七味白术散治疗儿童脾虚湿盛型腹泻的疗效评价研究

发布时间：2018-02-13 21:55

本文关键词： 腹泻病脾虚湿盛型七味白术散　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景：儿童腹泻病是由多种病因引起的以大便次数增多与大便性状改变为主要症状的疾病,是婴幼儿时期最常见的疾病之一,发病率在我国排第二位。根据世界卫生组织(WHO)2009年的报告,每年共有150万儿童死于腹泻病,在世界范围内也是导致儿童死亡的一大病因。急性腹泻可出现脱水及电解质紊乱,持续腹泻可导致消化功能障碍、营养不良、生长发育落后等。按病程分类,可将儿童腹泻病分为急性腹泻、迁延性腹泻和慢性腹泻；依照病因,可分为感染性腹泻和非感染性腹泻,由于病原体不同,又可将感染性腹泻分为细菌感染、病毒感染等。中医将该病归为“泄泻”范畴,由于小儿脾常不足,感受外邪或内伤饮食都易致病。在儿科临床诊疗中发现,根据病因给予中医辨证论治疗效颇佳,尤其对于儿童常见的脾虚湿盛型腹泻,中医辨证论治不但药效价廉,而且对于相关证候的改善效果明显。综合大量文献发现,七味白术散治疗儿童腹泻病的疗效显著,并优于肠黏膜保护剂等部分西药,而以微生态调节剂作对比的研究尚待探索。目的：本研究以七味白术散为方,治疗儿童脾虚湿盛型腹泻,并与西药双歧杆菌四联活菌片作对照,对其治疗前后的证候进行观察,初步探索七味白术散汤剂治疗儿童脾虚湿盛型腹泻的优势所在。方法：本课题为前瞻性研究,研究对象为68例,为2014年6月——2015年9月期间在石景山区中医医院儿科门诊就诊并诊断为脾虚湿盛型腹泻的患儿,应用SPSS17.0软件随机分为治疗组和对照组各34例,两组均予饮食指导。治疗组予口服七味白术散汤剂,每日1/3-1剂,对照组予口服双歧杆菌四联活菌片1-3片,每日3次。观察患儿治疗前后的证候并评分。所有资料均采用SPSS17.0进行分析,所有计量资料治疗组、对照组治疗前后比较采用配对t检验,组间比较采用独立样本t检验,计数资料采用卡方检验,等级资料采用秩和检验。结果：1.两组疗效比较：治疗组、对照组的总有效率分别为94.1%和91.2%。两组总有效率差异无统计学意义(卡方值=0.216,P=0.6420.05);两组显效率差异有统计学意义(卡方值=0.965,P=0.0150.05)。2.治疗组治疗前后证候评分比较：在大便次数、大便性状、腹泻病程、腹痛、呕吐、精神、口渴、饮食、小便、面色、肛门各项评分存在差异,有统计学意义(P0.05)。3.两组治疗后第3天证候评分比较：治疗组、对照组治疗后第3天腹痛、口渴、饮食、面色各项评分存在差异,有统计学意义(P0.05)。结论：1.七味白术散治疗儿童脾虚湿盛型腹泻疗效可靠。2.治疗组在部分相关证候改善方面优于对照组。
[Abstract]:Background: diarrhoeal disease in children is one of the most common diseases in infantile age, which is mainly characterized by the increase of defecation frequency and the change of defecation character. According to the 2009 report of the World Health Organization (WHO), 1.5 million children die from diarrhoeal diseases every year, which is also a major cause of death in the world. Acute diarrhea can lead to dehydration and electrolyte disorders. Persistent diarrhea can lead to dyspepsia, malnutrition, stunted growth, etc. According to the course of disease, children's diarrhoeal diseases can be divided into acute diarrhea, persistent diarrhea and chronic diarrhea; according to the etiology, It can be divided into infectious diarrhea and non-infectious diarrhea. Because of the different pathogens, infectious diarrhea can also be divided into bacterial infection, viral infection and so on. In clinical diagnosis and treatment of pediatrics, it was found that it was very effective to treat TCM with syndrome differentiation according to the etiology, especially for the common diarrhea of spleen deficiency and dampness, and the differentiation of symptoms and signs of TCM was not only effective, but also cheap. It was found that Qiwei Baizhu Powder had a remarkable effect on treating diarrhea in children, and was superior to some western medicine such as intestinal mucosal protectant. Objective: in this study, Qiwei Baizhu Powder was used as the prescription to treat the diarrhea of children with spleen deficiency and dampness, and compared with the western medicine Bifidobacterium tetralogicum tablets, the syndromes before and after treatment were observed. Objective: to explore the advantages of Qiwei Baizhu decoction in treating diarrhea with spleen deficiency and dampness in children. From June 2014 to September 2015, children with diarrhea of spleen deficiency and dampness were randomly divided into treatment group (34 cases) and control group (34 cases). The treatment group was given 1 / 3-1 dose of Qiwei Baizhu decoction daily, while the control group was given 1-3 tablets of bifidobacterium tetralogens. All the data were analyzed by SPSS17.0. All the metrological data in treatment group and control group were matched t test before and after treatment, and independent sample t test was used for comparison between groups. The counting data were chi-square test and rank data were rank sum test. Results the curative effect of the two groups was compared: treatment group, The total effective rate of the control group was 94.1% and 91.2, respectively. There was no significant difference in the total effective rate between the two groups (chi-square value was 0.216p, P < 0.6420.05), and the difference between the two groups was statistically significant (chi-square value was 0.965p 0.0150.05n.2.) before and after treatment, the scores of syndromes in the treatment group were as follows: the number of defecation times, the defecation traits, the difference between the two groups were statistically significant. The course of diarrhea, abdominal pain, vomiting, spirit, thirst, diet, urination, facial color, anus scores were different, there were significant differences between the two groups after treatment on the third day after the treatment of syndrome score comparison: treatment group, control group 3 days after treatment abdominal pain, There were significant differences in the scores of thirst, diet and facial color. Conclusion: 1. Qiwei Baizhu Powder is effective and reliable in treating diarrhea of children with spleen deficiency and dampness. 2. The treatment group is superior to the control group in improving some related syndromes.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R272

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