發(fā)布時間：2018-01-10 18:22

  本文關(guān)鍵詞：“溫陽健脾湯”治療脾胃虛弱型慢性萎縮性胃炎的臨床療效觀察　出處：《北京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 臨床療效觀察 慢性萎縮性胃炎 脾胃虛弱型 “溫陽健脾湯”

【摘要】：研究背景慢性萎縮性胃炎(Chronic atrophic gastritis CAG)是慢性胃炎的一種類型,其病程長,復(fù)發(fā)率較高,是消化系統(tǒng)的多發(fā)病、難治性疾病。慢性萎縮性胃炎由正常胃黏膜一炎癥一萎縮一腸上皮化生一不典型增生一胃癌的演變規(guī)律已被大家公認(rèn)�；诖�,慢性萎縮性胃炎也已被明確定為癌前疾病,嚴(yán)重威脅人類健康。亞洲是慢性萎縮性胃炎發(fā)生的主要地區(qū),其中又以中國和日本的發(fā)病率最高,且有相當(dāng)一部分患者最后會惡化演變?yōu)槲赴�。在年齡分布上,慢性萎縮性胃炎是老年人的常見病、多發(fā)病,其發(fā)病率隨著年齡的增長也相應(yīng)的增高。所以,及早的發(fā)現(xiàn)和識別癌前病變,進行有效的隨訪監(jiān)測,最好能干預(yù)和阻斷其惡化就成為降低胃癌發(fā)病率和死亡率的有效措施之一。慢性萎縮性胃炎作為一種由多種致病因素導(dǎo)致的消化系統(tǒng)慢性疾病,目前現(xiàn)代醫(yī)學(xué)對其仍無特殊、有效的治療方法,仍以對癥治療為主,而且西醫(yī)治療存在著復(fù)發(fā)率高、副作用較多等諸多弊端。近些年來,中醫(yī)在慢性萎縮性胃炎的治療上依靠合理的辨證論治,聯(lián)合應(yīng)用中藥、中成藥、針灸等多種治療手段,取得了顯著的治療效果。中醫(yī)治療不僅可以在短時間內(nèi)有效的改善患者的臨床癥狀,最重要的是還可以在一定程度上逆轉(zhuǎn)已經(jīng)發(fā)生病變的胃粘膜,從而進一步阻止慢性萎縮性胃炎癌變的發(fā)生�？梢哉f中醫(yī)中藥在慢性萎縮性胃炎的治療方面擁有巨大的優(yōu)勢和廣闊的前景。研究目標(biāo)本研究是在導(dǎo)師治療慢性萎縮性胃炎的臨床經(jīng)驗的指導(dǎo)下,對其經(jīng)驗方“溫陽健脾湯”治療脾胃虛弱型慢性萎縮性胃炎的臨床療效進行觀察,并借助專業(yè)的統(tǒng)計分析對其給予客觀評價,從而為中醫(yī)辨證論治脾胃虛弱型慢性萎縮性胃炎提供臨床思路和依據(jù)。研究內(nèi)容導(dǎo)師周斌主任醫(yī)師通過總結(jié)長期的臨床實踐,主張臨床上慢性萎縮性胃炎多以脾胃虛弱為主要病機,又結(jié)合中醫(yī)關(guān)于脾腎“先天”和“后天”的相互資生關(guān)系理論,主張應(yīng)以“溫陽健脾、化瘀通絡(luò)”作為慢性萎縮性胃炎的基本治則,并依據(jù)此治療原則組方“溫陽健脾湯”來治療脾胃虛弱型慢性萎縮性胃炎,觀察其治療前后臨床癥狀、胃鏡及病理的變化。本次研究分為文獻綜述和臨床實驗研究兩個部分。文獻綜述：比較系統(tǒng)的回顧和總結(jié)了慢性萎縮性胃炎現(xiàn)代醫(yī)學(xué)的診療進展,并對慢性萎縮性胃炎所屬的中醫(yī)范疇、中醫(yī)病因病機、辨證分型以及辨證治療進行了系統(tǒng)的闡述。臨床試驗研究：收集中醫(yī)辨證為脾胃虛弱型慢性萎縮性胃炎患者的病例,應(yīng)用“溫陽健脾湯”對其進行12周為一療程的治療,并在一個療程結(jié)束后進行一定時間的隨訪,通過比較服藥前后患者臨床癥狀和胃鏡、病理結(jié)果的變化,探討“溫陽健脾湯”治療脾胃虛弱型慢性萎縮性胃炎的臨床療效。研究結(jié)果研究結(jié)果顯示“溫陽健脾湯”治療脾胃虛弱型慢性萎縮性胃炎具有顯著的療效,其癥狀療效總有效率為90.59%,其中痊愈率10.59%,顯效率52.94%,有效率27.06%。在病理療效方面,胃粘膜萎縮在胃竇的總有效率為83.05%,胃體為100%,胃角為64.52%；腸化在胃竇的總有效率為90.76%,胃體為73.33%,胃角為73.33%；本次研究中不典型增生在胃竇、胃角未出現(xiàn)無效病例,而胃體部因未收集到出現(xiàn)不典型增生的病例,這里不予討論。結(jié)論“溫陽健脾湯”對于治療中醫(yī)辨證為脾胃虛弱型的慢性萎縮性胃炎有很好的臨床療效,不僅能顯著改善患者的臨床癥狀,還能在不同程度上逆轉(zhuǎn)胃粘膜的萎縮、腸化以及不典型增生。并且隨著治療時間的延長,患者的臨床癥狀和胃粘膜病理的改善程度也是逐漸提高的。另外,通過一個療程結(jié)束后的隨訪發(fā)現(xiàn),停服“溫陽健脾湯”后,仍有某些癥狀可以得到繼續(xù)緩解,可見中藥在降低復(fù)發(fā)率方面有一定的優(yōu)勢。
[Abstract]:On the background of chronic atrophic gastritis (Chronic atrophic gastritis CAG) is a type of chronic gastritis and its long duration, high recurrence rate, is a disease of the digestive system, refractory disease. Chronic atrophic gastritis from normal gastric mucosa inflammation a atrophy of intestinal metaplasia dysplasia gastric cancer a a evolution has been recognized. Based on this, chronic atrophic gastritis has been clearly identified as a precancerous disease, a serious threat to human health. Asia is the main area of chronic atrophic gastritis, and the incidence of China and Japan was high, and there is a considerable number of patients will eventually deteriorate the evolution of gastric cancer in the age distribution, chronic atrophic gastritis is a common disease in the elderly, the incidence, the incidence rate increased with age also increased. Therefore, the early discovery and identification of precancerous lesions, monitored effectively The best, can intervene and block the deterioration has become one of the effective measures to reduce the morbidity and mortality of gastric cancer. Chronic atrophic gastritis is caused by a variety of pathogenic factors of chronic diseases of digestive system, modern medicine to still no special, effective treatment for symptomatic treatment, still exist, and Western medicine treatment the recurrence rate is high, more side effects and many other disadvantages. In recent years, Chinese medicine in the treatment of chronic atrophic gastritis through reasonable diagnosis and treatment, the combination of traditional Chinese medicine, Chinese medicine, acupuncture and other therapies, the treatment effect was significant. The clinical symptoms of TCM treatment not only in a short period of time can effectively improve the patient's and the most important is also to some extent can reverse the pathological gastric mucosa, so as to further prevent the canceration of chronic atrophic gastritis. It can be said in Chinese Medicine Have a huge advantage and broad prospects for the treatment of chronic atrophic gastritis. The goal of this research is the clinical experience in the treatment of chronic atrophic gastritis in the teacher under the guidance of the clinical curative effects of the experience of "Wenyang Jianpi Decoction" in the treatment of chronic atrophic gastritis of spleen stomach deficiency were observed, and with the help of professional statistics give the analysis on the objective evaluation, so as to provide clinical basis for TCM syndrome differentiation of spleen and stomach type of chronic atrophic gastritis. The research content of Professor Zhou Bin by summing up the long-term clinical practice, advocates of clinical chronic atrophic gastritis with spleen and stomach is the main pathogenesis, and the combination of traditional Chinese medicine on spleen and kidney "congenital" and "acquired" mutual promotion relations theory, should be the "Wenyang Jianpi Huayu Tongluo," as the basic treatment for chronic atrophic gastritis, and on the basis of the treatment principle The prescription "Wenyang Jianpi Decoction" in treating chronic atrophic gastritis of spleen stomach deficiency, clinical symptoms were observed before and after treatment, the change of gastroscope and pathology. This study is divided into two parts: literature review and clinical trials. Literature review: systematic reviews and summarizes the advances in diagnosis and treatment of chronic atrophic gastritis in modern medicine, and category of TCM on chronic atrophic gastritis of the TCM etiology and pathogenesis, syndrome differentiation and treatment were described. Clinical research: collect syndrome of spleen and stomach type of chronic atrophic gastritis patients cases, application of "Wenyang Jianpi Decoction on the treatment for 12 weeks a course of treatment, and for a certain period of time in the end after a period of follow-up, by comparing before and after treatment in patients with clinical symptoms and gastroscope, pathological changes of the results, to explore the" Wenyang Jianpi Decoction "in the treatment of spleen stomach deficiency The clinical curative effect of weak type of chronic atrophic gastritis. Results: the results showed that the significant efficacy of Wenyang Jianpi Decoction "in the treatment of chronic atrophic gastritis of spleen stomach deficiency symptoms, the total effective rate was 90.59%, the cure rate was 10.59%, the effective rate was 52.94%, efficiency of 27.06%. In pathological effect, gastric mucosa atrophy in the antrum of the total efficiency was 83.05%, gastric body 100%, gastric angle 64.52%; intestinal metaplasia in gastric antrum of the total efficiency of 90.76%, gastric body 73.33%, gastric angle was 73.33%; the study of atypical hyperplasia in the gastric antrum, gastric angle does not appear invalid cases, and the body of the stomach because of the uncollected dysplasia cases, will not be discussed here. Conclusion Wenyang Jianpi Decoction has good curative effect for the treatment of TCM syndrome of spleen and stomach type of chronic atrophic gastritis, not only can significantly improve the clinical symptoms of the patients, but also in different The degree of reversal of gastric mucosal atrophy, intestinal metaplasia and atypical hyperplasia. And with the prolongation of treatment time, the degree of improvement in clinical symptoms and pathology of gastric mucosa is also gradually increased. In addition, through a course after the follow-up, stop taking "Wenyang Jianpi Decoction", there are still some symptoms you can continue to ease, the traditional Chinese medicine has some advantages in reducing the recurrence rate.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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