柴胡疏肝散合左金丸治疗胃食管反流病伴焦虑抑郁状态的疗效观察

发布时间：2018-07-22 19:38

【摘要】：目的:胃食管反流病(Gastroesophageal Reflux Disease,GERD)是消化科常见疾病,随着人们生活习惯和饮食结构的改变,其发病率呈逐渐升高的趋势,且越来越多的胃食管反流病患者伴随精神心理障碍,如焦虑、抑郁等,使西药如质子泵抑制剂、促胃动力药物等的疗效大大降低,而且多数患者需长期维持用药。本研究旨在观察柴胡疏肝散合左金丸加味联合西药治疗胃食管反流病伴焦虑抑郁状态的临床疗效,为中医治疗胃食管反流病的有效性和安全性提供临床依据,并为胃食管反流病患者提供更安全有效的治疗策略。方法:1.将2016年1月至2016年12月于北京中医药大学东直门医院消化科门诊就诊,经填写焦虑自评量表(Self-rating Anxiety Scale,SAS)和抑郁自评量表(Self-rating Depression Scale,SDS)证实存在焦虑或抑郁状态的证属肝胃郁热型的胃食管反流病患者78例,按就诊的先后顺序随机分为治疗组和对照组,其中治疗组39例,3例失访,最终疗效评价36例,对照组39例,5例失访,最终疗效评价34例。2.治疗组予以雷贝拉唑钠肠溶胶囊20mg,每日晨起空腹口服,并予以中药柴胡疏肝散合左金丸加味,基本药物组成柴胡15g,炒枳壳15g,白芍15g,生甘草10g,川芎10g,炙香附10g,陈皮10g,川楝子10g,莪术10g,酒大黄2g,黄连6g,吴茱萸1g。中药颗粒剂,每日一剂,分早晚口服。对照组仅予雷贝拉唑钠肠溶胶囊20mg 口服,晨起空腹口服。疗程8周。服药期间两组患者均戒烟酒,低脂饮食,忌生冷、辛辣刺激食物,睡前3小时不进食。治疗期间密切观察患者症状、体征变化及药物相关的不良反应。3.统计学方法:数据统计分析应用SPSS19.0统计软件进行分析处理,计量资料用X±S(均值±标准差)表示,治疗前后变化若符合正态分布,采用t检验,计数资料采用卡方检验,不符合正态分布者,用非参数检验。P0.05为无统计学差异,P0.05为有统计学差异。结果:1.经治疗后,治疗组和对照组患者的症状总积分均有明显下降,且治疗组积分低于对照组,差异有统计学意义(P0.05);2.两组患者各单项症状包括反酸、烧心、反食、嗳气、上腹不适、胸闷、纳差及咽部不适积分均有明显降低(P0.05),且治疗组积分低于对照组,差异有统计学意义(P0.05);治疗组胸骨后疼痛症状积分明显降低(P0.05),对照组则无明显差异(P0.05)03.经治疗后,两组RE患者的胃镜下分级均有明显改善,治疗组总有效率高于对照组,差异有统计学意义(P0.05);4.经治疗后两组患者的SAS、SDS评分较治疗前明显降低,且治疗组积分低于对照组,差异有统计学意义(P0.05)。5.治疗期间两组患者均未发生服药后症状加重、新发不适或与药物相关的严重不良反应。结论:柴胡疏肝散合左金丸加味联合雷贝拉唑治疗胃食管反流病伴焦虑抑郁状态,能有效改善患者临床症状和精神心理异常,并促进黏膜愈合,比单纯使用西药有明显优势,且无明显不良反应。
[Abstract]:Objective: gastroesophageal reflux disease (GERD) is a common disease in digestive department. With the change of people's living habits and diet structure, the incidence of GERD is increasing gradually, and more patients with gastroesophageal reflux disease are accompanied by mental and psychological disorders. For example, anxiety and depression have greatly reduced the efficacy of western drugs such as proton pump inhibitors and gastric motility drugs, and most patients need to maintain their medication for a long time. The purpose of this study was to observe the clinical efficacy of Chaihu Shugan Powder combined with Zuo Jin Pill combined with western medicine in the treatment of gastroesophageal reflux disease with anxiety and depression, and to provide clinical basis for the efficacy and safety of traditional Chinese medicine in the treatment of gastroesophageal reflux disease. And to provide a more safe and effective treatment strategy for patients with gastroesophageal reflux disease. Method 1: 1. From January 2016 to December 2016 at the Department of Digestive Medicine, Dongzhimen Hospital, Beijing University of traditional Chinese Medicine, Seventy-eight patients with gastroesophageal reflux syndrome with anxiety or depression were randomly divided into treatment group and control group by filling out self-rating Anxiety scale SAS and self-rating depression scale SDS. Among them, 39 cases in the treatment group had lost visit, 36 cases in the final curative effect evaluation, 39 cases in the control group and 35 cases in the control group, and 34 cases in the final curative effect evaluation. The treatment group was treated with Rabeprazole sodium enteric-coated capsule 20mg daily from an empty stomach and was treated with Chaihu Shugan Powder and Zuojin Pill. The essential drugs consisted of Bupleurum Bupleurum 15g, Fructus Aurantii 15g, Radix Paeoniae Alba 15g, Glycyrrhiza uralensis 10g, Ligusticum chuanxiong 10g, Roxburghum chinensis 10g, Zedoary 10g, Rhubarb 2g, Coptis chinensis 6g, Evodia officinalis 1 g. Traditional Chinese medicine granules, one dose a day, oral in the morning and evening. The control group was treated only with Rabeprazole sodium enteric-coated capsule 20mg and with fasting oral administration in the morning. The course of treatment was 8 weeks. Patients in both groups quit alcohol and tobacco, low fat diet, avoid cold, spicy and stimulating food, do not eat 3 hours before bedtime. During treatment, the changes of symptoms, signs and adverse drug reactions were closely observed. 3. 3. Statistical method: the data were analyzed by SPSS 19.0 statistical software. The measurement data were expressed as X 卤S (mean 卤standard deviation). If the changes before and after treatment were in accordance with normal distribution, t test was used, and the counting data were chi-square test. There was no statistical difference with nonparametric test (P 0.05) and there was statistical difference (P 0.05) in those who did not accord with normal distribution. The result is 1: 1. After treatment, the total symptom score of the treatment group and the control group were significantly decreased, and the treatment group score was lower than that of the control group, the difference was statistically significant (P0.05). The symptoms of the two groups included acid reflux, heartburn, food reversion, belching, upper abdominal discomfort, chest tightness, anorexia and pharynx discomfort (P0.05), and the scores in the treatment group were lower than those in the control group. The difference was statistically significant (P0.05); the score of post-sternal pain in the treatment group was significantly lower (P0.05), while in the control group there was no significant difference (P0.05). After treatment, the two groups of RE patients were significantly improved under gastroscopy, the total effective rate in the treatment group was higher than that in the control group, the difference was statistically significant (P0.05). After treatment, the SDS scores of the two groups were significantly lower than those before treatment, and the score of the treatment group was lower than that of the control group, the difference was statistically significant (P0.05). During the treatment, there were no symptoms aggravation, new discomfort or serious adverse drug-related reactions in both groups. Conclusion: Chaihu Shugan Powder combined with Rabeprazole can effectively improve the clinical symptoms and mental and psychological disorders and promote mucosal healing in patients with gastroesophageal reflux disease and anxiety and depression. It has obvious advantages over western medicine alone in the treatment of patients with gastroesophageal reflux disease and anxiety and depression. There was no obvious adverse reaction.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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