清胃降逆方治疗肝胃郁热型胃食管反流病的临床观察及血管活性肠肽的影响

发布时间：2018-06-28 21:21

本文选题：胃食管反流病 + 肝胃郁热证　；参考：《安徽中医药大学》2016年硕士论文

【摘要】：目的本研究主要观察清胃降逆方治疗肝胃郁热型胃食管反流病患者的临床疗效及血管活性肠肽的影响。方法本研究选择70例符合诊断标准的胃食管反流病患者,严格按照随机化原则,分为治疗组和对照组,每组各35例。两组均给予雷贝拉唑和莫沙必利口服,治疗组在此基础上加用清胃降逆方水煎剂,治疗期间均停用其它药物,治疗8周,观察患者治疗前后的中医证候积分、电子胃镜下食管黏膜的变化及血管活性肠肽水平的变化情况,并进行统计学分析比较。结果(1)临床综合疗效:治疗组临床痊愈15例,显效者有10例,有效者为7例,无效者3例,总有效率为91.43%;对照组临床痊愈10例,显效者8例,有效有6例,无效为11例,总有效率为68.57%。两组进行比较,治疗组明显优于对照组,差异有统计学意义(P0.05)。(2)中医证候疗效比较:(1)各项症状的综合疗效比较:两组在烧心、反酸、胸骨后灼痛三个主要症状的比较,差异无统计学意义(P0.05)。而在脘腹胀满、胃部嘈杂、口干口苦、心烦易怒、嗳气等次要症状症状上,治疗组优于对照组(P0.05),差异有统计学意义。(2)中医证候总积分比较:两组内治疗前后比较,在主要症状总积分、次要症状总积分及综合症状总积分上差异有统计学意义(P0.05);两组组间治疗后比较,在主要症状的总积分上,差异无统计学意义(P0.05),在次要症状总积分及综合症状总积分两个方面上,差异有统计学意义(P0.05)。(3)各项症状积分的比较:各组在治疗后优于治疗前,差异有统计学意义(P0.05);经过2个疗程治疗后,在反酸、烧心症状的改善程度上,两组的治疗效果相当(P0.05),在其他临床症状的缓解程度上,治疗组明显优于对照组(P0.05)。(3)电子胃镜下黏膜象比较:经治疗后,两组在改善黏膜炎症方面,内镜下黏膜象表现与治疗前均有不同程度地改善,但治疗组明显优于对照组(P0.05)。(4)血清血管活性肠肽比较:治疗后,两组血清VIP均下降,而治疗组血清VIP的水平下降明显,与对照组比较,差异有统计学意义(P0.05)。结论清胃降逆方联合西药可以明显改善肝胃郁热型胃食管反流病患者的临床症状和内镜下食管黏膜炎症的程度,同时也能够降低血清VIP的水平,临床上值得进一步研究及应用。
[Abstract]:Objective to observe the clinical effect of Qingwei Jiangni recipe in treating gastroesophageal reflux disease with liver and stomach stagnation and the effect of vasoactive intestinal peptide. Methods 70 patients with gastroesophageal reflux disease (GERD) who met the diagnostic criteria were randomly divided into treatment group (n = 35) and control group (n = 35). Both groups were given rabeprazole and mosapride orally. The treatment group was treated with Qingwei Jiangni decoction on this basis. During the treatment, other drugs were stopped and treated for 8 weeks. The TCM syndromes scores before and after treatment were observed. The changes of esophageal mucosa and the level of vasoactive intestinal peptide under electronic gastroscopy were analyzed and compared statistically. Results (1) Clinical comprehensive curative effect: in the treatment group, 15 cases were cured, 10 cases were effective, 7 cases were effective, 3 cases were ineffective, and the total effective rate was 91.43%, while in the control group, 10 cases were cured, 8 cases were effective, 6 cases were effective, 11 cases were ineffective. The total effective rate was 68.57. Two groups were compared, the treatment group was significantly better than the control group, the difference was statistically significant (P0.05). (2) TCM syndrome efficacy comparison: (1) comparison of the comprehensive efficacy of symptoms: the two groups in heart burning, acid regurgitation, sternal pain after the comparison of three main symptoms, The difference was not statistically significant (P0.05). However, the treatment group was superior to the control group (P0.05) in the secondary symptoms of abdominal distension, gastric noise, dry mouth, irritability, belching and other minor symptoms. (2) comparison of the total score of TCM syndromes: comparison between the two groups before and after treatment, There were significant differences in the total scores of main symptoms, secondary symptoms and comprehensive symptoms between the two groups (P0.05); after treatment, there were significant differences in the total scores of major symptoms between the two groups. The difference was not statistically significant (P0.05). The difference was statistically significant in the total score of secondary symptoms and the total integral of comprehensive symptoms (P0.05). (3). The difference was statistically significant (P0.05); after two courses of treatment, the improvement of the symptoms of regurgitation and heartburn was similar between the two groups (P0.05), and the degree of remission of other clinical symptoms was similar (P0.05). The treatment group was better than the control group (P0.05). (3) compared with the electronic gastroscope mucosal image: after treatment, the two groups in improving mucosal inflammation, endoscopic mucosal image and before treatment were improved in varying degrees. But the treatment group was significantly better than the control group (P0.05). (4) serum vasoactive intestinal peptide comparison: after treatment, the two groups serum VIPs decreased significantly, compared with the control group, the difference was statistically significant (P0.05). Conclusion Qingwei Jiangni prescription combined with western medicine can obviously improve the clinical symptoms and the degree of endoscopic esophagomucosal inflammation in patients with gastroesophageal reflux with liver and stomach stagnation heat, and can also reduce the level of serum VIP, which is worthy of further study and application.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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