温肾健脾法治疗脾肾阳虚型功能性便秘的临床研究

发布时间：2018-04-21 08:56

本文选题：脾肾阳虚 + 功能性便秘　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察温肾健脾法治疗脾肾阳虚型功能性便秘的临床疗效及安全性。方法:1所选研究对象均来自于2015年5月~2016年10月,河北省中医院肛肠门诊确诊为脾肾阳虚型功能性便秘的患者。2采用前瞻性临床随机对照的研究方法,将符合本研究纳入标准的70例患者,随机分为中药组和对照组;中药组35例用温肾健脾法治疗,对照组35例用聚乙二醇4000治疗。中药组脱落病例1例,对照组剔除病例1例,终止病例2例,最终参与统计分析患者共66例,治疗组34例,对照组32例。疗程均为4周,治疗后随访1个月。3疗程结束后对两组病例治疗前后主要症状消失率、次要症状消失率、症状总积分、中医症候疗效、远期疗效、安全性指标进行统计学分析,做出评价。4采用SPSS21.0统计学软件对数据进行分析。计量资料符合正态分布,表示为均数±标准差((?)±s),运用t检验;不符合正态分布及方差齐性的运用秩和检验;计数资料运用c2检验。以P0.05,表示两组比较有统计学意义,具有可比性;以P0.01,表示两组比较具有显著性差异。结果:1经统计学软件分析,两组病例年龄、性别、病程、病情轻重、治疗前症状总积分无统计学差异(P0.05),具有可比性。2临床症状的消失率:中药组患者治疗大便性质,腹中冷痛、喜温,四肢不温的消失率优于聚乙二醇4000散(P0.05),而两组患者在排便间隔,排便时间,排便困难,面色fD白,小便清长方面治疗效果相当。3临床症状疗效评价:中药组总有效率为94.12%,对照组总有效率81.25%,经统计学分析,两组总有效率对比有统计学意义(P0.05),提示中药组在治疗脾肾阳虚型功能性便秘疗效上优于对照组。4中药组及对照组治疗前后中医症状总积比较P0.01,提示中药组在中医症状总积分方面治疗后较治疗前改善显著。对照组P0.01,提示对照组患者在中医症候总积分方面治疗后亦改善显著。中药组与对照组在治疗后效果比较,经秩和检验P0.01,说明中药组效果明显优于对照组,两组治疗后在中医症状总积分方面存在显著性差异。5两组患者治疗1个月随访,中药组复发率为20%,对照组复发率为36.84%,P0.05,具有统计学意义,说明远期疗效中药组优于对照组。6安全性分析:中药组与对照组治疗前后血常规、尿常规、便常规+潜血试验、肝功、肾功及心电图等检查未见明显异常,所用中药组(温肾健脾法)及聚乙二醇4000治疗脾肾阳虚功能性便秘未见明显不良反应,具有安全性。结论:1温肾健脾法能有效改善脾肾阳虚型功能性便秘患者的临床症状。2温肾健脾法治疗脾肾阳虚型功能性便秘与聚乙二醇4000散比较,均能明显改善其临床症状,总有效率优于对照组。3温肾健脾法能有效改善脾肾阳虚型功能性便秘患者大便性质及中医症候中的腹中冷痛、喜温,四肢不温等症状,其治疗后总积分明显优于对照组。4温肾健脾法治疗脾肾阳虚型功能性便秘的远期疗效好,复发率低,安全可靠,值得进一步深入研究和探讨。
[Abstract]:Objective: to observe the clinical efficacy and safety of warming kidney and invigorating spleen in the treatment of functional constipation with deficiency of spleen and kidney yang. Methods from May 2015 to October 2016, the patients with functional constipation of spleen and kidney yang deficiency type were selected from May 2015 to October 2016 in Hebei Provincial traditional Chinese Medicine Hospital. Seventy patients who met the criteria of this study were randomly divided into two groups: the Chinese medicine group (35 cases) and the control group (35 cases) treated with the method of warming the kidney and strengthening the spleen; the control group (35 cases) were treated with polyethylene glycol 4000 (PEG). There were 1 case of shedding in the Chinese medicine group, 1 case of elimination and 2 cases of termination in the control group. 66 cases were involved in the statistical analysis, 34 cases in the treatment group and 32 cases in the control group. The course of treatment was 4 weeks. After 1 month follow up for 1 month, the main symptoms disappeared rate, secondary symptom disappearance rate, symptom total score, TCM symptom curative effect, long-term curative effect, safety index before and after treatment in two groups were analyzed statistically. The data were analyzed by SPSS21.0 statistical software. The measured data accord with normal distribution, which is expressed as mean 卤standard deviation) 卤sg, using t test, using rank sum test for nonconforming normal distribution and homogeneity of variance, and using c2 test for counting data. The comparison between the two groups was statistically significant and comparable with P0.05, and the difference between the two groups was significant with P0.01. Results the age, sex, course of disease, severity of illness, total score of symptoms before treatment were not significantly different between the two groups by statistical software analysis, and the rate of disappearance of clinical symptoms was comparable. 2. The Chinese medicine group had the nature of stool treatment, the cold pain in abdomen, the rate of disappearance of clinical symptoms was comparable (P < 0.05). The disappearance rate of non-warm limbs was better than that of polyethylene glycol 4000 powder (P0.05A), and the defecation interval, defecation time, defecation difficulty, and fD white face between the two groups. The total effective rate of the traditional Chinese medicine group was 94.12, and the total effective rate of the control group was 81.255.The total effective rate was statistically analyzed. The total effective rate of the two groups was significantly higher than that of the control group (P 0.01), which indicated that the TCM group was superior to the control group (P 0.01) in the treatment of functional constipation with deficiency of spleen and kidney yang. The total symptom score was significantly improved after treatment than before treatment. P0.01 in the control group suggested that the total score of TCM symptoms in the control group also improved significantly after treatment. Compared with the control group, the effect of TCM group was significantly better than that of the control group by rank sum test (P0.01). There was significant difference in the total score of TCM symptoms between the two groups after treatment. 5 patients in the two groups were followed up for 1 month. The recurrence rate of TCM group was 20, and that of control group was 36.84g / P0.05, which showed that the long-term curative effect of TCM group was better than that of control group (P 0.05). The safety analysis of TCM group was superior to that of control group: blood routine, urine routine, routine occult blood test, liver function before and after treatment in Chinese medicine group and control group. There was no obvious abnormality in renal function and electrocardiogram. The treatment of functional constipation due to deficiency of spleen and kidney with traditional Chinese medicine (warming kidney and invigorating spleen) and polyethylene glycol 4000 was safe. Conclusion the method of warming kidney and invigorating spleen can effectively improve the clinical symptoms of patients with functional constipation with deficiency of spleen and kidney yang. 2 the treatment of functional constipation of deficiency of spleen and kidney yang by warming kidney and strengthening spleen with polyethylene glycol 4000 powder can obviously improve the clinical symptoms of functional constipation. The total effective rate was better than that of the control group. 3. The method of warming the kidney and strengthening the spleen could effectively improve the stool nature of the patients with functional constipation with deficiency of spleen and kidney yang and the symptoms of cold abdominal pain, warm-loving and unwarm limbs in the symptoms of traditional Chinese medicine, etc. The total score after treatment was obviously superior to that of control group (group 4) in the treatment of functional constipation with deficiency of spleen and kidney yang. The long-term curative effect was good, the recurrence rate was low, and the total score was safe and reliable, which was worthy of further study and discussion.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.35

【参考文献】