半夏泻心汤治疗慢性胃炎临床观察回顾研究

发布时间：2018-08-31 11:53

【摘要】：目的:通过统计分析近十年发表的半夏泻心汤治疗慢性胃炎的临床观察文献,探讨国内半夏泻心汤治疗慢性胃炎的研究状况,明确半夏泻心汤治疗慢性胃炎发展方向,为将来临床治疗提供更有力的参考。方法:检索CNKI《中国医院数字图书馆》从2007年01月-2016年12月关于半夏泻心汤治疗慢性胃炎的临床观察文献,将符合纳入条件的文献中所涉及的相关数据全部录入Excel 97-2003版数据库,应用文献计量学和循证医学以及统计学方法,对符合标准的半夏泻心汤治疗慢性胃炎临床观察类文献的分布年代和比例、临床试验设计情况(包括文献的样本含量、随机化原则、对照原则、盲法、均衡性、统计学检验方法、毒副作用、并发症、不良反应、随访以及复发率)、诊断标准、纳入/排除标准、辨病类型、中医辨证分型、临床试验用药(中药、中成药及西医)、疗效评判标准、临床治疗效果等各方面进行统计分析。结果:1.累计检索符合纳入条件的半夏泻心汤治疗慢性胃炎的临床观察文献共232篇,共计病例为24312例;2.临床设计情况:样本含量在60-99例的文献有107篇,约占46.2%;有190篇文献运用随机化原则,约占81.9%;有164篇文献提及“对照组”,约占70.6%;共有121篇文献进行了均衡性比较,约占52.2%;所有纳入文献中只有1篇提及盲法,为双盲;有13篇文献叙述并发症,约占5.6%;其中只有1篇文献提及毒副作用;有7篇文献有随访记录,约占3%;累计有58篇文献提及不良反应,约占25.0%;3.所纳入的文献中共有145篇文献无明确诊断标准,约占62.5%;有122篇文献无纳入/排除标准,约占52.6%。应用临床症状作为评价参照的文献为226篇,约占97.4%;以内镜下诊断作为评价指标的有196篇,约占84.5%;以病理作为疗效依据的有43篇,约占18.5%;以Hp清除率为评价标准的有39篇,约占16.8%;以症状评分作为评价指标有26篇,约占11.2%;4.纳入文献中,有126篇明确慢性胃炎的类型,约占54.3%;其中明确慢性萎缩性胃炎的文献有63篇,约占27.2%;慢性浅表性胃炎的文献有54篇,约占23.3%;合并以上两种胃炎的文献有21篇,约占9.1%;有15篇文献为Hp感染相关性胃炎,约占6.5%;5.有195篇文献进行了临床证型分类,共出现35种证候类型,其中出现前三名的为寒热错杂证、肝胃不和证、脾胃湿热证;按照虚实分析,虚实夹杂证证型共182次,实证证型共140次,虚证证型共83次,各占证型总数的44.9%、34.6%及20.5%;6.所有纳入文献中一共涉及中药245种,累计频次5490次,以半夏、甘草、黄连、白术使用次数最多(200次),党参、黄芩、柴胡、陈皮、白芍、大枣次之(150次),药物主要以补虚药、理气药、清热药物为主;其中合并使用方剂出现较多的为四逆散与左金丸;7.常用西药为奥美拉唑、阿莫西林、克林霉素出现次数最多(40次),其次为枸橼酸铋钾、兰索拉唑、雷贝拉唑等。常用中成药为胃复春片、三九胃泰颗粒等;8.疗效分析:半夏泻心汤治疗慢性胃炎具有显著临床效果。结论:1.近十年来半夏泻心汤治疗慢性胃炎临床观察文献呈上升趋势,取得良好的研究进展;但大多数文献的临床研究设计存在不足,样本含量偏小,对于不良反应、毒副作用、并发症、随访以及复发率等临床关键组成构件存在严重缺失,临床诊断以及疗效评价缺乏循证医学依据的统一标准,指南共识的采用较少,使得研究结果可能存在偏倚。2.半夏泻心汤不仅可以缓解患者的腹痛、腹胀、呃逆等不适症状,对于幽门螺杆菌清除也有一定作用,能促进胃黏膜的炎症修复,使已萎缩或肠化的腺体恢复正常,对于慢性胃炎具有显著临床疗效。
[Abstract]:OBJECTIVE:To analyze the clinical observation literature of Banxia Xiexin Decoction on chronic gastritis published in the last ten years,to explore the research status of Banxia Xiexin Decoction on chronic gastritis in China,to clarify the development direction of Banxia Xiexin Decoction on chronic gastritis,and to provide more powerful reference for clinical treatment in the future. Guan > From January 2007 to December 2016, the clinical observation literature on Banxia Xiexin Decoction in treating chronic gastritis was recorded in Excel 97-2003 edition database. Bibliometrics, evidence-based medicine and statistical methods were applied to treat chronic gastritis with Banxia Xiexin Decoction. Distribution age and proportion of clinical observation literature, clinical trial design (including sample content, randomization principle, control principle, blind method, balance, statistical test method, toxicity, side effects, complications, adverse reactions, follow-up and recurrence rate), diagnostic criteria, inclusion/exclusion criteria, disease type, syndrome differentiation of traditional Chinese medicine, clinical practice Results: 1. A total of 232 clinical observation literatures of Banxia Xiexin Decoction in treating chronic gastritis were retrieved, with a total of 24312 cases; 2. Clinical design: 107 literatures with 60-99 samples. About 46.2%; 190 papers used randomization principle, accounting for 81.9%; 164 papers referred to the "control group", accounting for 70.6%; 121 papers were compared equally, accounting for 52.2%; only one of them mentioned blindness, which was double blindness; 13 papers described complications, accounting for about 5.6%; only one of them referred to toxic side effects. 7 literatures had follow-up records, accounting for 3%; 58 literatures mentioned adverse reactions, accounting for 25.0%; 3. 145 literatures included in the literature did not have clear diagnostic criteria, accounting for 62.5%; 122 literatures did not include / exclude criteria, accounting for 52.6%. 226 literatures used clinical symptoms as evaluation reference, accounting for 97.4%; endoscopy. There were 196 (84.5%) cases as evaluation index, 43 (18.5%) cases based on pathology, 39 (16.8%) cases based on Hp clearance rate, 26 (11.2%) cases based on symptom score, and 126 (54.3%) cases of chronic gastritis. There were 63 papers on constrictive gastritis, accounting for 27.2%; 54 papers on chronic superficial gastritis, accounting for 23.3%; 21 papers on combination of the two gastritis, accounting for 9.1%; 15 papers on HP infection-related gastritis, accounting for 6.5%; 5.195 papers on clinical syndrome classification, a total of 35 types of syndrome, of which the top three appeared. According to the analysis of deficiency and excess, deficiency and excess combined with syndromes were 182 times, 140 times and 83 times respectively, accounting for 44.9%, 34.6% and 20.5% of the total syndromes; 6. All of the Chinese medicines involved in the literature, a total of 245 times, a total of 5490 times, Pinellia ternata, Glycyrrhiza uralensis, Coptis chinensis, and Atractylodes macrocephala were the most frequently used. Radix Codonopsis, Radix Scutellariae, Radix Bupleuri, Cortex Citri, Radix Paeoniae Alba, Dazao (150 times), the main drugs to tonify the deficiency, Qi-regulating drugs, antipyretic drugs; Sini powder and Zuojin pills were more commonly used in combination; 7. Omeprazole, amoxicillin, clindamycin appeared most frequently in Western medicine (40 times), followed by bismuth potassium citrate, Lansopra. Zuo, Rabeprazole, et al. The commonly used Chinese patent medicine is Weifuchun tablets, Sanjiuweitai granules, etc. 8. Therapeutic effect analysis: Banxia Xiexin Decoction has a significant clinical effect on chronic gastritis. Conclusion: 1. In the past decade, Banxia Xiexin Decoction for chronic gastritis clinical observation literature showed an upward trend, made good progress; but most of the literature of clinical research settings; There are serious deficiencies in clinical key components such as adverse reactions, toxic and side effects, complications, follow-up and recurrence rates, lack of uniform standards for evidence-based medicine in clinical diagnosis and efficacy evaluation, and less consensus on guidelines, which may lead to bias in the results of the study. 2. It can only relieve abdominal pain, abdominal distention, hiccup and other discomfort symptoms of patients, also has a certain role in clearing Helicobacter pylori, can promote the repair of gastric mucosa inflammation, make atrophic or intestinal glands to return to normal, for chronic gastritis has a significant clinical effect.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

【参考文献】