麦门冬汤合增液承气汤加味“肺肠同治”治疗阿片类药物所致阴虚便秘的临床研究

发布时间：2018-03-25 16:29

本文选题：麦门冬汤合增液承气汤　切入点：肺肠同治　出处：《云南中医学院》2017年硕士论文

【摘要】：研究目的:评价麦门冬汤合增液承气汤加味“肺肠同治”治疗阿片类药物所致阴虚便秘的的临床疗效和安全性,探讨阿片类药物所致阴虚便秘的治疗方法,为中医药治疗阿片类药物所致阴虚便秘提供新思路和新方法。研究方法:采用临床研究的方法,以随机对照法进行临床研究,设立样本诊断标准,纳入标准,排除标准及中止临床试验标准。观察云南省中医医院(2015年12月至2016年12月)住院及门诊病人63例,治疗组31例,对照组32例,治疗组:麦门冬汤合增液承气汤加味(由云南省中医医院煎药室煎药机煎制,一剂煎2袋,150ml/袋)日一剂,早晚各一次,1次1袋)。对照组:聚乙二醇4000散(10g*10袋(福松),博福-益普生制药有限公司,10g,2次/天,水冲服)。分别记录两组治疗前、治疗后的便秘评分、中医证候评分、疼痛评分(NRS评分)、生活质量评分(KPS评分),评价疗效并做统计学分析。研究结果:1.在改善阿片类药物所致阴虚便秘的便秘症状上,两组在便秘总疗效上对比无统计学差异(P0.05),治疗组和对照组对改善阿片类药物所致的阴虚便秘疗效基本相同;两组各项便秘症状评分治疗前后对比,均P0.01,具有显著统计学差异,两组治疗后各项便秘症状评分对比,均P0.05,无统计学差异,提示两组均能显著改善各项便秘症状(排便时间间隔、粪便性质、排便费力程度、排便不尽感、排便直肠梗阻感/阻塞感),且疗效基本相同。2.在改善阿片类药物所致阴虚便秘的中医证候上,两组在中医证候总疗效上对比具有显著统计学差异(P0.01),治疗组在改善阿片类药物所致阴虚便秘的中医证候上优于对照组。治疗组各项中医证候评分治疗前后对比,除形体消瘦P0.05,无统计学差异,其余各项中医证候评分均P0.01,具有显著统计学差异,提示除形体消瘦外,治疗组能显著改善使用阿片类药物所致阴虚便秘引起的头晕、耳鸣、失眠、潮热盗汗、腰膝酸软、五心烦热。而对照组各项中医证候评分治疗前后对比,均P0.05,无统计学差异,提示对照组治疗前后各项中医证候无明显改善;两组中医证候单项评分治疗后对比,除形体消瘦、失眠外,P0.05,无统计学差异,其余各项,均P0.05,具有统计学差异,提示治疗组在改善头晕、耳鸣、潮热盗汗、膝膝酸软、五心烦热上优于对照组。3.在改善患者疼痛(NRS评分)上,两组治疗前后比较均无统计学差异(P0.05),说明两组治疗前后疼痛控制情况无明显变化,提示两组对阿片类药物止痛作用无明显影响。4.在改善患者生存质量(KPS评分)上,治疗组治疗前后比较有统计学差异(P0.05),提示治疗组用药后生活质量较前显著提高。对照组治疗前后对比无统计学差异(P0.05),提示对照组用药前后患者生活质量无明显变化;两组治疗后比较,有显著统计学差异(P0.01),提示治疗组优于对照组。5.在各项安全性指标观察内容上,治疗组和对照组治疗前后对比无统计学差异(P0.05),提示两组均有良好的安全性。结论:麦门冬汤合增液承气汤加味方可有效缓解因使用阿片类药物引起的阴虚便秘,并可显著改善除形体消瘦外的中医证候(头晕、耳鸣、失眠、潮热盗汗、腰膝酸软、五心烦热),提高患者生活质量。
[Abstract]:Objective: To evaluate the Hezeng Maimendong Decoction fluid Chengqi Decoction "lung intestine" in the treatment of opioid induced constipation due to yin deficiency of the clinical efficacy and safety, to explore the methods of treatment of opioid induced constipation due to yin deficiency, provide treatment of opioid induced constipation due to yin deficiency of new ideas and new methods for TCM research. Methods: the clinical study, clinical study with randomized method, setting up the sample diagnostic criteria, inclusion criteria, exclusion criteria and standards for clinical trials suspended. To observe the traditional Chinese Medicine Hospital of Yunnan province (December 2015 to December 2016) 63 inpatients and outpatients, 31 cases in the treatment group, 32 cases in the control group, the treatment group: Maimendong Decoction Hezeng fluid Chengqi Decoction (Decoction by the office of the Yunnan Provincial Hospital of traditional Chinese medicine decocting machine for frying, frying a dose of 2 bags, 150ml/ bags) a day, sooner or later each time, 1 times 1 bags). The control group: polyethylene glycol 4000 powder (10g*10 bag (Fu Song) , Beaufour lpsen Pharmaceutical Co. Ltd, 10g, 2 times / day). The water flushes the clothing in two groups were recorded before treatment, after treatment of constipation score, TCM syndrome score, pain score (NRS score), quality of life score (KPS score), curative effect evaluation and do statistical analysis. Results: 1. in the improvement of opioid induced constipation due to yin deficiency constipation symptoms, two groups in the total curative effect on constipation compared no significant difference (P0.05), the treatment group and the control group of yin deficiency constipation improved efficacy of opioid induced constipation is basically the same; the two groups the symptom score were compared before and after treatment, P0.01, significant statistical differences between two groups after the treatment of the symptoms of constipation score comparison, P0.05, no significant difference, suggesting that the two groups can significantly improve the symptoms of constipation (defecation interval, stool properties, defecation, defecation imcompletely, bowel obstruction, rectal obstruction /), TCM syndrome and the curative effect is basically the same as.2. in improving opioid induced constipation due to yin deficiency, two groups in the total curative effect of TCM syndrome compared with significant difference (P0.01), TCM treatment group in improving opioid induced constipation due to yin deficiency than those in the control group. The treatment group before and after comparison in addition to the treatment of TCM syndrome score, emaciation P0.05, no significant difference, the rest of the TCM syndrome scores of P0.01, the difference was statistically significant, suggesting that in addition to emaciation, the treatment group can significantly improve the use of opioid induced constipation due to yin deficiency caused by dizziness, tinnitus, insomnia, night sweats, hot flashes, Yaoxisuanruan, five tired of heat. While the control group before and after comparison, the TCM syndrome score in the treatment of P0.05, no significant difference, suggesting that the control of the TCM syndrome has no obvious improvement group before and after treatment were compared between the two groups; single TCM syndrome score after treatment In addition, emaciation, insomnia, P0.05, no significant difference, the rest of the P0.05, are, statistically, suggesting that the treatment group in improving dizziness, tinnitus, hot flashes, night sweats, knee knees, Fanre than the control group.3. in improving the pain (NRS score), the two groups before and after treatment were compared no statistical difference (P0.05), that pain control had no obvious change before and after treatment in two groups, two groups of opioid analgesic effect had no obvious effect in improving the quality of life of patients.4. (KPS score), the treatment group before and after treatment were statistically significant difference (P0.05), the treatment group after treatment compared with the quality of life the control group increased significantly. Compared before and after treatment showed no significant difference (P0.05), suggesting that the quality of life in patients with no significant changes in control group before and after treatment; the two groups after treatment, there was statistically significant difference (P0.01), the treatment group than in control group. 5. to observe the content in the security index, treatment group and control group before and after treatment compared with no significant difference (P0.05), suggesting that the safety of two groups were good. Conclusion: Maimendong Decoction Hezeng Chengqi Decoction liquid can effectively relieve constipation due to yin deficiency caused by the use of opioids, and can significantly improve the TCM in addition to the syndrome of emaciation (dizziness, tinnitus, insomnia, night sweats, hot flashes, Yaoxisuanruan, five upset hot), improve the quality of life of patients.

【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.35

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