本文選題：慢性胃炎　切入點：幽門螺桿菌　出處：《遼寧中醫(yī)藥大學》2017年碩士論文

【摘要】：研究背景:幽門螺桿菌相關(guān)性胃炎為臨床上的常見病,因其纏綿難愈,并且易反復發(fā)作,逐漸成為目前的研究熱門。目前學術(shù)界共識,幽門螺桿菌是慢性胃炎以及消化性潰瘍的重要致病因子,并且是胃癌發(fā)生的啟動因子之一。目前,西醫(yī)根除幽門螺桿菌的方法很多,但隨著其耐藥性的增加,其根除率逐漸下降,且多復發(fā)。中醫(yī)藥因其獨特的辨證優(yōu)勢,在西藥的基礎(chǔ)上,結(jié)合不同患者的不同癥狀進行辨證治療,可以提高Hp的根除率,還能使患者的臨床癥狀減輕,提高病患的生活質(zhì)量,并減少復發(fā)的可能。目的:評價辨證應用中藥湯劑、中藥固定方劑聯(lián)合“四聯(lián)療法”提高慢性胃炎患者幽門螺桿菌(Hp)根除率的有效性。材料與方法:用隨機、對照、單盲臨床試驗設(shè)計方法。應用SPSS16.0軟件,計算病例數(shù),以60例作為該實驗樣本含量�？紤]不超過20%的退出率,總的例數(shù)確定為75例。采用整體分層區(qū)組隨機化方法,分試驗組B、C,對照組A。試驗組為西藥四聯(lián)配合中藥固定方劑(抗幽合劑)療法14天,西藥四聯(lián)配合中藥湯劑(辨證方劑)療法14天;對照組為西藥四聯(lián)療法14天。試驗設(shè)計、實施、結(jié)局評價分工進行,結(jié)局評價者不清楚干預措施的分配,采用不參與治療的第三方進行結(jié)局評價。結(jié)果:1、Hp根除率:A組西藥四聯(lián)組為84.0%,B組抗幽合劑聯(lián)合西藥四聯(lián)組為92.0%,C組中藥辨證方劑聯(lián)合西藥四聯(lián)組為88.0%。2、經(jīng)Wilcoxon秩和檢驗(p0.05),三組藥物能夠明顯緩解胃部不適癥狀(胃脹、胃疼、惡心嘔吐、噯氣、反酸燒心)。以B實驗組效果最好,A、C實驗藥物療效無顯著性差異。3、在緩解胃疼癥狀上,經(jīng)Kruskal-Wall H秩和檢驗,P0.05,B實驗組效果最好,評分差值的平均秩次明顯高于A組、C組。三組藥物在惡心嘔吐、噯氣、反酸燒心三個癥狀的表現(xiàn),p0.05,差異不顯著。4、治療后三組PRO量表評分比較:治療后B組的排便情況的恢復好于A組(P0.05),與C組比較差異沒有統(tǒng)計學意義(P0.05);治療后B組的消化不良的恢復狀態(tài)好于A組(P0.05),與C組比較差異沒有統(tǒng)計學意義(P0.05);治療后B組的精神狀態(tài)好于A組(P0.05),與C組比較差異沒有統(tǒng)計學意義(P0.05);治療后B組的總體狀態(tài)的恢復好于A組(P0.05),與C組比較差異沒有統(tǒng)計學意義(P0.05);治療后B組的社會功能恢復優(yōu)于A組和C組(P0.05);治療后B組的健康滿意度好于A組和C組,(P0.05),而A組和C組沒有統(tǒng)計學差異。5、B組藥物在改善患者排便維度上的效果與A組和C組間差異不明顯;B組在社會功能維度、健康滿意維度的評分改變上優(yōu)于A組和C組,而A組與C組間差異不顯著。結(jié)論:經(jīng)研究分析,三組試驗都能有效提高Hp的根除率,但三者間的差異沒有統(tǒng)計學意義,尚不能認為中藥抗幽合劑合并四聯(lián)組優(yōu)于其他兩種療法。但使用抗幽合劑對于緩解胃痛癥狀,提高患者生活質(zhì)量有著明顯作用。對未來該領(lǐng)域研究有一定參考價值。
[Abstract]:Background: Helicobacter pylori associated gastritis is a common clinical disease.The current academic consensus is that Helicobacter pylori is an important pathogenic factor of chronic gastritis and peptic ulcer, and is one of the promoters of gastric cancer.At present, there are many methods to eradicate Helicobacter pylori in western medicine, but with the increase of drug resistance, the eradication rate of Helicobacter pylori decreases gradually, and more relapse.Because of its unique advantage of syndrome differentiation, traditional Chinese medicine can improve the eradication rate of HP, alleviate the clinical symptoms and improve the quality of life of patients by combining different symptoms of different patients with syndrome differentiation on the basis of western medicine.And reduce the possibility of recurrence.Objective: to evaluate the effectiveness of TCM decoction and fixed prescription combined with quadruple therapy in improving the eradication rate of Helicobacter pylori (HP) in patients with chronic gastritis.Materials and methods: a randomized, controlled and single blind clinical trial design method was used.SPSS16.0 software was used to calculate the number of cases and 60 cases were used as the sample content of the experiment.Taking into account the exit rate of no more than 20%, the total number of cases is determined to be 75 cases.The whole stratified block randomization method was used to divide the trial group into two groups: BX C and A control group.The experimental group was treated with western medicine combined with traditional Chinese medicine fixed prescription (Kangyou mixture) for 14 days, the western medicine with traditional Chinese medicine decoction for 14 days, and the control group with western medicine for 14 days.Trial design, implementation, outcome evaluation division of labor, outcome evaluators are not clear about the allocation of intervention measures, using non-participation in the treatment of third parties to conduct outcome evaluation.Results the eradication rate of HP was 84.0 in the control group and 84.0 in the fourth group of western medicine, and that in the fourth group was 92.00.The medicine differentiation prescription combined with western medicine in group C was 88.0.2.The Wilcoxon rank sum test showed that the three groups could relieve the symptoms of stomach discomfort (stomach distension, stomachache).Nausea and vomiting, belching, acid regurgitation.There was no significant difference in the effect of drug in group B with the best effect. The effect of Kruskal-Wall H rank sum test was the best in group B, and the average rank of score difference was significantly higher than that in group C.Three groups of drugs in nausea, vomiting, belching,After treatment, the scores of PRO scale in group B were better than those in group A (P0.05), and there was no significant difference between group A and group C (P 0.05), and after treatment in group B, the recovery of defecation in group B was better than that in group A (P 0.05), but there was no significant difference between group A and group C (P 0.05).The recovery of dyspepsia in group A was better than that in group A (P 0.05), but there was no significant difference between group C and group C (P 0.05); after treatment, the mental state of group B was better than that of group A (P 0.05), and there was no significant difference between group A and group C (P 0.05).The recovery of social function in group B was better than that in group A and group C, and the health satisfaction of group B was better than that of group A and group C after treatment.There was no significant difference between group B and group A and group C in improving the defecation dimension of patients.The scores of health satisfaction were better than those of group A and group C, but there was no significant difference between group A and group C.Conclusion: the results show that the three groups can effectively improve the eradication rate of HP, but the difference among the three groups is not statistically significant, so it can not be considered that the anti-you mixture combined with the other two groups is superior to the other two kinds of therapy.But the use of Kangyou mixture can relieve the symptoms of stomach pain and improve the quality of life of patients.It has certain reference value to the future research in this field.
【學位授予單位】：遼寧中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R573.3

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