腹泻型肠易激综合征肝郁脾虚证的临床观察

发布时间：2018-10-11 20:02

【摘要】：目的采用临床观察研究,验证自拟处方安肠汤治疗腹泻型肠易激综合征肝郁脾虚型的临床疗效及安全性,并从理论和临床研究两方面系统地探讨疏肝健脾法治疗腹泻型肠易激综合征的临床疗效。方法选取符合纳入标准的60例患者随机分为治疗组和对照组,每30例。治疗组与安肠汤口服,1日1剂,分早晚两次服用。对照组与马来酸曲美布汀胶囊口服,1粒1次,3次/日。两组均连续用药8周为一疗程。8周后分别进行两组中医症候疗效比较、前后IBS-SSS量表积分、前后IBS-QOL量表积分、前后PRO量表积分比较。治疗结束后随访8周,观察患者的复发情况。结果1.综合疗效:治疗组中治愈6例,显效8例,有效12例,无效4例,总有效率86.7%;对照组中治愈2例,显效8例,有效8例,无效12例,总有效率60%。两组疗效经Ridit分析,有显著性差异(P0.05),治疗组总有效率高于对照组。2.治疗组治疗前后IBS-SSS量表积分比较,有显著性差异(P0.01);对照组治疗前后IBS-SSS量表积分比较,有明显差异(P0.05);治疗后对照组与治疗组IBS-SSS量表积分比较,有显著性差异(P0.01)。3.两组治疗前中医各项症状积分比较无明显差异(P0.05),具有可比性;治疗组治疗前、后中医各症状积分均有明显改善(P0.05),对照组除了腹痛较前有不同程度改善,其余症状较前无明显改善(P0.05)。4.治疗前两组中医症候总积分无明显差异(P0.05),具有可比性,治疗前后组内总积分有差异(P0.05),具有可比性,说明两组治疗均有效,治疗后两组总积分比较有显著性差异(P0.05),具有可比性,说明治疗组在缓解中医症候疗效优于对照组。5.治疗前两组IBS-QOL量表8个维度积分组间比较无显著性差异(P0.05),组间具有可比性。对照组仅在健康忧虑、家庭关系2个维度治疗前后积分有差异,其余维度无明显差异,而治疗组仅在家庭关系、异性概念治疗前后积分无显著差异(P0.05),其余均表现出显著性差异(P0.05)。6.治疗前两组PRO量表6个维度积分比较均无显著性差异(P0.05),提示两组该量表的基线具有可比性。治疗后两组量表6个维度的得分均有降低,但治疗组在系统状态、反流、排便、消化不良4个维度积分较对照组表现出显著性差异(P0.05),说明治疗组在系统状态、反流、排便、消化不良4个领域得到了更大的改善。7.复发率比较:两组患者的不良反应症状均较轻,呈一过性出现,停药后缓解,均不影响治疗。随访2个月的过程中,治疗组复发率为11.5%,对照组复发率为44.4%,表明安肠汤治疗腹泻型肠易激综合征能减少复发率,远期疗效好,值得进一步应用与推广。结论安肠汤治疗腹泻型肠易激综合征临床综合疗效优于马来酸曲美布汀胶囊,且远期疗效好,能减少复发率,改善症状,提高患者的生活质量,值得进一步应用与推广。
[Abstract]:Objective to investigate the efficacy and safety of self-prescribed Anchang decoction in the treatment of diarrhea irritable bowel syndrome with liver depression and spleen deficiency. The clinical effect of soothing liver and invigorating spleen in treating diarrhea irritable bowel syndrome was discussed systematically from both theoretical and clinical aspects. Methods 60 patients who met the inclusion criteria were randomly divided into treatment group and control group, every 30 cases. Treatment group and an Chang Tang oral, 1 dose, divided into morning and evening two times. The control group and trimebutine maleate capsule were taken orally once, 3 times a day. After 8 weeks of treatment, the curative effects of TCM symptoms were compared between the two groups. The scores of IBS-SSS scale, IBS-QOL scale and PRO scale were compared before and after 8 weeks. The patients were followed up for 8 weeks to observe the recurrence. Result 1. In the treatment group, 6 cases were cured, 8 cases were effective, 12 cases were effective, 4 cases were ineffective, and the total effective rate was 86.7%, while in the control group, 2 cases were cured, 8 cases were markedly effective, 8 cases were effective, 12 cases were ineffective, and the total effective rate was 60%. Ridit analysis showed a significant difference between the two groups (P0.05). The total effective rate in the treatment group was higher than that in the control group. There were significant differences in IBS-SSS scale scores before and after treatment in the treatment group (P0.01); in the control group, the IBS-SSS scale scores were significantly different before and after treatment (P0.05); after treatment, there was a significant difference in the IBS-SSS scale scores between the control group and the treatment group (P0.01). There is no significant difference between the two groups before treatment (P0.05), there is comparability; before treatment, after the treatment of TCM symptoms were significantly improved (P0.05), in the control group, in addition to abdominal pain, there were different degrees of improvement. There was no significant improvement in other symptoms (P0.05). Before treatment, there was no significant difference (P0.05) in the total score of TCM symptoms between the two groups (P0.05), and the total score was comparable before and after treatment (P0.05), which showed that the two groups were effective. After treatment, there were significant differences (P0.05) in the total integral between the two groups (P0.05), and there was comparability between the two groups (P0.05). It shows that the curative effect of the treatment group in relieving TCM symptoms is better than that in the control group. 5. 5. Before treatment, there was no significant difference between the two groups in the eight dimensional scores of IBS-QOL scale (P0.05), and there was comparability between the two groups. In the control group, there was only significant difference in health anxiety, family relationship between the two dimensions before and after treatment, while there was no significant difference in the other dimensions, while in the treatment group there was no significant difference in the family relationship, heterosexual concept before and after treatment (P0.05), and the others showed significant differences (P0.05). There was no significant difference in the six dimensional scores of PRO scale between the two groups before treatment (P0.05), indicating that the baseline of the two groups was comparable. After treatment, the scores of the six dimensions of the two groups were all decreased, but the scores of the four dimensions in the treatment group were significantly different from those in the control group (P0.05), which indicated that the treatment group was in the system state, reflux, defecation, and had significant difference in the scores of system state, reflux, defecation, and dyspepsia (P0.05). Four areas of indigestion have improved further. 7. 7%. Comparison of recurrence rate: the symptoms of adverse reactions in both groups were mild and transient, remission after withdrawal of drugs did not affect the treatment. During the follow-up of 2 months, the recurrence rate of the treatment group was 11.5 and that of the control group was 44.4, which indicated that Anchang decoction could reduce the recurrence rate of diarrhea irritable bowel syndrome, and the long-term effect was good, which was worthy of further application and popularization. Conclusion Anchang decoction is better than trimebutine maleate capsule in the treatment of diarrhea irritable bowel syndrome. It can reduce the recurrence rate, improve the symptoms and improve the quality of life of the patients. It is worthy of further application and popularization.
【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】：2016
【分类号】：R259

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