蔡氏健脾通便汤治疗脾虚型便秘的实验研究和临床观察

发布时间：2017-12-30 17:59

本文关键词：蔡氏健脾通便汤治疗脾虚型便秘的实验研究和临床观察　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：本研究通过综合整理导师治疗便秘的思维模式及临床经验,结合既往的实验研究资料,试图从临床疗效观察和基础实验研究两个角度探索“蔡氏健脾通便汤”治疗脾虚型便秘的短期疗效及远期效果。方法：动物实验研究部分：选用昆明小鼠156只,雌雄各半,体重(20±2)g,应用复合因素造模法建立脾虚便秘的小鼠模型,随机分为6组：空白对照组(正常组)、造模组、蔡氏健脾通便汤高剂量组(高剂量组)、蔡氏健脾通便汤中剂量组(中剂量组)、蔡氏健脾通便汤低剂量组(低剂量组)、乳果糖组,造模完成后,各治疗组小鼠分别给药治疗,连续7天,观察各组小鼠的一般情况、体重和大便改变情况。在每组中随机选出8只小鼠观察停药后各组小鼠一般情况、体重及大便情况,余小鼠分别用墨汁推进试验检测肠道推进功能,用比色分析法测定各组血清D-木糖含量,用苏木素—伊红(HE)染色法观察结肠病理改变。临床病例研究部分：将2015年3月—2016年3月至湛江市第一中医医院门诊及住院的42例脾虚型便秘患者随机分为蔡氏健脾通便汤组(治疗组)和乳果糖组(对照组),每组各21例,比较两组患者临床疗效、便秘的主要临床症状和伴随症状、结肠传输功能改善情况、不良反应及停药2月后便秘复发情况。结果：动物实验研究部分 1.体重：治疗后及停药8天后,与正常组相比,造模组的体重明显下降(P0.05)；与造模组相比,各治疗组小鼠体重明显增加(P0.05)且在治疗后,高剂量组较低剂量组体重明显增加(P0.05)。2.灌胃6h后粪便情况：与造模组相比,各治疗组小鼠粪便数量、重量、粒粪便重量明显增加(P0.05)；与正常组相比,造模组小鼠粒粪便重量、数量明显下降(P0.05)；与正常组相比,中、低剂量组、乳果糖组及造模组小鼠粪便重量明显下降(PO.05)。3.停药后粪便情况：与正常组相比,造模组数量、重量、粒粪便重量明显下降(P0.05)；与造模组比较,各治疗组小鼠粪便数量、重量、粒粪便重量明显增加(P0.05)；与高剂量组相比,中、低剂量组、乳果糖组粒粪便重量明显下降(P0.05)；与中剂量组相比,乳果糖组及造模组粒粪便重量明显下降(P0.05)。4.肠道推进功能：与正常组比较,造模组小鼠肠道推进率明显降低(PO.05),与造模组相比,各治疗组小鼠肠道推进率明显升高(PO.05),且高、中剂量组的肠道推进功能明显高于低剂量组及乳果糖组(P0.05)。5.血清D-木糖水平：与正常组相比,造模组小鼠血清D—木糖水平明显下降(P0.05)；与造模组比较,各治疗组血清D—木糖水平明显增加(P0.05)。临床病例研究部分 1.给药后治疗组患者总有效(95.24%)高于对照组(85.71%),但两组之间差异性不显著(P0.05)。2.给药后治疗组患者便秘主要临床症状和伴随症状均较对照组患者显著降低(P0.05)。3.给药后治疗组结肠传输功能改善的总有效率显著高于对照组(P0.05)。4.给药过程中治疗组的不良反应率显著低于对照组(P0.05)。5.停药2m时治疗组患者便秘的复发率均显著低于对照组(P0.05)。结论：蔡氏健脾通便汤对脾虚便秘型小鼠疗效明显,具有健脾通便的作用,其中以高、中剂量组明显,突出表现在停药后粒粪便重量的改善及肠道推进功能促进方面；蔡氏健脾通便汤对脾虚型便秘患者具有较好的临床疗效,主要在服药中的不良反应和停药后复发方面优势明显,值得临床推荐。
[Abstract]:Objective: To study the mode of thinking and clinical experience of comprehensive tutor in the treatment of constipation, combined with previous studies on the experimental data, attempts to explore "Chua's spleen through short-term curative effect and long-term effect Decoction" in the treatment of spleen deficiency constipation from two angles of observation and experimental study on basis of clinical curative effect. Methods: animal experiment: selection of Kunming 156 mice, male and female, weight (20 + 2) g mouse model, application of composite factors establish spleen deficiency constipation modeling method, were randomly divided into 6 groups: control group (normal group), model group, Chua's spleen Tongbian Decoction high dose group (high dose group), Chua Jianpi Tongli dose group then the soup (medium dose group), Chua's spleen Tongbian Decoction low dose group (low dose group), lactulose group. After modeling, the treatment group mice were administered for 7 consecutive days, the general condition of the mice were observed, and the changes of stool weight 2. Randomly selected in each group of 8 mice in each group were observed after discontinuation of the general condition of mice body weight and defecate, more than mice were treated with ink propelling test intestinal propulsive function, serum D- xylose content by colorimetric method, using hematoxylin - Yi Hong (HE) staining was used to observe the pathological changes of the colon. Clinical research: March 2015 - March 2016 to Zhanjiang City, the first hospital of traditional Chinese medicine outpatient hospital and 42 cases of spleen deficiency constipation patients were randomly divided into spleen group Chua's Tongbian Decoction (treatment group) and lactulose group (control group), 21 cases in each group, compared the clinical efficacy of the two groups, the main clinical symptoms of constipation and with the symptoms of colonic transit function to improve the situation, the situation of recurrent constipation adverse reaction and drug withdrawal after February. Results: part 1.: experimental study of animal weight after treatment and 8 days after drug withdrawal, compared with the normal group, model group weight Decreased (P0.05); compared with the model group, the weight of each treatment group mice significantly increased (P0.05) and after treatment, high dose group and low dose group significantly increased body weight (P0.05) stool.2. gavage after 6h: compared with the model group, the number of each treatment group, mice feces weight, feces the weight increased significantly (P0.05); compared with the normal group, model group mice feces weight number decreased significantly (P0.05); compared with the normal group, low dose group, lactulose group and model group mice feces weight decreased significantly (PO.05) after discontinuation of.3. stool: compared with the normal group, the model number, grain weight, stool weight decreased significantly (P0.05); compared with model, quantity and weight of each group of mice feces, feces weight increased significantly (P0.05); compared with the high dose group, low dose group, lactulose group significantly decreased the grain weight of feces (P0.05); and agent Volume group, lactulose group and model group were significantly decreased stool weight (P0.05).4. intestinal propulsive function: compared with the normal group, build module of mouse intestinal propulsion rate was significantly reduced (PO.05), compared with the model group, the treatment group significantly increased the intestinal propulsion rate (PO.05), and high dose group. The intestinal propulsive function was significantly higher than the low dose group and lactulose group (P0.05.5.) serum D- xylose level: compared with the normal group, model group, mice serum D xylose levels were significantly decreased (P0.05); compared with model group, each treatment group serum D xylose level increased significantly (P0.05). The clinical research part 1. after administration of the total effective treatment group (95.24%) was higher than the control group (85.71%), but no significant difference between the two groups (P0.05) in patients with constipation treatment.2. after administration of the main clinical symptoms and associated symptoms were significantly lower than that in control group (P0.05) after administration of.3. The treatment group of colonic transit function improvement of total efficiency was significantly higher than the control group (P0.05.4.) to the adverse reaction rate of the treatment group was significantly lower than the control group in the process of drug discontinuation of.5. (P0.05) 2m treatment group patients with constipation recurrence rate were significantly lower than the control group (P0.05). Conclusion: Jianpi Chua Tongbian Decoction significantly the effect of spleen deficiency constipation mice with spleen laxative effect, which was high, middle dose group, outstanding performance after the discontinuation of grain improvement and intestinal propulsive function promoting weight; spleen Chua's Tongbian decoction has good clinical curative effect on spleen deficiency constipation patients, the main adverse reaction in the treatment and the recurrence of obvious advantages, is worthy of recommendation.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.35

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