【摘要】：目的:觀察清郁和降湯聯(lián)合奧美拉唑治療肝胃郁熱型非糜爛性反流病伴焦慮狀態(tài)的臨床療效及復(fù)發(fā)率,并進(jìn)行客觀評(píng)價(jià)。方法:通過(guò)胃食管反流病問(wèn)卷(GerdQ)、胃鏡、PPI診斷試驗(yàn)、肝胃郁熱型非糜爛性反流病臨床癥狀分級(jí)量化評(píng)分表對(duì)患者進(jìn)行中西醫(yī)診斷,對(duì)符合診斷標(biāo)準(zhǔn)者予填寫(xiě)焦慮自評(píng)量表(SAS),篩選SAS評(píng)分大于50的患者,最終共納入62例,采用完全隨機(jī)、復(fù)合處理對(duì)照原則將其分為治療組和對(duì)照組各31例,因剔除治療組1例,故實(shí)際納入61例,治療組30例,對(duì)照組31例。對(duì)照組口服奧美拉唑腸溶膠囊,治療組在西藥基礎(chǔ)上予以清郁和降湯治療,療程均為8周,分別在治療結(jié)束時(shí)、停藥4周后對(duì)患者癥狀進(jìn)行評(píng)分,通過(guò)前后積分對(duì)照了解患者病情變化,比較并評(píng)價(jià)治療效果以及觀察停藥后病情復(fù)發(fā)情況。結(jié)果:1.兩組治療后西醫(yī)癥狀總療效比較,治療組和對(duì)照組均有療效,治療組總有效率90.0%,對(duì)照組總有效率87.1%,兩組療效無(wú)顯著統(tǒng)計(jì)學(xué)差異(P=0.722 P0.05)。胃食管反流病問(wèn)卷(GerdQ)各癥狀治療后比較,治療組與對(duì)照組在改善反流、燒心等典型癥狀上無(wú)明顯差別,而治療組在改善因典型癥狀引起的睡眠障礙方面優(yōu)于對(duì)照組;各癥狀自身前后比較有顯著統(tǒng)計(jì)學(xué)差異(P0.05),表明治療組與對(duì)照組對(duì)改善各癥狀均有療效。2.兩組治療后中醫(yī)癥狀總療效比較,治療組總有效率93.3%,對(duì)照組總有效率74.2%,兩組療效有極顯著統(tǒng)計(jì)學(xué)差異(P=0.044P0.05),表明治療組對(duì)改善肝胃郁熱型非糜爛性反流病(NERD)的療效優(yōu)于對(duì)照組。3.在患者肝胃郁熱證型的癥狀比較中,兩組自身前后比較有統(tǒng)計(jì)學(xué)差異(P0.05),表明治療組與對(duì)照組對(duì)癥狀改善均有療效;兩組治療后比較,對(duì)于兩脅脹滿(mǎn)或隱痛、暖氣反流、大便干燥、食欲減退癥狀的改善具有顯著統(tǒng)計(jì)學(xué)差異(P0.05),其中在改善噯氣反流、大便干燥、食欲減退癥狀有極顯著統(tǒng)計(jì)學(xué)差異(P0.01),其他癥狀無(wú)顯著性差異(P0.05),表明治療組在改善全身癥狀方面優(yōu)于對(duì)照組。4.兩組治療后SAS評(píng)分比較,治療組有極顯著統(tǒng)計(jì)學(xué)差異(P=0.000,P0.01),對(duì)照組無(wú)顯著統(tǒng)計(jì)學(xué)差異(P=0.083,P0.05),說(shuō)明治療組在改善患者焦慮狀態(tài)方面明顯優(yōu)于對(duì)照組。5.兩組停藥4周后復(fù)發(fā)情況的比較,治療組與對(duì)照組的復(fù)發(fā)率分別為3.3%和26.0%,具有顯著性統(tǒng)計(jì)學(xué)差異(P=0.013,P0.05),表明治療組比對(duì)照組復(fù)發(fā)率低。結(jié)論:清郁和降湯聯(lián)合奧美拉唑治療肝胃郁熱型非糜爛性反流病療效明確,臨床具有較低的復(fù)發(fā)率,未見(jiàn)明顯不良反應(yīng)。清郁和降湯能有效改善患者全身癥狀及焦慮狀態(tài)、提高患者的生活質(zhì)量。
[Abstract]:Objective: to observe the clinical effect and recurrence rate of Qingyu and Jiangtang combined with omeprazole in the treatment of non-erosive reflux of liver and stomach. Methods: the gastroesophageal reflux disease (GERD) was diagnosed by (GerdQ), gastroscope, PPI diagnostic test, and clinical symptom scale of non-erosive reflux of liver and stomach. 62 patients with SAS scores greater than 50 were selected by filling out the anxiety Self-Rating scale (SAS),) to meet the diagnostic criteria. The patients were randomly divided into treatment group (31 cases) and control group (31 cases). There were 61 cases in the treatment group, 30 cases in the treatment group and 31 cases in the control group. The control group was treated with omeprazole enteric-coated capsule, the treatment group was treated with Qingyu and Jiangtang on the basis of western medicine, the course of treatment was 8 weeks. The changes of patients' condition were compared and evaluated, and the relapse after withdrawal was observed. Results: 1. The total effective rate of the treatment group was 90.0%, the total effective rate of the control group was 87.1%, there was no significant difference between the two groups (P0.722 P0.05). There was no significant difference between the treatment group and the control group in improving reflux, heartburn and other typical symptoms, but the treatment group was superior to the control group in improving the sleep disorder caused by typical symptoms. There was a significant difference between the symptoms before and after (P0.05), indicating that the treatment group and the control group were effective in improving each symptom. 2. The total effective rate of the treatment group and the control group were 93.3and 74.2 respectively. There was a significant difference between the two groups (P=0.044P0.05). The results showed that the curative effect of the treatment group was better than that of the control group in improving the (NERD) of the non erosive reflux disease of the type of liver and stomach stagnation heat. In the syndrome of stagnation of the liver and stomach, there was statistical difference between the two groups before and after the comparison (P0.05), indicating that the treatment group and the control group were effective in improving the symptoms. After treatment, there were significant differences between the two groups in the improvement of symptoms of fullness or pain, warm air reflux, dry stool and anorexia (P0.05), among which belching and stool dryness were improved. There was significant difference in appetite loss (P0.01), but no significant difference in other symptoms (P0.05), which indicated that the treatment group was better than the control group in improving systemic symptoms. 4. There was significant difference in SAS score between the two groups after treatment (P0. 000 P 0. 01), while in the control group there was no significant difference (P 0. 083 P 0. 05). It shows that the treatment group is obviously superior to the control group in improving the anxiety state of the patients. 5. 5. The recurrence rate of the treatment group and the control group were 3.3% and 26.0 respectively (P < 0.05), which indicated that the recurrence rate of the treatment group was lower than that of the control group. Conclusion: Qingyu and Jiangtang combined with omeprazole are effective in the treatment of non-erosive reflux disease with stagnation of liver and stomach. Qingyu and Jiangtang can effectively improve patients' systemic symptoms and anxiety, and improve their quality of life.
【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】：2017
【分類(lèi)號(hào)】：R571

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