xuan Fu Dai Zuo Jin Pill has the function of inhibiting gastric acid secretion, thus promoting mucosal repair and inhibiting ulcer formation. It can increase the frequency of contraction amplitude of esophagus, increase the rhythm of gastrointestinal peristalsis, accelerate the emptying of gastrointestinal tract, stimulate or regulate the immune system, adjust the function of gastrointestinal tract, and relieve spasmolysis and pain. In addition, there are significant bacteriostasis, anti-inflammatory effect. Combined therapy with related western medicine can enhance the therapeutic effect. It shows that the prescription of Xuan Fu Dai Zhe Tang and Zuo Jin Pill decoction is suitable for clinical practice and has definite curative effect in treating gastroesophageal reflux disease with phlegm dampness and internal obstruction, which is worth applying and popularizing in clinic.
【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

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