行气散结除痰法治疗痰气互结型咽喉反流的临床研究

发布时间：2018-06-19 10:45

本文选题：咽喉反流 + 胃食管反流　；参考：《辽宁中医药大学》2017年硕士论文

【摘要】：目的:咽喉反流(Laryngopharyngeal Reflux,LPR)又称咽喉反流疾病,是指胃内酸性H离子和胃蛋白酶原,大部分随气体、小部分随液体经食管到达喉、咽、气管、支气管、中耳、鼻等所引起的临床症候群的总称,由于该病患者所表现的临床症状与一些其他原因引起的咽喉疾病所表现的临床症状比较相似,常常与慢性咽炎、胃食管反流病相混淆,所以咽喉反流诊断率不高,治疗效果不佳,越来越得到耳鼻咽喉科医生的高度重视。对于咽喉反流患者通常于促进胃肠动力药和质子泵抑制剂治疗为首选治疗,但随着临床研究的长期进行,患者病情的发展,医生不易掌握这些药物的治疗时间和剂量,长期使用会出现减少钙吸收导致骨质疏松和盆骨骨折,提高了肺炎的发生率以及降低了抗血小板凝集药的作用等不良反应缺点,并对某些咽喉反流患者治疗效果不明显,这些用药情况就让我们在临床上不断的探索与研究,目前祖国医学对于咽喉反流的研究并不完善,但是我们祖国医学有着自己的优势,根据其中医辨证论治的特点以及中医整体观念,该病是由于思虑伤脾或肝郁日久,横逆犯脾,以致脾失健运,聚湿生痰,痰气互结阻于咽喉而发病,中药汤剂对咽喉反流治疗具有较好的临床疗效,本研究就是观察行气散结除痰法治疗痰气互结型咽喉反流的临床疗效。方法:按照随机对照原则,对符合纳入标准的咽喉反流患者70例分为治疗组与对照组各35例,对照组为口服奥美拉唑肠溶胶囊40mg日二次,治疗组为在对照组基础上口服行气散结除痰之中药汤剂。治疗两个疗程后进行随访,通过对比患者治疗前后的反流症状指数得分以及反流体征检查得分,以评估治疗效果。结果:1.两组患者在性别、年龄、病程的数据经统计学分析均无显著性差异(P0.05),提示两组具有可比性。2.用药前两组患者进行反流症状指数得分比较无显著性差异(P0.05),提示具有可比性;用药后两组患者进行反流症状指数得分比较,差异有统计学意义(P0.05)。用药前两组患者进行反流体征得分比较无显著性差异(P0.05),提示具有可比性;用药后两组患者反流体征得分比较,差异有统计学意义(P0.05)。用药前两组患者进行视觉模拟评分无显著性差异(P0.05),提示具有可比性;用药后两组患者进行视觉模拟评分比较,差异有统计学意义(P0.05)。3.用药后,对照组总有效率为74.29%,治疗组总有效率为88.57%,治疗组总有效率明显高于对照组总有效率,说明行气散结除痰之中药汤剂治疗痰气互结型咽喉反流有效。结论:运用行气散结除痰之中药汤剂治疗咽喉反流疾病,突出了中医的辨证论治的特点,临床疗效较好,值得临床推广和应用。
[Abstract]:Objective: largopharyngopharyngeal reflux (LPR), also known as throat reflux disease, refers to acidic H ions and pepsinogen in the stomach, most of which follow gas, and a small part of the fluid passes through the esophagus to the larynx, pharynx, trachea, bronchus, middle ear. The general term for clinical syndromes caused by nose and other diseases, because the clinical symptoms of patients with the disease are similar to those of throat diseases caused by some other causes, and are often confused with chronic pharyngitis and gastroesophageal reflux disease. Therefore, the diagnosis rate of pharynx and larynx reflux is not high and the therapeutic effect is not good, which has been paid more and more attention by the doctors of otolaryngology. For patients with pharynx and throat reflux, the first choice is to promote gastrointestinal motility drugs and proton pump inhibitors. However, with the long-term clinical study and the development of the patient's condition, it is difficult for doctors to control the treatment time and dosage of these drugs. Long-term use of calcium may lead to osteoporosis and pelvic fractures, increase the incidence of pneumonia and reduce the role of antiplatelet agglutinin, and the treatment of some patients with pharynx and larynx reflux is not obvious. These medication conditions allow us to continue to explore and study clinically. At present, the study of pharynx and larynx reflux in Chinese medicine is not perfect, but our motherland medicine has its own advantages. According to the characteristics of TCM syndrome differentiation and treatment and the whole concept of TCM, the disease is caused by thinking about the injury of the spleen or liver depression for a long time, transversely invading the spleen, causing the spleen to lose health and transportation, accumulating dampness to generate phlegm, and phlegm and qi intertwining to block the pharynx and larynx. Traditional Chinese medicine decoction has a good clinical effect on pharynx and larynx reflux. This study is to observe the clinical effect of the method of removing phlegm and eliminating phlegm and qi to eliminate phlegm and throat regurgitation. Methods: according to the principle of randomized control, 70 patients with pharynx and larynx reflux were divided into two groups: treatment group (n = 35) and control group (n = 35). The control group was treated with omeprazole enteric-coated capsule (40mg) twice a day. The treatment group was treated with traditional Chinese medicine decoction for removing phlegm. The patients were followed up after two courses of treatment to evaluate the effect of treatment by comparing the scores of reflux symptom index and reflux signs before and after treatment. The result is 1: 1. There was no significant difference in sex, age, course of disease between the two groups by statistical analysis, indicating that the two groups have comparability. 2. There was no significant difference in the score of reflux symptom index between the two groups before medication, indicating comparability, and there was significant difference in the score of reflux symptom index between the two groups after treatment. There was no significant difference in the scores of reflux signs between the two groups before medication, indicating comparability, and there was significant difference in the scores of reflux signs between the two groups. There was no significant difference in visual analogue score between the two groups before medication, indicating comparability, and there was significant difference in visual analogue score between the two groups after medication. The total effective rate was 74.29 in the control group and 88.57 in the treatment group. The total effective rate in the treatment group was significantly higher than that in the control group. Conclusion: the treatment of pharynx and larynx reflux with traditional Chinese medicine decoction for removing phlegm and qi dispersing highlights the characteristics of syndrome differentiation and treatment of traditional Chinese medicine, and the clinical effect is good, and it is worth popularizing and applying in clinic.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R276.1

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