發(fā)布時間：2018-05-01 02:09

  本文選題：加味補中益氣湯 + 老年人　； 參考：《湖北中醫(yī)藥大學》2014年碩士論文

【摘要】：目的 本臨床研究旨在探討加味補中益氣湯聯合西藥治療老年反流性食管炎的臨床療效及藥物安全性，為臨床治療老年反流性食管炎提供理論依據，以便更好為老年患者健康服務。 方法 病例全部選自2012年8月至2013年10月在湖北省武漢市中西醫(yī)結合醫(yī)院消化內科及中醫(yī)部名醫(yī)堂門診就診的患者，符合反流性食管炎西醫(yī)診斷標準，中醫(yī)辨證為中虛氣逆型患者共70例，依據患者就診時間隨機分為對照組及治療組各35例。對照組，給予常規(guī)西藥治療：奧美拉唑腸溶膠囊（彼司克）20mg，口服，1/日，噯氣、腹脹或反流明顯患者加服枸櫞酸莫沙必利片(加斯清)，5mg，口服，3/日。治療組：在對照組的基礎上加服加味補中益氣湯，1包（采用湖北省武漢市第一醫(yī)院中藥煎藥室自制包裝，每包中藥藥汁約200ml），口服，2/日。兩組患者治療總周期均為8周。觀察兩組患者治療前后的臨床綜合療效、臨床表現改善情況、胃鏡下食管粘膜改善情況、生活質量表各維度積分改善情況、3個月隨訪復發(fā)率及藥物安全性。 結果 兩組患者均進行8周的臨床治療后其臨床試驗結果： 1.治療組臨床綜合療效優(yōu)于對照組：對照組患者痊愈7例，顯效10例，有效11例，無效7例，總有效率為80.00%；而治療組患者痊愈13例，顯效12例，有效7例，無效3例，總有效率為91.43%。兩組臨床綜合療效比較經統計學處理，P＜0.05，差異有統計學意義。 2.中醫(yī)證候積分情況：兩組患者治療后反酸、胃脘隱痛癥候積分改善無顯著差異，P＞0.05；其他中醫(yī)證候積分改善情況治療組優(yōu)于對照組，P＜0.05，，有顯著性差異，有統計學意義。 3.主要臨床表現改善情況：兩組患者在反酸、燒心及非心性胸痛三個方面治療效果基本相當，P＞0.05；而在改善泛吐清涎、噯氣及呃逆癥狀方面，治療組效果優(yōu)于對照組，P＜0.05，有統計學意義。 4.胃鏡下食管粘膜改善情況：對照組食管粘膜正常7例，Ⅰa級5例，Ⅰb級9例，Ⅱ級11例，Ⅲ級4例，痊愈率為20.00%；治療組食管粘膜正常13例，Ⅰa級8例，Ⅰb級6例，Ⅱ級6例，Ⅲ級2例，痊愈率為37.14%。經統計學分析，P＜0.05，治療組治愈率優(yōu)于對照組，有統計學意義。 5.生活質量改善情況：采用SF-36生活質量調查表評分比較，治療后兩組生理功能、軀體疼痛評分比較，P＞0.05，兩組治療效果無明顯差異，無統計學意義。而其他各維度積分比較P＜0.05，差異有統計學意義。 6.隨訪3個月復發(fā)率及藥物安全性評價情況：對照組的復發(fā)率63.33%，治療組為41.94%，兩者之間比較經統計學處理：P＞0.05，但治療組復發(fā)率低于對照組；藥物安全性評價：對照組有7例出現惡心、頭暈，排除其他危險因素后繼續(xù)予以服藥至治療周期結束，停藥后上述癥狀未再出現。治療組有4名出現輕度嘔吐，予以對癥處理癥狀消失后繼續(xù)服用未出現其他不適。 結論 加味補中益氣湯治療老年反流性食管炎（中虛氣逆型）的臨床療效滿意，能有效改善老年患者的臨床癥狀，提高其生活質量，降低復發(fā)率。本次臨床試驗證實在改善患者臨床表現、食管粘膜及復發(fā)率等方面上，加味補中益氣湯聯合西藥治療老年反流性食管炎效果優(yōu)于單純西藥治療，且不良反應少，臨床安全性較高，值得臨床參考運用。
[Abstract]:objective
This clinical study aims to explore the clinical efficacy and drug safety of Jiawei Bu Zhong Yiqi Decoction Combined with western medicine in the treatment of reflux esophagitis in the elderly, and to provide a theoretical basis for the treatment of reflux esophagitis in the elderly so as to better serve the health of the elderly.
Method
All cases were selected from August 2012 to October 2013 in the outpatient of the Department of Gastroenterology and the famous medical Hall of the Ministry of traditional Chinese medicine in Wuhan, Hubei province. The patients were in accordance with the standard of Western medicine for reflux esophagitis. The TCM syndrome was divided into 70 patients with middle asthenia gas inverse type. The patients were randomly divided into the control group and the treatment group (35 cases each) according to the patient's time. Group, give routine western medicine treatment: Omeprazole Enteric-coated Capsules (Peter) 20mg, oral, 1/ day, belching, abdominal distention or reflux patients with Mosapride Citrate Tablets (Garth Qing), 5mg, orally, 3/ day. Treatment group: on the basis of the control group, add flavored Tonifying Qi Yiqi Decoction, 1 packets (using Chinese medicine in Wuhan No.1 Hospital of Hubei province decoction medicine) Room self-made packaging, each package of Chinese medicine juice about 200ml), oral, 2/ day, two groups of patients with a total period of 8 weeks of treatment, observe the clinical comprehensive efficacy of the two groups of patients before and after treatment, the improvement of clinical manifestation, the improvement of the esophagus mucosa under gastroscope, the improvement of the quality of life scales in all dimensions, the recurrence rate of 3 months and the safety of medicine.
Result
Two groups of patients were treated for 8 weeks after clinical treatment.
1. in the treatment group, the clinical comprehensive effect was better than the control group: the patients in the control group were cured 7 cases, effective 10 cases, effective 11 cases, invalid 7 cases, the total effective rate was 80%, and the treatment group cured 13 cases, 12 cases, effective 7 cases, 3 cases invalid, the total effective rate was 91.43%. two clinical comprehensive therapeutic effect comparison after statistical treatment, P < 0.05, the difference has statistical significance. Righteousness.
2. TCM syndrome score: two groups of patients after treatment anti acid, gastric epigastric pain syndrome score improvement no significant difference, P > 0.05; other TCM syndrome score improvement treatment group is better than the control group, P < 0.05, there are significant differences, there is statistical significance.
3. the main clinical manifestations of improvement: two groups of patients in the treatment of acid, heart and non heart pain three aspects of the basic treatment effect is basically equal, P > 0.05; and in improving the puke saliva, belching and hiccup symptoms, the effect of the treatment group is better than the control group, P < 0.05, there is statistical significance.
4. the improvement of esophagus mucosa under Gastroscope: 7 cases of normal esophageal mucosa, 5 cases of grade I, grade I 5, grade I B 9 cases, 11 cases of grade II, 4 cases of grade III, 20% of cure rate, 13 cases of normal esophagus mucosa, 8 cases of grade I, 6 cases of grade I, 6 cases of grade I, 2 cases of grade III, P < 13, cure rate of treatment group is superior to control group. There is a statistical significance.
5. improvement of quality of life: compared with the SF-36 quality of life questionnaire, two groups of physiological functions and somatic pain scores were compared, P > 0.05, and there was no significant difference in the treatment effect between the two groups, and the scores of other dimensions were compared to P < 0.05, the difference had statistical significance.
6. the recurrence rate of 3 months and the evaluation of drug safety: the recurrence rate of the control group was 63.33% and the treatment group was 41.94%. The comparison between the two groups was statistically treated: P > 0.05, but the recurrence rate of the treatment group was lower than that of the control group; the safety evaluation of the treatment group: the control group had 7 cases of nausea and dizziness, and the other risk factors were excluded and continued taking the medicine after excluding the other risk factors. At the end of the treatment cycle, the symptoms were not reappeared after the withdrawal of the drug. In the treatment group, 4 had mild vomiting.
conclusion
The clinical efficacy of Jiawei Bu Zhong Yiqi Decoction in the treatment of reflux esophagitis (middle Asthenia Type) is satisfactory. It can effectively improve the clinical symptoms of the elderly, improve the quality of life and reduce the recurrence rate. This clinical trial verifies that the clinical manifestations of the patients, the esophageal mucosa and the recurrence rate are improved, and the combination of Tonifying Qi and replenishing qi and Western medicine is added to the treatment of the patients. The effect of elderly reflux esophagitis is better than that of Western medicine alone, with fewer adverse reactions and higher clinical safety. It is worthy of clinical reference.

【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R571

【參考文獻】

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本文編號：1827249