本文選題：柴芩溫膽湯　切入點(diǎn)：膽熱犯胃證　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的本研究旨在通過觀察柴芩溫膽湯聯(lián)合西藥(雷貝拉唑腸溶片、枸櫞酸莫沙必利片)治療胃食管反流病(GERD)膽熱犯胃證的臨床療效,對(duì)比單純應(yīng)用西藥治療胃食管反流病的效果,并從理論和臨床研究兩個(gè)方面探討柴芩溫膽湯治療胃食管反流病膽熱犯胃證的作用機(jī)制,為治療胃食管反流病提供更好的方案。方法本研究選取60例就診于武漢市中醫(yī)院消化內(nèi)科住院部及門診患者,其中男性33例,女性27例,年齡處于25-70歲。病例均符合胃食管反流病西醫(yī)診斷標(biāo)準(zhǔn)以及中醫(yī)膽熱犯胃證標(biāo)準(zhǔn),按就診順序隨機(jī)將60例病例分為治療組和對(duì)照組,治療組30例,包括男性16例、女性14例,其中反流性食管炎(RE)21例,非糜爛性反流病(NERD)9例;對(duì)照組30人,包括男性17例、女性13例,其中RE 24例,NERD 6例。兩組患者經(jīng)統(tǒng)計(jì)學(xué)分析后,年齡、性別、病程、治療前癥狀積分及胃鏡下積分差異無統(tǒng)計(jì)學(xué)意義(p0.05),具有可比性。對(duì)照組予以雷貝拉唑鈉腸溶片(20mg早晚飯前口服)、枸櫞酸莫沙必利片(5mg于3餐前口服);治療組在對(duì)照組的基礎(chǔ)上加用柴芩溫膽湯聯(lián)合治療。柴芩溫膽湯是筆者導(dǎo)師楊康主任應(yīng)用多年的經(jīng)驗(yàn)方(其組成為柴胡10g黃芩10g黃連6g法半夏10g陳皮15g茯苓30g甘草6g枳殼15g竹茹15g厚樸15g生姜10g大棗10g),水煎服,日1劑,早晚飯后溫服,每次200ml,服藥時(shí)間均為4周。觀察兩組病例治療前后臨床癥狀、體征等變化,4周為一個(gè)療程,分別于治療前及治療后4周將患者癥狀發(fā)作的程度及頻率登記并予以相應(yīng)評(píng)分,RE患者于治療一個(gè)療程后復(fù)查胃鏡,評(píng)估并比較兩組患者的了臨床療效及胃鏡下療效。一個(gè)療程結(jié)束后,用SPSS20.0統(tǒng)計(jì)軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)量資料采用t檢驗(yàn),計(jì)數(shù)資料采用χ2檢驗(yàn),等級(jí)資料采用秩和檢驗(yàn)。結(jié)果兩組藥物對(duì)GERD均有一定的療效,治療組臨床療效總有效率為93.33%,RE患者內(nèi)鏡下總有效率為75.00%;對(duì)照組總有效率為81.00%,RE患者內(nèi)鏡下總有效率為70.83%;兩組比較,治療組臨床療效總有效率高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05),治療組內(nèi)鏡下總有效率高于對(duì)照組,差異無統(tǒng)計(jì)學(xué)意義(p0.05)。在證候積分方面,治療前后臨床證候、內(nèi)鏡下積分兩組均有較顯著性的差異(p0.05),治療組證候積分改善明顯優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05),治療組內(nèi)鏡下積分改善優(yōu)于對(duì)照組,但差異無統(tǒng)計(jì)學(xué)意義(p0.05)。對(duì)于病程1年的患者,治療組的治療效果優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論柴芩溫膽湯聯(lián)合西藥治療胃食管反流病膽熱犯胃證,比單用西藥療效顯著,能夠在很大程度上改善患者的臨床癥狀,提高生活質(zhì)量,為臨床治療GERD提供了良好的方法,值得在臨床應(yīng)用和推廣。
[Abstract]:Objective to observe the clinical effect of Chaiqin Wendan decoction combined with western medicine (rabeprazole enteric-coated tablet, mosapride citrate tablet) in treating gastroesophageal reflux disease (GERD) with gallbladder heat invading stomach syndrome.The therapeutic effect of western medicine on gastroesophageal reflux disease was compared, and the mechanism of Chaiqin Wendan decoction in treating gastroesophageal reflux disease was discussed from two aspects of theory and clinical study, which provided a better scheme for the treatment of gastroesophageal reflux disease.Methods A total of 60 inpatient and outpatient patients, 33 males and 27 females, aged 25 to 70 years, were selected from the Department of Digestive Medicine, Wuhan traditional Chinese Medicine Hospital.60 cases were randomly divided into treatment group (n = 30) and control group (n = 30), including 16 males and 14 females.There were 21 cases of reflux esophagitis and 9 cases of non-erosive reflux disease, and 30 cases of control group, including 17 males and 13 females, including 24 cases of RE and 6 cases of NERD.After statistical analysis, there was no significant difference in age, sex, course of disease, symptom score before treatment and score under gastroscope between the two groups.The control group was treated with rabeprazole sodium enteric-coated tablets 20mg before meals and mosapride citrate 5mg before meals, while the treatment group was treated with Chaiqin Wendan decoction on the basis of the control group.Chaiqin Wendan decoction is an experienced prescription used for many years by our tutor Yang Kang (its composition is 10g of Radix Bupleurum 10g Scutellaria 10g Rhizoma Coptidis 10g old skin 15g Poria cocos 15g Fructus Glycyrrhiza 6g Fructus Aurantii 15g Fructus Glycyrrhiza 15g Magnolia officinalis 15g Ginger 10g Jujube 10g, water decoction, 1 dose per day.Morning and evening after meal warm, each time 200 ml, the medicine time is 4 weeks.The changes of clinical symptoms and signs before and after treatment were observed for 4 weeks as a course of treatment.The degree and frequency of symptom attack were registered before and 4 weeks after treatment, and the patients with RE were evaluated and compared after a course of treatment with gastroscopy.After a course of treatment, the data were analyzed by SPSS20.0 statistical software. T test was used to measure the data, 蠂 2 test was used for counting data, and rank sum test was used for rank data.Results the total effective rate of the treatment group was 93.33%, the total effective rate of the control group was 81.00%, the total effective rate of the control group was 81.00%, the total effective rate of the two groups was 75.00%, the total effective rate of the two groups was 75.00%, the total effective rate of the treatment group was 75.00%, and the total effective rate of the control group was 81.00%.The total effective rate in the treatment group was higher than that in the control group, and the difference was statistically significant (P 0.05). The total effective rate under endoscopy in the treatment group was higher than that in the control group, but the difference was not statistically significant (P 0.05).In the aspect of syndromes integral, there was significant difference between the two groups before and after treatment. The improvement of syndrome integral in the treatment group was better than that in the control group, and the difference was statistically significant (P 0.05). The improvement of the endoscopic integral in the treatment group was better than that in the control group.But the difference was not statistically significant (P 0.05).The therapeutic effect of the treatment group was better than that of the control group, and the difference was statistically significant (P 0.05).Conclusion Chaiqin Wendan decoction combined with western medicine is more effective than western medicine in treating gastroesophageal reflux disease, which can improve the clinical symptoms and quality of life to a great extent, and provide a good method for clinical treatment of GERD.It is worth applying and popularizing in clinic.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R571

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