加味四逆散治疗非糜烂性反流病肝胃不和证的临床研究

发布时间：2018-06-06 13:01

本文选题：非糜烂性反流病 + 肝胃不和证　；参考：《山西中医学院》2016年硕士论文

【摘要】：目的:本课题旨在观察加味四逆散治疗非糜烂性反流病肝胃不和证的临床疗效,进一步探讨加味四逆散治疗本病的作用机制,通过临床研究为治疗NERD肝胃不和证探讨新方法。方法:1.本研究全部病例选自2014年10月至2015年12月山西中医学院附属医院脾胃病科门诊的患者。采用随机对照的方法,选取符合中西医纳入标准的60例患者,分为治疗组30例,对照组30例。2.治疗组给予中药加味四逆散,1剂/日;对照组给予枸橼酸莫沙必利片,5mg/次,3次/日。两组病人均每周复诊一次,共治疗4周,在治疗开始前及治疗后两组患者填写RDQ量表、中医证候程度积分表,行食管压力测定,对所有资料进行统计分析,观察治疗前后两组RDQ量表积分、中医证候程度积分及食管压力测定值的变化。3.采用SPSS18.0统计软件对所有数据进行统计分析。结果:1.临床症状改善情况(1)治疗组和对照组患者RDQ积分改善总有效率分别为83.33%和70.00%,两组比较差异有统计学意义(P0.05)。(2)两组患者RDQ积分治疗前后比较,差异均有统计学意义(P0.05);治疗后两组患者RDQ总积分比较,差异有统计学意义(P0.05)。(3)治疗组RDQ单项积分进行组内比较,差异均有统计学意义(P0.05),对照组在烧心、泛酸、反流方面的改善差异有统计学意义(P0.05);治疗后两组RDQ单项积分分别比较,四个单项症状的改善差异均有统计学意义(P0.05)。(4)治疗组中医证候改善总有效率为86.66%,对照组为73.00%,差异有统计学意义(P0.05)。(5)治疗前后治疗组各单项症状差异均有统计学意义(P0.05),对照组在改善反酸、烧心、嗳气、纳差、恶心方面差异有统计学意义(P0.05),在改善胸痛牵及两胁、情绪不畅加重方面差异无统计学意义(P0.05);两组进行组间比较,在改善反酸、烧心、胸痛牵及两胁、嗳气、情绪不畅加重方面治疗组与对照组差异有统计学意义(P0.05),在纳差、恶心方面差异无统计学意义(P0.05)。2.食管动力改善情况(1)治疗后治疗组与对照组下食管括约肌压力(LESP)较治疗前均不同程度增加分别为:23.85±3.16mmHg vs 12.24±5.86mmHg;16.69±5.18mmHg vs 11.85±6.38mmHg,差异均有统计学意义(P0.05);组间比较治疗组优于对照组(P0.05)。(2)治疗后治疗组与对照组食管远端波幅(PA)较治疗前增加分别为:72.70±28.76mmHg vs 54.39±24.13mmHg,P0.05;64.89±25.17mmHg vs57.82±22.33mmHg,差异均有统计学意义(P0.05),组间比较治疗组优于对照组(P0.05)。(3)治疗后治疗组与对照组湿咽成功率均不同程度增加分别为:72.53±23.62%vs 47.50±26.13%;66.71±36.04%vs 46.42±32.61%,差异均有统计学意义(P0.05),两组组间比较差异无统计学意义(P0.05)。(4)治疗后治疗组与对照组远端收缩积分(DCI)均不同程度增加分别为:974.30±428.81mmHg.cm.s vs732.08±191.60mmHg.cm.s;936.21±331.28mmHg.cm.s vs 694.23±178.36mmHg.cm.s,差异均有统计学意义(P0.05),两组组间比较差异无统计学意义(P0.05)。3.安全性指标:治疗前后两组均未见明显异常不良反应。结论:1.两组患者RDQ量表积分都有明显改善,加味四逆散组总有效率83.33%,莫沙必利组总有效率70.00%,结果显示治疗组RDQ量表积分改善优于对照组。通过RDQ量表单项积分也可以看出,加味四逆散改善患者烧心、胸痛、泛酸、反流症状的作用优于对照组。2.治疗组中医证候总有效率86.66%,对照组中医证候总有效率73.33%,治疗组总有效率高于对照组。说明加味四逆散在改善NERD患者中医证候方面的总疗效优于对照组。3.加味四逆散组在改善患者肝胃不和证,如反酸、烧心、胸痛牵及两胁、嗳气、情绪不畅加重病情等中医证候方面具有明显的疗效,明显优于对照组。说明加味四逆散能明显改善NERD患者肝胃不和证候。4.两组均能提高改善NERD患者的LESP、PA、湿咽成功率、DCI,而加味四逆散在提高患者LESP、PA方面优于对照组。说明NERD患者可能存在食管远端动力障碍,运用加味四逆散提高LES压力,改善食管运动障碍以及加强体部运动,起到抗反流的作用,改善患者胃食管反流症状。5.试验前后患者的血尿便三大常规及肝肾功能检测均未见异常,未发生胃肠道过敏反应。说明加味四逆散临床运用安全。
[Abstract]:Objective: the purpose of this study is to observe the clinical efficacy of Jiawei four inverse powder in the treatment of liver stomach disharmony of non erosive reflux disease, and to further explore the mechanism of adding flavored four inverse powder in the treatment of this disease and to explore new methods for the treatment of NERD liver stomach disharmony through clinical study. Methods: 1. cases were selected from October 2014 to December 2015 in Shanxi traditional Chinese medicine. The patients in the outpatient department of the spleen and stomach department of the Hospital Affiliated Hospital were randomly selected to select 60 patients conforming to the standard of traditional Chinese and Western medicine, which were divided into 30 cases in the treatment group, and 30 cases in the control group, which were given the traditional Chinese medicine plus four inverse powder, 1 doses / day, and the control group with Mosapride Citrate Tablets, 5mg/ times, 3 times per day. All the two groups were treated once a week, a total of the patients were revisited once a week, a total of the patients were revisited once a week, a total of 60 patients were retreated once a week, a total of the patients were revisited once a week, altogether. After 4 weeks of treatment, before and after the treatment, two groups of patients were filled in RDQ scale, TCM syndrome degree integral table, esophageal pressure measurement, all data were statistically analyzed, two groups of RDQ scale integral before and after treatment, TCM syndrome degree integral and change of esophageal pressure measurement value.3. were applied to all data by SPSS18.0 statistical software. Results: 1. the improvement of clinical symptoms (1) the total effective rate of RDQ integral improvement in the treatment group and the control group was 83.33% and 70% respectively. The two groups were statistically significant (P0.05). (2) the difference between the two groups of patients before and after the RDQ integral treatment was statistically significant (P0.05); the total RDQ score of the two groups after the treatment was compared. Statistical significance (P0.05). (3) the treatment group RDQ single score in group comparison, the difference was statistically significant (P0.05), the control group in the heart, pantothenate, reflux improvement has statistical significance (P0.05); after the treatment, the two groups of RDQ single score, respectively, the difference between the four symptoms of the improvement were statistically significant (P0.05). (4) treatment. The total effective rate of TCM syndrome in the treatment group was 86.66%, the control group was 73%, the difference was statistically significant (P0.05). (5) the difference of single symptom in the treatment group before and after treatment was statistically significant (P0.05). The control group had statistical significance (P0.05) in improving anti acid, heartburn, belching, nausea and nausea, and in improving chest pain and two flank, emotion was not good. There was no statistical significance (P0.05) in the difference between the two groups. The difference between the treatment group and the control group was statistically significant (P0.05) in the improvement of anti acid, heart burning, chest pain and two coerced, belching, and bad mood aggravation. There was no significant difference in nausea (P0.05).2. esophageal motility improvement (1) after treatment group. Compared with the control group, the lower esophageal sphincter pressure (LESP) increased in different degrees, respectively, 23.85 + 3.16mmHg vs 12.24 + 5.86mmHg, 16.69 + 5.18mmHg vs 11.85 + 6.38mmHg, the difference was statistically significant (P0.05), and the comparison group was superior to the control group (P0.05). (2) the distal end of the esophagus (PA) in the treatment group and the control group was compared with the treatment. The anterior increase was 72.70 + 28.76mmHg vs 54.39 + 24.13mmHg, P0.05, 64.89 + 25.17mmHg vs57.82 + 22.33mmHg, and the difference was statistically significant (P0.05). The comparison between the group and the control group was superior to the control group (P0.05). (3) the difference between the treatment group and the control group was 72.53 + 23.62%vs 47.50 + 26.13%, 66.71 + 36.04%. Vs 46.42 + 32.61%, the difference was statistically significant (P0.05), there was no significant difference between the two groups (P0.05). (4) the distal contraction integral (DCI) of the treatment group and the control group increased in varying degrees, respectively, 974.30 + 428.81mmHg.cm.s vs732.08 + 191.60mmHg.cm.s, 936.21 + 331.28mmHg.cm.s vs 694.23 + 178.36mmHg.cm.s, the differences were all There was statistical significance (P0.05). There was no significant difference (P0.05).3. safety index between the two groups. There was no obvious abnormality in the two groups before and after treatment. Conclusion: the scores of the RDQ scale in the 1. two groups were obviously improved, the total effective rate of the Jiawei four converse group was 83.33%, the total effective rate of the mosapride group was 70%, and the result showed the RDQ quantity in the treatment group. The improvement of table integral was better than that of the control group. Through the integral of RDQ form item, it can be seen that the effect of adding four inverse powder to improve the patient's heartburn, chest pain, pantothenic acid and reflux symptoms is better than that of the control group.2., the total effective rate of TCM syndrome in the control group is 73.33%, the total effective rate of the treatment group is higher than that of the control group. It shows that the addition of four inverses in the treatment group is more than that of the control group. The total curative effect of improving the TCM syndrome of NERD patients is better than that of the control group.3. four in the group of the anti dispersal group in improving the syndrome of liver and stomach disharmony of the patients, such as anti acid, heart burning, chest pain, two coerced, belching, and bad mood aggravation of the TCM syndrome, which is obviously better than that in the group. It shows that the addition of four inverse powder can obviously improve the liver of the patients with NERD. Gastric Disharmony Syndrome.4. two can improve the LESP, PA, wet throat success rate of NERD patients, DCI, and the addition of flavored four inverse scatter is superior to the control group in improving the patient's LESP and PA. It shows that the patients with NERD may have the distal esophageal motility disorder, improve the LES pressure, improve the esophageal motility and strengthen the body movement, and play anti reflux in the patients with NERD. The three major routine and liver and kidney function tests before and after the.5. test of the patients with gastroesophageal reflux symptoms were not found to be abnormal and no gastrointestinal anaphylaxis occurred. It was indicated that the clinical application of Jiawei four inverse dispersion was safe.
【学位授予单位】：山西中医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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