健脾固肠汤配合穴位艾灸治疗腹泻型肠易激综合征的临床研究

发布时间：2018-03-19 22:28

本文选题：腹泻型肠易激综合征　切入点：健脾固肠汤　出处：《湖北中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究采用导师自拟方健脾固肠汤配合穴位艾灸治疗中医辨证为肝郁脾虚证的腹泻型肠易激综合征(IBS-D),旨在观察评价其临床疗效及安全性,为推广应用于临床提供依据。方法:1.选取2015年4月-2016年10月间于湖北省中医院脾胃病科专家门诊就诊,确诊为腹泻型肠易激综合征(IBS-D),中医辨证属肝郁脾虚型的患者72例。将这72例患者按就诊先后顺序随机分为两组,治疗组36例,对照组36例。最终有69例患者完成临床试验并纳入统计分析,其中治疗组和对照组分别为35例及34例。两组患者经统计学比较后在年龄、性别、病程、中医症状总积分方面差异无统计学意义,具有可比性(P0.05)。2.治疗组予以健脾固肠汤加减(焦白术15g、白芍20g、防风10g、茯苓15g、薏苡仁30g、陈皮10g、木香10g、黄连6g、藿香10g、佩兰10g、煨诃子10g、芡实10g、石榴皮10g、炙甘草6g),每日一剂以水煎服,分早、晚两次于饭后半小时温服,每次150ml;穴位艾灸(神阙、关元、天枢),每日一次。对照组予以蒙脱石散(哈药集团世一堂制药厂生产,国药准字H20093375),每日3次,每次1袋(3g),水冲服;复方谷氨酰胺肠溶胶囊(地奥集团成都药业股份有限公司生产,国药准字:H51023598),每日3次,每次2粒,口服。治疗期间嘱患者饮食清淡,忌生冷、辛辣刺激之品,保持心情舒畅,勿服用与本病治疗相关的其他药物。两组疗程均为4周,治疗过程中若对照组患者出现大便秘结症状则停用蒙脱石散。治疗前后对两组病例各进行1次安全性观察指标的检查,并记录治疗前后两组患者的症状、体征变化情况,综合评价健脾固肠汤配合穴位艾灸治疗肝郁脾虚型IBS-D的临床疗效。疗程结束后对痊愈及显效患者进行4周随访,了解病情复发情况。3.所有数据资料采用SPSS21.0软件进行分析。计量资料采用t检验;计数资料采用x2检验;等级资料采用秩和检验。结果:1.治疗组临床痊愈10例、显效10例、有效13例、无效2例,总有效率94.29%;对照组分别为5例、8例、14例、7例,总有效率为79.41%。两组数据经比较后差异有统计学意义(P0.05),表明治疗组比对照组临床疗效更好。2.治疗前两组患者的中医症状总积分无显著差异(P0.05),具有可比性;治疗后两组患者的中医症状总积分均低于治疗前,其中治疗组中医症状总积分与对照组相比下降明显,差异有统计学意义(P0.05),表明治疗组能更好的改善中医症状。3.治疗组在粪便性状、腹痛、腹胀及情志异常症状的改善上明显优于对照组,差异具有统计学意义(P0.05);在其他症状的改善上疗效相当,差异无统计学意义(P0.05)。4.经随访4周后,治疗组复发率为20.00%,对照组复发率为69.23%,两组数据差异有统计学意义(P0.05),表明治疗组远期疗效优于对照组。5.在治疗过程中,两组病例均未出现明显不良反应。结论:两组治疗方案对于本病的治疗均有明显效果,但健脾固肠汤配合穴位艾灸的疗效更加显著,尤其是在排便频率、腹痛腹胀、情志异常等主症的改善方面优势突出,能有效改善生活质量,降低疾病复发率,是一种疗效显著、安全性高、副作用少、易于操作和接受的治疗方法,可推广应用于临床。
[Abstract]:Objective: diarrhea type intestinal using tutor Jianpi Decoction Combined with acupuncture moxibustion treatment of solid bowel syndrome of liver stagnation and spleen deficiency on the irritable bowel syndrome (IBS-D), to evaluate the clinical efficacy and safety, for the promotion of the basis on clinical application. Methods: 1. from April 2015 -2016 year in October in Hubei Provincial Traditional Chinese Medical Hospital of the spleen and stomach department of expert outpatient service, diagnosed with diarrhea type irritable bowel syndrome (IBS-D), 72 cases of patients with TCM is liver and spleen deficiency. The 72 patients were randomly divided into two groups, treatment group 36 cases, control group 36 cases. Finally 69 patients completed clinical trials and included in the statistical analysis, the treatment group and control group were 35 cases and 34 cases. The two groups of patients were statistically in age, gender, disease duration, no statistically significant difference in the total score of clinical symptoms, with comparable treatment of.2. (P0.05) By strengthening the spleen and intestinal Decoction group (focal white atractylodes rhizome 15g, white peony root 20g, wind 10g, Poria 15g, Coix 30g, orange peel 10g, 10g of Radix Aucklandiae, Rhizoma Coptidis 6G, agastache 10g, Perrin 10g, 10g 10g for Myrobalam, Gorgon fruit, pomegranate peel 10g, licorice 6g), a daily agent with water decoction, divided early, late in two after half an hour. Every time, 150ml; Acupoint Moxibustion (Shenque, Guanyuan, Tianshu), once a day. The control group was given (Montmorillonite powder production, Shiyitang pharmaceutical factory of Harbin Pharmaceutical Group Zhunzi H20093375), 3 times a day, each time 1 bags (3G), Compound Glutamin Entersoluble Capsules (production with water; Chengdu pharmaceutical Limited by Share Ltd, thepilot Zhunzi: H51023598), 3 times daily, 2 capsules each time, oral diet during treatment. Patients have light, avoid cold, spicy food, maintain good mood, do not take other drugs associated with this disease treatment. Two groups were treated for 4 weeks, treatment if the process of control group patients The emergence of constipation symptoms. Montmorillonite powder is disabled before and after treatment in the two groups, the 1 safety observation index examination, and record the symptoms of the two groups of patients before and after treatment, changes of symptoms, comprehensive evaluation of strengthening the spleen and intestinal decoction combined with clinical curative effect of Acupoint Moxibustion in the treatment of liver stagnation and spleen deficiency type IBS-D after treatment for 4 weeks. Follow up of cure and effective patients understand the disease recurrence.3. all the data were analyzed by SPSS21.0 software. The measurement data using t test; x2 test with count data; ranked data using rank sum test. Results: 10 cases were cured and 1. treatment group, 10 cases were markedly effective, 13 cases effective, 2 cases ineffective, the total the efficiency of 94.29%; the control group were 5 cases, 8 cases, 14 cases, 7 cases, the total efficiency of 79.41%. was statistically significant difference after two groups of data comparison (P0.05), showed that the treatment group than the control group clinical curative effect better.2. treatment There was no significant difference between the total scores of the two groups before symptoms of traditional Chinese medicine (P0.05), comparable; the total score after treatment two groups of patients with symptoms were lower than those before treatment, the treatment group symptom total score decreased significantly compared with the control group, the difference was statistically significant (P0.05), showed that the symptoms of.3. treatment the treatment group were better in the stool, abdominal pain, abdominal distension and abnormal emotional symptoms improved significantly better than the control group, the difference was statistically significant (P0.05); efficacy in other symptoms, there was no statistically significant difference (P0.05) by.4. after 4 weeks of follow-up, the recurrence rate of treatment group 20%, control group the recurrence rate was 69.23%, there were significant differences between the two groups (P0.05), the data show that the treatment group curative effect is better than that of control group.5. in the course of treatment, two cases had no obvious adverse reactions. Conclusion: the two treatment programs for the Treatment of disease has obvious effect, but the effect of strengthening the spleen and intestinal decoction combined with moxibustion is more significant, especially in the frequency of defecation, abdominal pain, emotional abnormalities and other main symptoms improved to highlight the advantages, can effectively improve the quality of life, reduce the recurrence rate, a significant effect, high safety, less side effects easy to operate, and to accept the treatment, can be widely used 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】：2017
【分类号】：R259

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