本文選題：潰瘍性結(jié)腸炎 + 大腸濕熱　； 參考：《湖北中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:該臨床研究主要旨在觀察應(yīng)用中藥灌腸方法聯(lián)合西藥治療慢性潰瘍性結(jié)腸炎活動期(大腸濕熱證)的臨床療效,觀察并記錄患者在本治療過程中的癥狀、體征、實驗室檢查結(jié)果及復(fù)發(fā)次數(shù),將之與對照組進行比較。比較二者在接受相應(yīng)治療后的近期及遠期療效,以此來評價該治療方法的有效性及安全性,為以后臨床使用滌腸愈瘍湯灌腸治療潰瘍性結(jié)腸炎提供依據(jù)。研究方法:該觀察中的64例病例,均來自于自2015年10月至2016年10月就診于湖北省中醫(yī)院光谷院區(qū)脾胃科住院病房,將患者隨機分成實驗組32例,對照組32例。依據(jù)隨機分組法將病人列為實驗組32例,對照組32例。西藥組吩咐病人口服西藥美沙拉嗪腸溶片治療,1.0g/次,3次/天,療程為2個月。以西藥組為基礎(chǔ),治療組則加用自擬方滌腸愈瘍湯(方劑組成:白頭翁10g,青黛10g,川連10g,川柏炭10g,敗醬草10g,白及15g,三七5g,炒蒲黃10g,槐花炭10g)水煎300ml,分成兩份,早晚各取150ml保留灌腸,連續(xù)使用2個月。治療結(jié)束后對比兩組患者總療效、中醫(yī)證候積分、腸鏡黏膜評級表現(xiàn)、中醫(yī)證候療效、疾病活動指數(shù)及C-反應(yīng)蛋白(CRP)、大便潛血(OB)評分結(jié)果的變化。結(jié)果:(1)治療組的總有效率為87.5%,對照組的總有效率為62.5%,兩組結(jié)果經(jīng)統(tǒng)計學(xué)比較,差異具有顯著性(P0.05);在改善中醫(yī)證候積分、降低DAI指數(shù)、中醫(yī)證候改善、內(nèi)鏡下黏膜評級改善情況、改善OB評分指標(biāo)方面,兩組具有統(tǒng)計學(xué)意義,治療組均優(yōu)于對照組(P0.05);在改善兩組CRP值方面,兩組無統(tǒng)計學(xué)差異(P0.05);(2)治療過程中兩組患者均偶見頭痛現(xiàn)象,初期偶見患者腹瀉癥狀加重,幾天后癥狀減輕,該現(xiàn)象考慮與美沙拉嗪副作用及藥物耐受有關(guān);治療結(jié)束3個月后隨訪,治療組復(fù)發(fā)2人,對照組復(fù)發(fā)10人,治療組的復(fù)發(fā)率低于對照組。結(jié)論:滌腸愈瘍湯灌腸聯(lián)合美沙拉嗪腸溶片口服能有效的治療慢性潰瘍性結(jié)腸炎活動期(大腸濕熱證)患者,能明顯改善患者臨床癥狀、降低DAI指數(shù)、修復(fù)患者腸道黏膜,并且復(fù)發(fā)率低,在臨床運用安全有效,值得推廣使用。
[Abstract]:Objective: to observe the clinical effect of traditional Chinese medicine enema combined with western medicine in treating active stage of chronic ulcerative colitis (large intestine damp-heat syndrome), and to observe and record the symptoms and signs of the patients. The results of laboratory examination and the times of recurrence were compared with those of the control group. In order to evaluate the efficacy and safety of the two methods, the short-term and long-term effects of the two treatments were compared, which provided the basis for the treatment of ulcerative colitis with Ditan Changyu decoction (DYYTang). Methods: from October 2015 to October 2016, 64 cases were admitted to the inpatient ward of Department of spleen and stomach of Guanggu Hospital of Hubei traditional Chinese Medicine Hospital. The patients were randomly divided into experimental group (n = 32) and control group (n = 32). The patients were divided into experimental group (32 cases) and control group (32 cases). The western medicine group ordered the patients to take orally the western medicine mesalazine enteric-coated tablets for 3 times a day for 2 months. On the basis of the western medicine group, the treatment group was added with the decoction of self-made formula Ditan Chang Yu Yang Tang (the composition of the prescription: Weng 10g, Qing Dai 10g, Chuan Lian 10g, Chuan Pai Tan 10g, paussurea 10g, White and 15g, panax notoginseng 5g, fried fuhuang 10g, Sophora japonica 10g), and divided into two parts. Take 150ml to retain enema in the morning and evening and use continuously for 2 months. After treatment, the changes of total curative effect, TCM syndromes score, mucosal grading, TCM syndromes efficacy, disease activity index, C-reactive protein (CRP) and occult blood (OB) score were compared between the two groups. Results: (1) the total effective rate was 87.5 in the treatment group and 62.5 in the control group. The difference between the two groups was statistically significant (P0.05). In improving the OB score, the two groups have statistical significance, the treatment group is better than the control group (P0.05); in improving the value of); (in the two groups, there is no statistical difference (P0.05) in the treatment process of the two groups of patients have occasional headache phenomenon, The symptoms of diarrhea were aggravated in the early stage and relieved a few days later, which was related to the side effects of mesalazine and drug tolerance. After 3 months of treatment, there were 2 relapses in the treatment group and 10 in the control group. The recurrence rate in the treatment group was lower than that in the control group. Conclusion: Dishangyu decoction enema combined with mesalazine enteric-coated tablets can effectively treat patients with active stage of chronic ulcerative colitis (large intestine damp-heat syndrome), can significantly improve the clinical symptoms of patients, reduce the Dai index, repair the intestinal mucosa of patients. And the recurrence rate is low, safe and effective in clinical use, worth popularizing.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.62

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