肠复安治疗腹泻型肠易激综合征肝郁脾虚证的临床研究

发布时间：2018-04-24 06:01

本文选题：腹泻型肠易激综合征 + 肠复安　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:观察肠复安汤治疗腹泻型肠易激综合征的临床疗效,通过症状量表评估各项症状改善情况和总体疗效;运用超声方法检测IBS-D患者近端胃容积前后变化,观察近端胃运动功能,以求证IBS-D的近端胃运动紊乱,并通过中药治疗前后及与对照组的比较,探讨中药对近端胃功能影响。方法:将符合条件的48例IBS患者随机分为治疗组和对照组,治疗组、对照组各24例,予培菲康治疗,治疗组加用自拟方肠复安汤剂口服,治疗疗程6周。治疗前、治疗2周、4周、6周后分别予症状评分。两组病患治疗前后分别以超声检测近端胃容积。检测方法是:检查者空腹8小时以上,饮温水500ml,即刻测量近端胃容积,记为V1,30min后再次测量胃容积,记为V2,近端胃排空分数计算公式EF=(V1-V2)/V1×100%。比较两组治疗前后的临床疗效及近端胃容积、排空分数变化,另选20例健康者,依上述方法测定近端胃容积值和近端胃排空分数,作为正常对照。结果:入组患者共48例,研究过程中对照组2例因家庭住址较远回访困难脱落,治疗组1例因工作出差外地无法续服中药,中止研究。最终共45例患者完成本次课题研究,进入数据统计分析。临床疗效结果显示:治疗组总有效率91.3%、愈显率69.57%,对照组总有效率72.73%、愈显率27.27%,治疗组总体疗效优于对照组,两组比较差异有统计学意义(P0.05);治疗前后症状总积分比较,治疗组、对照组均明显低于治疗前,差异有统计学意义(P0.01);治疗后两组症状积分比较,治疗组低于对照组,差异有统计学意义(P0.01);治疗组在腹痛、腹泻、腹胀、多思多虑易紧张、纳少脘痞这5项症状积分低于对照组,差异有统计学意义(P0.05)。近端胃运动观察结果显示:治疗前,治疗组和对照组近端胃排空分数均高于正常组,差异有统计学意义(P0.05);治疗后,治疗组和对照组近端胃排空分数分别与正常组比较,无统计学差异(P0.05),治疗组与对照组之间亦无统计学差异(P0.05);治疗组治疗前后比较,P=0.0540.05,对照组治疗前后比较,P=0.2760.05,差异均无统计学意义。结论:肠复安汤用于治疗IBS-D能够显著提高临床疗效,可以很好地减轻IBS-D患者症状,同时对本病的情志异常亦有改善作用,说明中医药是治疗IBS的有效方法。超声液体观察是胃运动功能检测的重要方法,本次试验通过该方法再次证实IBS-D的近端胃运动功能存在一定异常;治疗后胃排空分数减低,但治疗组与治疗前及与对照组比较均未见统计学差异,未能证实中药能改善上消化道运动紊乱,中药治疗IBS-D的作用机制仍需进一步探究。
[Abstract]:Objective: to observe the clinical effect of Changfuan decoction in treating diarrhea irritable bowel syndrome, to evaluate the improvement of symptoms and the overall curative effect by symptom scale, to detect the changes of proximal gastric volume in patients with IBS-D by ultrasonic method. The proximal gastric motility was observed in order to prove the proximal gastric motility disorder of IBS-D. The effects of traditional Chinese medicine on proximal gastric function were compared before and after treatment with traditional Chinese medicine (TCM) and compared with the control group. Methods: 48 patients with IBS were randomly divided into the treatment group and the control group, the treatment group and the control group (n = 24 each) were treated with Peifeikang, and the treatment group was treated with self-made Changfu an decoction orally for 6 weeks. Symptoms were scored before 2 weeks and 4 weeks and 6 weeks after treatment. The proximal gastric volume was measured by ultrasound before and after treatment. The test method was as follows: the examiner had fasting for more than 8 hours, drank warm water 500 ml, immediately measured the proximal gastric volume, and then remeasured the gastric volume after 30 minutes as V1: V2. The formula for calculating the proximal gastric emptying fraction was EF=(V1-V2)/V1 脳 100. The clinical efficacy and the changes of proximal gastric volume and emptying fraction were compared between the two groups before and after treatment. 20 healthy subjects were selected to measure the proximal gastric volume and proximal gastric emptying fraction as normal control. Results: there were 48 patients in the study group. In the course of the study, 2 cases in the control group had difficulty falling off due to their home address, and one case in the treatment group was unable to continue taking Chinese medicine because of work trip. Finally, a total of 45 patients completed the study and entered the statistical analysis of the data. The results showed that the total effective rate of the treatment group was 91.3%, the effective rate of the treatment group was 69.57, the total effective rate of the control group was 72.73 and the effective rate of the treatment group was 27.27. The overall curative effect of the treatment group was better than that of the control group, and the difference between the two groups was statistically significant (P 0.05). The scores of symptoms in the treatment group were significantly lower than those in the control group (P 0.01), and the difference was statistically significant in the treatment group (P < 0.01). The scores of these five symptoms were lower than those of the control group, and the difference was statistically significant (P 0.05). The results of proximal gastric motility observation showed that the scores of proximal gastric emptying in the treatment group and the control group were higher than those in the normal group before treatment, and the difference was statistically significant (P 0.05), and after treatment, the proximal gastric emptying fraction in the treatment group and the control group were compared with those in the normal group, respectively. There was no statistical difference between the treatment group and the control group, and there was no statistical difference between the treatment group and the control group, and there was no significant difference between the treatment group and the control group before and after treatment, and there was no significant difference between the treatment group and the control group before and after treatment. Conclusion: Changfuan decoction can significantly improve the clinical efficacy of IBS-D, can alleviate the symptoms of IBS-D patients, and improve the emotional abnormality of the disease, indicating that Chinese medicine is an effective method for the treatment of IBS. Ultrasonic fluid observation is an important method for detecting gastric motor function. This method has proved that the proximal gastric motility of IBS-D is abnormal, and the gastric emptying fraction is decreased after treatment. However, there was no statistical difference between the treatment group and the control group before treatment and compared with the control group. It was not proved that the Chinese medicine could improve the upper digestive tract movement disorder, and the mechanism of the treatment of IBS-D still needs to be further explored.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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