健脾渗湿汤治疗胃食管反流病（脾虚湿阻型）的临床研究

发布时间：2018-04-22 06:10

本文选题：胃食管反流病 + 脾虚湿阻型　；参考：《河南中医药大学》2016年硕士论文

【摘要】：目的:通过观察胃食管反流病(脾虚湿阻型)患者治疗前后中医证候评分、临床安全性、不良反应发生率及疾病复发率等指标的变化,研究健脾渗湿汤方的临床疗效,对其全面的客观的评估、并试从理论上阐述其治疗机制,为该方在中医临床上的应用提供参考。方法:选择符合纳入标准并经排除标准筛选后的68例患者,均来自洛阳市第二中医院2015年4月至2015年9月肝胆脾胃科就诊的门诊患者,共入组64例,采用分层随机分组,分为治疗组32例,对照组32例。对照组给予一般治疗加用奥美拉唑肠溶胶囊(奥克,常州四药制药有限公司,生产批号为:120605),20mg/粒,每次20mg,每日2次,口服。治疗组在对照组治疗的基础上给予健脾渗湿汤方(麸炒白术12g,党参12g,炒山药24g,茯苓12g,鸡内金15g,炒白扁豆24g,桔梗10g,薏苡仁24g,麸炒麦芽30g,川厚朴12g,炙甘草6g,砂仁6g)治疗,方药均由洛阳市第二中医院统一煎制,采用YFY13/3A型号的煎药机煎药,每1剂煎取400ml,分装为2袋,每袋200ml,每次1袋,每日2次,早晚加热后口服;两组疗程均为4周;分别观察并记录两组患者治疗前后的临床症状、中医证候积分等方面的变化。治疗结束后第3个月末回访患者,比较两组患者的远期疗效。结果:临床疗效观察显示:1.本研究纳入病例64例,脱落4例,试验结束后治疗组30例,对照组30例,两组治疗前一般情况如性别、年龄、病程等方面无明显差异(P0.05),具有可比性;2.总体疗效比较:治疗组总有效率96.67%明显优于对照组总有效率76.67%,两组疗效差异有显著性统计学意义(P0.05)3.治疗组在改善患者烧心、反酸、胸骨后疼痛、脘腹痞满等方面的疗效明显优于对照组,但两组在改善神疲乏力、食欲不振两方面经统计学分析,无明显差异。4.治疗结束后第3个月末随访,治疗组的复发率明显低于对照组,说明加用健脾渗湿汤在治疗胃食管反流病(脾虚湿阻型)的远期疗效方面更有优势。结论:健脾渗湿汤方用于胃食管反流病(脾虚湿阻型),具有健脾行气、化湿和胃的作用,能够有效改善胃食管反流病患者的临床症状,且能明显降低远期复发率,在治疗过程中未发现明显的肝、肾功能损害,临床疗效确切,安全无不良反应,能减轻患者经济负担,值得临床推广。
[Abstract]:Objective: to observe the changes of TCM syndrome score, clinical safety, adverse reaction rate and disease recurrence rate before and after treatment in patients with gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). The comprehensive objective evaluation and the theoretical explanation of its therapeutic mechanism are discussed in order to provide a reference for the clinical application of the prescription in traditional Chinese medicine (TCM). Methods: Sixty-eight patients who met the inclusion criteria and were screened by exclusion criteria were selected from outpatient department of liver, gallbladder, spleen and stomach in Luoyang second traditional Chinese Medicine Hospital from April 2015 to September 2015. A total of 64 patients in the group were randomly divided into three groups. The patients were divided into treatment group (n = 32) and control group (n = 32). The control group was given general treatment plus omeprazole enteric-coated capsules (Oak, Changzhou four Medicines Pharmaceutical Co., Ltd.). The production lot number was 20 mg / granule, 20 mg / granule, 20 mg per time, twice a day, orally. On the basis of the treatment in the control group, the treatment group was treated with Jianpi osmosis decoction (12g of bran, 12g of Codonopsis, 24g of Chinese yam, 12g of Poria cocos, 15g of chicken Neijin, 24g of fried lentil, 10g of Platycodon grandiflorum, 24g of Coix seed, 30g of gluten fried malt, 12g of Sichuan magnolia, 6g of grilled licorice, 6g of sand kernel). The prescriptions were made by the second Chinese Medicine Hospital of Luoyang City. The decoction was made by YFY13/3A type decoction machine, 400 ml per dose, divided into 2 bags, 200 ml per bag, 1 bag per bag, 2 times a day, after heating in the morning and evening, the two groups were treated for 4 weeks. Observe and record the changes of clinical symptoms and TCM syndromes before and after treatment. The long-term outcomes of the two groups were compared at the end of the third month after treatment. Results: clinical observation showed that 1. 1. 64 cases were included in the study, 4 cases dropped out, 30 cases in the treatment group and 30 cases in the control group after the end of the trial. There was no significant difference between the two groups in general conditions such as sex, age and course of disease before treatment, and there was no significant difference between the two groups in such aspects as sex, age, course of disease, etc. The total effective rate of the treatment group was 96.67%, which was significantly better than that of the control group (76.67%). The difference between the two groups was statistically significant (P 0.05). The curative effect of the treatment group was better than that of the control group in improving heart burning, regurgitation, pain after sternum and abdominal fullness, but there was no significant difference between the two groups in improving fatigue and loss of appetite. The recurrence rate of the treatment group was significantly lower than that of the control group at the end of the third month after treatment, which indicated that the combination of Jianpi and Yishi decoction had more advantages in the treatment of gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). Conclusion: the decoction of invigorating spleen and infiltrating dampness can be used in gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). It has the functions of invigorating spleen, removing dampness and stomach. It can effectively improve the clinical symptoms of patients with gastroesophageal reflux disease, and can obviously reduce the long term recurrence rate. No obvious damage of liver and kidney function was found in the course of treatment, the clinical effect was definite, safe and no adverse reaction, it can reduce the economic burden of the patients, and it is worth popularizing in clinic.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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