發(fā)布時間：2018-06-23 10:58

  本文選題：非糜爛性胃食管反流病 + 肝胃郁熱�。� 參考：《南京中醫(yī)藥大學》2017年碩士論文

【摘要】：研究目的探索總結導師治療非糜爛性胃食管反流病(NERD)的經驗,觀察疏肝理氣清熱法聯合奧美拉唑治療肝胃郁熱型NERD的臨床療效,證實中醫(yī)辨證聯合西藥可短期內迅速改善NERD臨床癥狀,并降低復發(fā)率,為推廣中醫(yī)治療NERD提供臨床依據,以推廣其臨床應用。研究方法選擇60例符合納入標準的NERD患者,隨機分為中西醫(yī)結合組20例、中藥組20例和西藥組20例,療程4周,共兩個療程,中藥組予中藥協(xié)定方,西藥組予奧美拉唑20mg口服bid,中西醫(yī)結合組予中藥協(xié)定方(同中藥組)并予奧美拉唑(服用方法同西藥組)。采取問卷方式,分別在治療前、治療4周后、治療8周后填寫耐信量表及中醫(yī)證侯積分量表,通過SPSS軟件分析比較三組療效,并于停藥8周時觀察停藥后復發(fā)情況,評價疏肝理氣清熱法治療NERD的臨床療效。研究結果1.綜合療效比較:三組治療4周后中西醫(yī)結合組和西藥組綜合療效明顯好于中藥組(P0.05),8周后三組綜合療效無明顯差異(P0.05)。2.在改善臨床癥狀方面:中西醫(yī)結合組及中藥組均可有效改善NERD各臨床癥狀(P0.01);西藥組對胃脘痞脹、心煩易怒、大便秘結改善不明顯(P0.05),對反酸、燒心、暖氣、咽部異物感、胸悶胸痛、口干口苦、兩脅脹滿可顯著改善(P0.01)。三組在用藥4、8周后,噯氣、咽部異物感、胸悶胸痛、兩脅脹滿癥狀積分無明顯差異,療效相當(P0.05);對于反流、燒心癥狀,中西醫(yī)結合組、西藥組在治療4周后和中藥組比較,癥狀積分明顯下降,有統(tǒng)計學差異(P＜0.05),而在治療第8周后,三組間癥狀積分比較無統(tǒng)計學意義(P0.05);在口干口苦、大便秘結方面,中西醫(yī)結合組、中藥組在用藥4、8周后療效均較優(yōu)于西藥組(P＜0.05);在胃脘痞脹、心煩易怒癥狀上,中西醫(yī)結合組在用藥第4、8周時療效均優(yōu)于另外兩組(P＜0.05)。3.在改善耐信量表積分方面:三組治療4、8周后積分均顯著降低(P0.01);治療4周后中西醫(yī)結合組與西藥組反流、燒心積分均較中藥組低(P0.05),胸骨后疼痛、反食積分三組療效無差異(P0.05)。治療8周后三組療效相當(P0.05)。4.遠期療效比較:中西醫(yī)結合組有2例復發(fā),中藥組有2例復發(fā),西藥組有9例復發(fā),中西醫(yī)結合組及中藥組復發(fā)率較西藥組低,遠期療效好,有統(tǒng)計學差異(P0.05)。研究結論疏肝理氣清熱法聯合奧美拉唑治療NERD的綜合療效及遠期療效確切,值得進一步推廣應用。
[Abstract]:Objective to explore the experience of tutor in the treatment of non-erosive gastroesophageal reflux disease (NERD), and to observe the clinical effect of soothing liver, regulating qi and clearing heat combined with omeprazole in the treatment of NERD with dampness of liver and stomach. It is proved that TCM syndrome differentiation combined with western medicine can quickly improve the clinical symptoms of NERD and reduce the recurrence rate in a short period of time. It provides a clinical basis for popularizing the treatment of NERD and popularizes its clinical application. Methods Sixty NERD patients who met the inclusion criteria were randomly divided into three groups: traditional Chinese medicine group (n = 20), traditional Chinese medicine group (n = 20) and western medicine group (n = 20). The western medicine group was given omeprazole 20mg orally, the traditional Chinese medicine agreement prescription (the same Chinese medicine group) and the omeprazole group (taking the method with the western medicine group). Questionnaires were used to fill out the credit tolerance scale and TCM syndromes integral scale before treatment, 4 weeks after treatment and 8 weeks after treatment respectively. The efficacy of the three groups was analyzed and compared by SPSS software, and the relapse after 8 weeks of withdrawal was observed. To evaluate the clinical effect of soothing liver, regulating qi and clearing heat on NERD. Results 1. Comprehensive efficacy comparison: the three groups after 4 weeks of treatment of integrated traditional Chinese and Western medicine group comprehensive efficacy was significantly better than the traditional Chinese medicine group (P0.05) 8 weeks after the three groups after the comprehensive efficacy of no significant difference (P0.05). 2. In terms of improving clinical symptoms: both the integrated Chinese and western medicine group and the traditional Chinese medicine group can effectively improve the clinical symptoms of NERD (P0.01); the western medicine group can effectively improve the symptoms of epigastric distension, irritability and irritability, and the improvement of the big constipation is not obvious (P0.05), and the foreign body sensation of regurgitation, heartburn, warm air and pharynx is not obvious in the western medicine group. Chest tightness and chest pain, dry mouth and bitter mouth, both side swelling can be significantly improved (P 0.01). After 4 weeks of medication, belching, foreign body sensation in pharynx, chest tightness and chest pain, and the integral score of the two hypochondriac fullness symptoms were not significantly different in the three groups (P0.05); for reflux, heartburn symptoms, the combination of traditional Chinese and western medicine group, western medicine group and traditional Chinese medicine group after 4 weeks of treatment compared with the traditional Chinese medicine group, The symptom score decreased significantly (P < 0.05), but after the 8th week of treatment, there was no significant difference between the three groups (P0.05), in the dry mouth bitter, big constipation, the combination of traditional Chinese and Western medicine group, The curative effect of the traditional Chinese medicine group was better than that of the western medicine group after 4 weeks (P < 0.05), and that of the traditional Chinese medicine group was better than that of the other two groups at the 8th week (P < 0.05), and the symptoms of stomach distension and irritability were better in the traditional Chinese medicine group than in the western medicine group at the 8th week (P < 0.05). After 4 weeks of treatment, the scores of the three groups were significantly lower than those of the traditional Chinese medicine group (P0.05), and the score of heartburn was lower than that of the traditional Chinese medicine group (P0.05). There was no difference in the curative effect among the three groups (P0.05). After 8 weeks of treatment, the efficacy of the three groups was similar (P0.05). 4. Comparison of long-term curative effect: there were 2 cases of recurrence in TCM group, 2 cases in TCM group and 9 cases in western medicine group. The recurrence rate of TCM group and TCM group was lower than that of western medicine group, and the long-term curative effect was better than that of western medicine group (P0.05). Conclusion the comprehensive and long-term curative effect of omeprazole combined with the method of soothing liver, regulating qi and clearing heat is definite and worthy of further application.
【學位授予單位】：南京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R571

【參考文獻】

相關期刊論文 前10條

1 傅睿;李亞平;;寧神清膽湯治療膽熱擾胃型非糜爛性胃食管反流病臨床觀察[J];新中醫(yī);2016年10期

2 杜義斌;龍祖宏;;龍祖宏以和法診治非糜爛性反流病經驗介紹[J];新中醫(yī);2016年10期

3 郭雪紅;;中藥紫蘇藥理及臨床研究新進展[J];天津藥學;2016年02期

4 王華蘭;劉寶良;;二式三法配合重灸法干預胃食管反流病療效觀察[J];遼寧中醫(yī)雜志;2016年04期

5 王宗明;王敏;吳文堯;;吳文堯教授診治胃食管反流病經驗拾要[J];亞太傳統(tǒng)醫(yī)藥;2016年06期

6 楊靖;楊艷;何李君;孔文霞;李培;張曉云;;李培教授治療非糜爛性胃食管反流病經驗[J];中醫(yī)藥信息;2016年02期

7 邱新萍;周滔;馬萬千;;馬萬千降逆清熱化濁法治療非糜爛性胃食管反流病經驗[J];北京中醫(yī)藥;2016年01期

8 劉小曼;陳朝明;;針灸治療胃食管反流病進展及機制探討[J];針灸臨床雜志;2015年12期

9 付國輝;馬香芹;;黃芩的化學成分及藥理作用研究進展[J];中國當代醫(yī)藥;2015年22期

10 金麗杰;;自擬降逆健胃方治療非糜爛性胃食管反流病臨床觀察[J];北京中醫(yī)藥;2015年07期

，

本文編號：2056896