本文選題：溫中健脾方 + 馬來酸曲美布汀��； 參考：《湖北中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：【目的】 觀察溫中健脾方聯(lián)合馬來酸曲美布汀治療腹瀉型腸易激綜合征脾陽(yáng)虛證的臨床療效，，并從理論和臨床兩個(gè)方面來系統(tǒng)探討溫中健脾方聯(lián)合馬來酸曲美布汀的作用機(jī)制。 【方法】 1.選取湖北省中醫(yī)院脾胃科2012年2月至2013年12月門診患者66例，西醫(yī)診斷均為腹瀉型腸易激綜合征，中醫(yī)診斷均為泄瀉（脾陽(yáng)虛證型），將全部患者隨機(jī)分為兩組:治療組34例和對(duì)照組32例，所有患者均在湖北省中醫(yī)院行電子結(jié)腸鏡檢查，結(jié)果均無明顯病理改變，血、尿、糞等常規(guī)體檢項(xiàng)目結(jié)果均正常，符合西醫(yī)學(xué)羅馬Ⅲ標(biāo)準(zhǔn)中腹瀉型IBS診斷標(biāo)準(zhǔn)，兩組患者在性別、年齡、病程、病情、癥狀積分等方面沒有明顯統(tǒng)計(jì)學(xué)差別，具有可比性(P0.O5)。 2.處理:對(duì)照組:餐前口服馬來酸曲美布汀分散片(浙江昂利康制藥有限公司生產(chǎn)，商品名為尼為孚)每天三次，每次2片（每片100mg）;治療組:在對(duì)照組基礎(chǔ)上加用溫中健脾方，基本方為:黨參、干姜、白術(shù)、茯苓、吳茱萸、黃連、山藥、薏苡仁、陳皮、雞內(nèi)金、木香、砂仁、柴胡、枳殼、赤白芍、延胡索、炙甘草。水煎服，每日一劑，每天兩次，于早餐和午餐后兩小時(shí)左右服用。療程均為4周。 兩組患者治療期間停服其它藥物，予以清淡飲食，并觀察記錄患者常規(guī)體檢情況以及可能出現(xiàn)的其它不良反應(yīng)等，療程結(jié)束后統(tǒng)計(jì)療效。 3.統(tǒng)計(jì)學(xué)處理:所有數(shù)據(jù)均應(yīng)用SPSS19.0軟件進(jìn)行處理。計(jì)數(shù)資料采用X2檢驗(yàn)，計(jì)量資料采用t檢驗(yàn)，等級(jí)資料采用Ridit檢驗(yàn)。 【結(jié)果】1.治療組:臨床痊愈5例，顯效16例，有效9例，無效4例，總有效率86.17%;對(duì)照組:臨床痊愈1例，顯效9例，有效13例，無效9例，總有效率71.87%。兩組總療效經(jīng)過統(tǒng)計(jì)學(xué)分析有顯著性差異(P0.O5)，治療組療效優(yōu)于對(duì)照組。 2.對(duì)照組與治療組在治療前后總積分比較有顯著性差異，具有統(tǒng)計(jì)學(xué)意義(P0.01），在總積分的改善方面治療組效果明顯優(yōu)于對(duì)照組。 3.治療組在改善患者臨床癥狀、緩解焦慮抑郁情緒、降低復(fù)發(fā)率、鞏固療效方面的效果明顯優(yōu)于對(duì)照組(P0.05)。 4.與對(duì)照組相比，治療組能夠更加有效的改善患者整體生存質(zhì)量。 【結(jié)論】 本課題研究發(fā)現(xiàn)溫中健脾方聯(lián)合馬來酸曲美布汀治療腹瀉型腸易激綜合證（脾陽(yáng)虛證）在減輕患者臨床癥狀、降低復(fù)發(fā)率、改善患者生存質(zhì)量等方面均優(yōu)于對(duì)照組，溫中健脾方組方嚴(yán)謹(jǐn)，全方從經(jīng)方化裁而來，以溫中祛寒，益氣健脾為原則，健脾燥濕，溫中散寒，振奮脾陽(yáng)。其現(xiàn)代藥理作用可能為以下幾個(gè)方面:1.有效調(diào)節(jié)胃腸運(yùn)動(dòng)，緩解腹痛腹脹等癥狀。2.調(diào)整紊亂的神經(jīng)內(nèi)分泌功能。3.調(diào)節(jié)機(jī)體免疫功能。4.平衡胃腸菌群。綜上所述，溫中健脾方聯(lián)合馬來酸曲美布汀治療腹瀉型腸易激綜合證(脾陽(yáng)虛證)有較好的臨床療效，值得更多更深入的去研究。
[Abstract]:[Objective]
To observe the clinical effect of warming spleen recipe combined with trimebutine maleic acid in treating diarrhea type irritable bowel syndrome spleen yang deficiency syndrome, and systematically explore the mechanism of the combination of the combination of warm and medium invigorating spleen prescription combined with trimebutine maleic from the two aspects of theory and clinical.
[method]
1. selected 66 outpatient patients from February 2012 to December 2013 of the Hubei Provincial Traditional Chinese Medical Hospital, all of which were diagnosed as diarrhea type irritable bowel syndrome, and all the patients were randomly divided into two groups: 34 cases in the treatment group and 32 cases in the control group. All the patients were examined by electronic colonoscopy in the hospital. There were no obvious pathological changes. The results of routine physical examination of blood, urine and feces were all normal. It was in line with the diagnostic standard of diarrhea type IBS in the Rome III standard of Western medicine. There was no significant difference between the two groups in sex, age, course of disease, condition and symptom score, and it was comparable (P0.O5).
2. treatment: control group: pre - meal oral Trimebutine Maleate Dispersible Tablets (Zhejiang Anlikang Pharmaceutical Co., Ltd. production, the name of NYF) three times a day, 2 tablets (100mg per tablet); treatment group: on the basis of the control group plus warm spleen prescription, the basic recipe is: Party ginseng, dried ginger, Atractylodes, Poria, Wu Zhuyu, Huanglian, yam, coix seed, Chen peel, chicken Internal gold, wood, Amomum, bupleurum, bupleurum, Fructus aurantii, Radix Paeoniae, Rhizoma Corydalis, roasted licorice. One dose a day, two times a day, about two hours after breakfast and lunch. The course of treatment is 4 weeks.
In the two groups of patients, other drugs were stopped during the treatment, a light diet was given, and the routine physical examination of the patients and other possible other adverse reactions were observed. After the course of treatment, the curative effect was statistically analyzed.
3. statistical processing: all data were processed by SPSS19.0 software. X2 test was used for counting data, t test was adopted for measurement data, and Ridit test was used for grading data.
[results] 1. treatment group: clinical recovery 5 cases, effective 16 cases, effective 9 cases, invalid 4 cases, total effective rate 86.17%; control group: clinical cure 1 cases, 9 cases, effective 13 cases, 9 cases, total effective 71.87%. two group total effect after statistical analysis has significant difference (P0.O5), treatment group effect is superior to the control group.
There was a significant difference between the 2. control groups and the treatment group before and after the treatment. The difference was statistically significant (P0.01). The effect of the treatment group was obviously better than the control group in the improvement of the total integral.
3. the treatment group was significantly better than the control group in improving clinical symptoms, relieving anxiety and depression, reducing relapse rate and consolidating curative effect (P0.05).
4. compared with the control group, the treatment group can improve the overall quality of life of patients.
[Conclusion]
The study found that Wen Zhong Jianpi Fang combined with maleic trimebutine is superior to the control group in the treatment of diarrhea type irritable bowel syndrome (spleen yang deficiency syndrome) in alleviating the clinical symptoms, reducing the recurrence rate and improving the quality of life of the patients. Wen Zhong is strict with the prescription of strengthening the spleen, and the whole prescription comes from the recipe, and the principle of Wen Zhong dispelling cold and invigorating qi and invigorating the spleen is the principle. Invigorating the spleen and drying the dampness, in the warm and cold, and exhilarating the spleen yang, its modern pharmacological action may be as follows: 1. effective regulation of gastrointestinal motility, relieving abdominal pain and abdominal distention and other symptoms of.2. adjusted neuroendocrine function.3. to regulate the body immune function.4. balance gastrointestinal bacteria group. The irritable bowel syndrome (spleen yang deficiency syndrome) has a good clinical curative effect and deserves more in-depth study.
【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】：2014
【分類號(hào)】：R574

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