本文關(guān)鍵詞： 胃食管反流病 新加坡 中醫(yī)證候 相關(guān)因素 辨證治療 臨床療效　出處：《南京中醫(yī)藥大學(xué)》2017年博士論文　論文類(lèi)型：學(xué)位論文

【摘要】：目的:通過(guò)回顧性病例分析,進(jìn)行新加坡流行病學(xué)調(diào)查,歸納胃食管反流病的證候分布規(guī)律,并找出與證候的相關(guān)因素,探討發(fā)病的病因病機(jī)和病程的演變,為中醫(yī)的臨床辨證治療提供參考。通過(guò)臨床病例資料的收集,觀察中醫(yī)辨證分型治療胃食管反流病的有效性,研究中醫(yī)藥的臨床思路,探討新加坡病人群的規(guī)范化與個(gè)體化的治療方案。方法:收集505例胃食管反流病患者的病例資料,根據(jù)中醫(yī)四診信息辨證分型,建立數(shù)據(jù)庫(kù),運(yùn)用SPSS統(tǒng)計(jì)方法,總結(jié)胃食管反流病的證候規(guī)律,分析其與多種因素之間的相關(guān)性;分析結(jié)果運(yùn)用于臨床治療44例患者,入選患者已經(jīng)PPI治療3個(gè)月以上并停藥后再?gòu)?fù)發(fā)者,主要癥狀燒心、胸痛、反酸、反食癥狀以RDQ問(wèn)卷癥狀積分,其他與反流相關(guān)的癥狀用中醫(yī)證候積分,進(jìn)行治療前與治療后比較,口服中醫(yī)顆粒8周,1天14-16克,日2次服用,觀測(cè)點(diǎn)分別為0周、2周、4周、8周,在完成8周治療后,評(píng)價(jià)臨床療效。治療結(jié)束,進(jìn)行停藥1月、3月的隨訪,觀察遠(yuǎn)期療效。結(jié)果:本組研究資料的發(fā)病年齡以50-69歲為最多,病程在1年內(nèi)最多,發(fā)病因素以飲食因素、情志因素最常見(jiàn),常見(jiàn)的前10位癥狀包括反酸、噯氣、上腹部脹滿、咽部癥狀、口干、燒心、胸骨后疼痛、嘈雜、上腹部灼熱感、口苦,常見(jiàn)的舌象為舌淡紅,薄白苔,常見(jiàn)脈象為弦脈或細(xì)脈。證型比例肝胃郁熱證肝胃不和證中虛氣逆證痰濕內(nèi)阻證陰虛胃熱證氣滯血瘀證。證型進(jìn)行了多元逐步Logisitic回歸分析顯示,肝胃不和證與病程相關(guān);肝胃郁熱證與情志因素有關(guān);中虛氣逆證的相關(guān)因素有病程、情志因素;痰濕內(nèi)阻證的相關(guān)因素也是與情志因素相關(guān)。在臨床治療的44病例中,臨床痊愈1例(2.27%)顯效21例(47.73%),有效18例(40.91%),無(wú)效4例(9.09%),�？傆行蕿�90.91%。針對(duì)癥狀為燒心、反酸、胸骨后疼痛、胃內(nèi)容物上涌以RDQ問(wèn)卷進(jìn)行癥狀積分計(jì)算,治療后明顯下降,非典型的反流癥狀和其他全身癥狀中醫(yī)證候積分,治療后也明顯下降,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。停藥后進(jìn)行遠(yuǎn)期療效的觀察,癥狀積分較治療前降低不到50%者,或RDQ量表問(wèn)卷12分者定為復(fù)發(fā),在44病例中,停藥1月復(fù)發(fā)有3例,3月后復(fù)發(fā)有8例,共有11例,復(fù)發(fā)率為27.50%,無(wú)復(fù)發(fā)為72.50%,遠(yuǎn)期療效理想。結(jié)論:胃食管反流病以胃失通降,脾失升清,氣機(jī)升降失常為主要病機(jī),涉及臟腑與脾胃、肝膽、肺相關(guān),與肝最為密切,病理因素以氣滯、郁熱、痰濕、血瘀等為標(biāo),初病多以氣病為主,實(shí)證多見(jiàn),久病脾胃虛損,中虛氣逆而發(fā)病,因虛致實(shí)虛實(shí)夾雜的病理演變,臨床以辨證分型治療,辨證與辨病相結(jié)合,療效良好,遠(yuǎn)期療效理想,是適合新加坡病人群的治療方案。
[Abstract]:Objective: to investigate the epidemiology of gastroesophageal reflux disease (GERD) in Singapore by retrospective case analysis, and to find out the related factors of GERD, and to explore the etiology, pathogenesis and evolution of disease course. To provide a reference for the clinical treatment of TCM. Through the collection of clinical case data, to observe the effectiveness of TCM syndrome differentiation in the treatment of gastroesophageal reflux disease, and to study the clinical thinking of TCM. Methods: the data of 505 patients with gastroesophageal reflux disease were collected. According to the information of four diagnosis of TCM, the database was established and the SPSS statistical method was used. The syndromes of gastroesophageal reflux disease (GERD) were summarized, and the correlation between GERD and various factors was analyzed. The results were applied to 44 patients who had been treated with PPI for more than 3 months. The symptoms of chest pain, acid regurgitation and regurgitation were scored by RDQ questionnaire, and other symptoms related to reflux were treated with TCM syndromes score. Before and after treatment, oral TCM granules were taken 14 to 16 grams per day for 8 weeks, twice a day. The observation points were 0 weeks, 2 weeks, 4 weeks and 8 weeks, respectively. After 8 weeks of treatment, the clinical efficacy was evaluated. After the treatment, the patients were followed up on January and March to observe the long-term effects. Results: the age of onset of this study was 50-69 years old. The first 10 common symptoms include acid regurgitation, belching, upper abdominal bloating, pharynx, dry mouth, heartburn, back sternum pain, noise, upper abdominal burning. Bitter mouth, common tongue for the tongue red, thin white fur, The common pulse pattern was chord pulse or vein.Syndromes proportion of liver and stomach stagnation heat syndrome liver stomach stagnation syndrome liver stomach disharmony syndrome phlegm dampness internal obstruction syndrome yin deficiency stomach heat syndrome qi stagnation blood stasis syndrome. Multiple stepwise Logisitic regression analysis showed that liver and stomach disharmony syndrome was related to the course of disease. The related factors of syndrome of stagnation of heat of liver and stomach were related to emotion factors; the related factors of syndrome of deficiency of qi and inverses of qi were course of disease, factors of emotion, and factors of internal obstruction of phlegm and dampness were also related to factors of emotion. In 44 cases of clinical treatment, 44 cases were treated with phlegm and dampness. The total effective rate was 90.91.The total effective rate was 90.91.The total effective rate was 90.91.The total effective rate was 90.91.The symptoms were heartburn, acid regurgitation, poststernal pain, stomach contents upwelling with RDQ questionnaire to calculate the symptom score, which was significantly decreased after treatment. The scores of TCM syndromes of atypical reflux symptoms and other systemic symptoms also decreased significantly after treatment, and the difference was statistically significant (P 0.01). In 44 cases, there were 3 cases of recurrence in January and 8 cases of recurrence after March, with a recurrence rate of 27.50 and no recurrence rate of 72.50. Conclusion: gastroesophageal reflux disease is reduced by gastric loss. The main pathogenesis of spleen lost clear, Qi Qi ascending and descending disorder is the main pathogenesis, involving viscera and spleen and stomach, liver and gallbladder, lung, and liver are most closely related, pathological factors are Qi stagnation, stagnation of heat, phlegm and dampness, blood stasis, etc., the primary diseases are mainly qi diseases, and empirical evidence is more common. Because of the pathological evolution of deficiency caused by deficiency of deficiency and deficiency of qi, clinical treatment with syndrome differentiation and syndrome differentiation combined with disease differentiation has good curative effect and ideal long-term curative effect, which is suitable for the treatment of Singaporean disease.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R259

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6 尚文t，

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