中藥分階段論治慢性乙型重型肝炎的臨床研究
發(fā)布時(shí)間：2019-03-27 19:58
【摘要】：目的：觀察分析中藥分階段論治慢性乙型重型肝炎的臨床療效。 方法：選取符合標(biāo)準(zhǔn)的慢性乙型重型肝炎患者44例(早、中期),隨機(jī)分為對(duì)照組22例(脫落2例),治療組22例。對(duì)照組采用西醫(yī)治療,而治療組在西醫(yī)治療的基礎(chǔ)上加用中藥治療。中藥治療組采用分階段論治法：前期著重“攻邪”,后期著重“扶正”并兼以“祛邪”。中藥均采用口服、灌腸、靜滴3個(gè)途徑給藥。前階段(一般為2周)重用清熱解毒涼血化瘀中藥,口服方以本院的肝毒清顆粒為基礎(chǔ)方加減,灌腸方為大承氣湯,靜滴方為丹參及清開(kāi)靈注射液。后階段采用扶正補(bǔ)虛方法治療。補(bǔ)虛時(shí)重視溫陽(yáng)扶正法的運(yùn)用。①陰虛患者：口服方為六味地黃丸合增液湯加減,灌腸方為增液承氣湯,靜滴方為生脈注射液和丹參注射液,②陽(yáng)虛患者：茵陳術(shù)附湯加入肉桂、干姜、黃芪、白術(shù)等溫補(bǔ)重劑,灌腸方為溫脾湯加減,靜滴方為參附注射液,③中間組(未表現(xiàn)出明顯的陰虛或陽(yáng)虛的患者),口服方以肝毒清為基礎(chǔ)方減少清熱涼血藥加入桂枝、茴香、白術(shù)、淫羊藿、巴戟天等溫補(bǔ)平劑,灌腸方采用小承氣湯加入附片(少量)、干姜、當(dāng)歸,而靜滴方為參麥注射液。療程為4周,療程結(jié)束后,對(duì)比治療組和對(duì)照組的生化指標(biāo)變化情況(如總膽紅素、凝血酶原活動(dòng)度、白蛋白等)、總有效率和癥狀改善情況,對(duì)臨床療效做出分析和評(píng)價(jià)。 結(jié)果：①療程結(jié)束后,治療組顯效7例,有效11例,無(wú)效4例,無(wú)效包括病死1例,總有效率81.8%,總體生存率95.5%。對(duì)照組顯效4例,有效7例,無(wú)效9例,無(wú)效包括病死1例,總有效率55.0%,總體生存率95.0%。兩組綜合有效率對(duì)比差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。②療程結(jié)束后,治療組凝血酶原活動(dòng)度(PTA)、總膽紅素(TBIL)的改善程度優(yōu)于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)；而白蛋白(ALB)、谷丙轉(zhuǎn)氨酶(ALT)、谷草轉(zhuǎn)氨酶(AST)的改善對(duì)比無(wú)明顯差異(P0.05)。③療程結(jié)束后,治療組中身軟乏力、飲食減少、便溏或便干結(jié)癥狀好轉(zhuǎn)率高于對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。而口干口苦、惡心嘔吐、脘腹脹滿的癥狀改善差異無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：分階段中西結(jié)合論治慢性乙型重型肝炎是有效治療慢性乙型重肝炎的方法,治療該病時(shí)應(yīng)注重病人之虛,不必?fù)?dān)心閉門(mén)留寇,越補(bǔ)而毒邪越熾。補(bǔ)中應(yīng)重視溫補(bǔ)。
[Abstract]:Objective: to observe and analyze the clinical efficacy of traditional Chinese medicine (TCM) in treating chronic severe hepatitis B in stages. Methods: 44 patients with chronic severe hepatitis B (early and middle stage) were randomly divided into control group (n = 22) and treatment group (n = 22). The control group was treated with western medicine, while the treatment group was treated with traditional Chinese medicine on the basis of western medicine treatment. The treatment group was divided into two groups: "attacking evil spirits" in the early stage and "strengthening the positive" in the later stage and "removing evil spirits" at the same time. All of them were given orally, enema and intravenous drip. The former stage (usually 2 weeks) reused the traditional Chinese medicine of clearing heat, detoxification, cooling blood circulation and removing blood stasis. The oral prescription was based on the Gan du Qing granule of our hospital, the enema prescription was Dachengqi decoction, and the intravenous drip prescription was Danshen and Qingkailing injection. The later stage was treated with Fuzheng tonifying deficiency method. 1 Yin deficiency patients: the oral prescription for Liuwei Dihuang pill combined with Zengye decoction, enema for the liquid Chengqi decoction, intravenous drip for Shengmai injection and salvia miltiorrhiza injection, the patient with Yin deficiency: oral prescription for Liuwei Dihuang pills combined with Zengye decoction, enema prescription for Zengliu Chengqi decoction, (2) Yang deficiency patients: Yin Chen Shu Fu Tang added cinnamon, dried ginger, astragalus membranaceus, and Atractylodes et al., the enema prescription was Wenpi decoction, the intravenous drip prescription was Shenfu injection, and the middle group (the patients without obvious deficiency of yin or yang), the middle group (without obvious deficiency of yin or yang). Oral prescription is based on Gan du Qing to reduce heat and cool blood by adding Guizhi, fennel, Atractylodes, Herba Epimedium, Euphorbia officinalis Isothermal tonifying Agent, enema recipe with Xiaochengqi decoction (small amount), dried ginger, Angelica sinensis, and intravenous drip prescription for Shenmai injection. After the course of treatment was 4 weeks, the changes of biochemical indexes (such as total bilirubin, prothrombin activity, albumin, etc.), total effective rate and symptom improvement were compared between the treatment group and the control group, and the clinical efficacy was analyzed and evaluated. Results: after 1 course of treatment, the treatment group was effective in 7 cases, effective in 11 cases, ineffective in 4 cases, including 1 case died of disease, the total effective rate was 81.8%, the overall survival rate was 95.5%. In the control group, 4 cases were effective, 7 cases were effective, 9 cases were ineffective, including 1 case died of disease, the total effective rate was 55.0%, and the overall survival rate was 95.0%. There was no significant difference in the comprehensive effective rate between the two groups (P0.05). After the end of the course of treatment, the improvement of prothrombin activity (PTA), total bilirubin (TBIL) in the treatment group was better than that in the control group, and the difference was statistically significant (P0.05). There was no significant difference in the improvement of albumin (ALB), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST) (P0.05). After 3 courses of treatment, the body weakness and diet decreased in the treatment group. Loose stool or stool dry knot symptom improvement rate was higher than the control group, the difference was statistically significant (P0.05). But dry mouth bitter, nausea and vomiting, abdominal distension symptom improvement has no statistical significance. Conclusion: the treatment of chronic severe hepatitis B by combination of Chinese and western medicine in stages is an effective method for treating chronic severe hepatitis B. in the treatment of this disease, we should pay attention to the deficiency of the patient, do not have to worry about leaving invaders behind closed doors, and the more replenishing the poison and evil, the more incandescent the toxin and evil. Attention should be paid to warming up in the process of tonifying.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R512.62
本文編號(hào)：2448510
[Abstract]:Objective: to observe and analyze the clinical efficacy of traditional Chinese medicine (TCM) in treating chronic severe hepatitis B in stages. Methods: 44 patients with chronic severe hepatitis B (early and middle stage) were randomly divided into control group (n = 22) and treatment group (n = 22). The control group was treated with western medicine, while the treatment group was treated with traditional Chinese medicine on the basis of western medicine treatment. The treatment group was divided into two groups: "attacking evil spirits" in the early stage and "strengthening the positive" in the later stage and "removing evil spirits" at the same time. All of them were given orally, enema and intravenous drip. The former stage (usually 2 weeks) reused the traditional Chinese medicine of clearing heat, detoxification, cooling blood circulation and removing blood stasis. The oral prescription was based on the Gan du Qing granule of our hospital, the enema prescription was Dachengqi decoction, and the intravenous drip prescription was Danshen and Qingkailing injection. The later stage was treated with Fuzheng tonifying deficiency method. 1 Yin deficiency patients: the oral prescription for Liuwei Dihuang pill combined with Zengye decoction, enema for the liquid Chengqi decoction, intravenous drip for Shengmai injection and salvia miltiorrhiza injection, the patient with Yin deficiency: oral prescription for Liuwei Dihuang pills combined with Zengye decoction, enema prescription for Zengliu Chengqi decoction, (2) Yang deficiency patients: Yin Chen Shu Fu Tang added cinnamon, dried ginger, astragalus membranaceus, and Atractylodes et al., the enema prescription was Wenpi decoction, the intravenous drip prescription was Shenfu injection, and the middle group (the patients without obvious deficiency of yin or yang), the middle group (without obvious deficiency of yin or yang). Oral prescription is based on Gan du Qing to reduce heat and cool blood by adding Guizhi, fennel, Atractylodes, Herba Epimedium, Euphorbia officinalis Isothermal tonifying Agent, enema recipe with Xiaochengqi decoction (small amount), dried ginger, Angelica sinensis, and intravenous drip prescription for Shenmai injection. After the course of treatment was 4 weeks, the changes of biochemical indexes (such as total bilirubin, prothrombin activity, albumin, etc.), total effective rate and symptom improvement were compared between the treatment group and the control group, and the clinical efficacy was analyzed and evaluated. Results: after 1 course of treatment, the treatment group was effective in 7 cases, effective in 11 cases, ineffective in 4 cases, including 1 case died of disease, the total effective rate was 81.8%, the overall survival rate was 95.5%. In the control group, 4 cases were effective, 7 cases were effective, 9 cases were ineffective, including 1 case died of disease, the total effective rate was 55.0%, and the overall survival rate was 95.0%. There was no significant difference in the comprehensive effective rate between the two groups (P0.05). After the end of the course of treatment, the improvement of prothrombin activity (PTA), total bilirubin (TBIL) in the treatment group was better than that in the control group, and the difference was statistically significant (P0.05). There was no significant difference in the improvement of albumin (ALB), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST) (P0.05). After 3 courses of treatment, the body weakness and diet decreased in the treatment group. Loose stool or stool dry knot symptom improvement rate was higher than the control group, the difference was statistically significant (P0.05). But dry mouth bitter, nausea and vomiting, abdominal distension symptom improvement has no statistical significance. Conclusion: the treatment of chronic severe hepatitis B by combination of Chinese and western medicine in stages is an effective method for treating chronic severe hepatitis B. in the treatment of this disease, we should pay attention to the deficiency of the patient, do not have to worry about leaving invaders behind closed doors, and the more replenishing the poison and evil, the more incandescent the toxin and evil. Attention should be paid to warming up in the process of tonifying.
【學(xué)位授予單位】：瀘州醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R512.62
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