针药结合治疗肝胃不和型胃食管反流病临床研究

发布时间：2018-06-30 07:45

本文选题：中药 + 针灸　；参考：《南京中医药大学》2017年硕士论文

【摘要】：本研究以中医对胃食管反流病肝胃不和证的患者为研究对象,观察患者使用单纯中药和针药结合组(中药合针灸)的治疗疗效,对比两个治疗方案的临床优势。分别从患者之工作、家庭、个性、饮食与针灸与中药疗效分析,探讨相关因素对患者症状改善之疗效影响。研究方法:本研究采用结构方程模式(structural equation modeling,SEM)提出研究架构,以最小偏微分法(PLS)和SPSS17.0进行数据分析及架构验证。临床研究共收集50例患者连续8周时间序列数据,因其中13例患者未能在本调查研究过程中持续观察8周,因此有效观察样本计37例患者。全部病患均给予胃食管反流病教育、合理饮食等基础治疗。单纯中药组的方药为左金丸合半夏厚朴汤加减。方药:黄连3g吴茱萸1g姜半夏10g厚朴10g茯苓10苏梗10g白芍10g炒白术10g柴胡5g炙甘草5g。每日1剂,水煎2次至300ml,分早、晚2次温服,4周为1个疗程,总共2个疗程。针药结合组的中药和单纯中药组的方药组成相同,其中针灸取穴以鸠尾、上脘、中脘、足三里、三阴交、内关、太冲为主穴治疗,针刺为常规泻法。留针30分钟,每周3次(隔日1次),比较两组之间的疗效差异。结果:(1)中药组与针药组均能有效治疗肝胃不和型胃食管反流病(2)中药组与针药组治疗前后主要症状以及伴随症状经配对以治疗前与第8周的差值进行成对T检定,中药组治疗前后主要症状都有明显改善,而中药组除了慢性咳嗽和大便不调无明显改善以外,其余伴随症状都有明显改善。(3)中药组与针药组患者治疗后,计算疗效指数,按照疗效评判标准统计显示,中药组临床痊愈1例,显效8例,有效5例,无效3例,总有效率为82.35%。针药组临床痊愈1例,显效11例,有效7例,无效1例,总有效率为90.00%。经统计分析,P=0.150.05,说明针药组在主要症状及伴随症状的改善方面明显优于中药组。(4)工作与饮食因子构面对患者有正向显著影响,改善工作压力与调整饮食习惯对患者主要与伴随症状有显著改善。家庭因子与个性因子构面对患者短期内多数未有明显改善,显示短期内患者不易改变家庭与个性因素的影响力。(5)实证结果显示治疗因素子构面治疗时间是对治疗患者具有正向显著影响,本研究显示治疗8周后对改善患者症状产生显著影响的改善;治疗时间越长患者改善程度越高。(6)主要症状在针药组与中药组分别跑PLS模型时因为样本数减少,导致因素负荷量会下降并出现部分参数低于0.5;未来研究需要扩大样本数即可修正此一问题。
[Abstract]:The aim of this study was to observe the therapeutic effect of traditional Chinese medicine (TCM) combined with acupuncture and moxibustion on the patients with gastroesophageal reflux syndrome of liver-stomach disharmony, and to compare the clinical advantages of the two treatment schemes. The effects of related factors on the improvement of patients' symptoms were analyzed from work, family, personality, diet, acupuncture and traditional Chinese medicine. Methods: in this study, the structural equation model (structural equation) was used to propose the research framework, and the minimum partial differential method (PLs) and SPSS 17.0 were used to analyze the data and verify the architecture. A total of 50 patients with 8 weeks of time series data were collected in the clinical study. Among them, 13 patients failed to observe for 8 weeks in the course of the investigation, so 37 patients were observed effectively. All patients were given gastroesophageal reflux disease education, reasonable diet and other basic treatment. The prescription of simple Chinese medicine group is Zuo Jin Wan and Banxia Houpu decoction. Prescription: Rhizoma Coptidis 3 g, Evodia rutaecarpa 1 g, ginger, Pinellia ternata 10g, Magnolia officinalis 10g, Poria cocos 10g, Radix Paeoniae Alba 10g, Atractylodes macrocephala 10g. 1 dose per day, 2 times to 300 ml water, early, 2 times in the evening for 4 weeks as a course of treatment, a total of 2 courses. The composition of traditional Chinese medicine in acupuncture and medicine combination group is the same as that in traditional Chinese medicine group, in which acupuncture and moxibustion are treated with Jiu tail, Shangwan, Zhongwan, Zusanli, Sanyinjiao, Neiguan, Taichong as main points, acupuncture as routine method of diarrhea. The therapeutic effects were compared between the two groups 3 times a week (3 times a week) for 30 minutes. Results: (1) both Chinese medicine group and acupuncture and medicine group could effectively treat gastroesophageal reflux disease of hepatogastric disharmony. (2) before and after treatment, the main symptoms and associated symptoms in the Chinese medicine group and the acupuncture and medicine group were matched to determine the difference between before and after treatment and at the 8th week. The main symptoms of the Chinese medicine group were obviously improved before and after treatment, while the Chinese medicine group had no obvious improvement except for chronic cough and defecation disorder. (3) after treatment, the curative effect index was calculated in the traditional Chinese medicine group and the acupuncture and medicine group. According to the statistics of curative effect criterion, 1 case of clinical cure, 8 cases of remarkable effect, 5 cases of effective and 3 cases of ineffective were found in TCM group. The total effective rate was 82.35. In the acupuncture and medicine group, 1 case was cured, 11 cases were effective, 7 cases were effective, and 1 case was ineffective. The total effective rate was 90.005%. The statistical analysis showed that the improvement of main symptoms and associated symptoms in acupuncture and medicine group was obviously superior to that in traditional Chinese medicine group. (4) work and dietary factors had positive and significant effects on the patients. Improvement of work stress and adjustment of eating habits significantly improved the main and accompanying symptoms of patients. Family factors and personality factors were not significantly improved in the short term. The results showed that the influence of family and personality factors was not easy to change in the short term. (5) the empirical results showed that the treatment time of treatment factors had a positive and significant effect on the patients. This study showed that the improvement of symptoms after 8 weeks of treatment had a significant effect on the improvement of symptoms, and the longer the treatment time, the higher the degree of improvement. (6) the number of samples decreased when the main symptoms were in the pls model of acupuncture and medicine group and traditional Chinese medicine group, respectively. The factor load will decrease and some parameters will be lower than 0.5. In the future research we need to expand the sample number to correct this problem.
【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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