本文選題：腹瀉型腸易激綜合征　切入點：健脾固腸湯　出處：《湖北中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:本研究采用導師自擬方健脾固腸湯配合穴位艾灸治療中醫(yī)辨證為肝郁脾虛證的腹瀉型腸易激綜合征(IBS-D),旨在觀察評價其臨床療效及安全性,為推廣應用于臨床提供依據(jù)。方法:1.選取2015年4月-2016年10月間于湖北省中醫(yī)院脾胃病科專家門診就診,確診為腹瀉型腸易激綜合征(IBS-D),中醫(yī)辨證屬肝郁脾虛型的患者72例。將這72例患者按就診先后順序隨機分為兩組,治療組36例,對照組36例。最終有69例患者完成臨床試驗并納入統(tǒng)計分析,其中治療組和對照組分別為35例及34例。兩組患者經(jīng)統(tǒng)計學比較后在年齡、性別、病程、中醫(yī)癥狀總積分方面差異無統(tǒng)計學意義,具有可比性(P0.05)。2.治療組予以健脾固腸湯加減(焦白術(shù)15g、白芍20g、防風10g、茯苓15g、薏苡仁30g、陳皮10g、木香10g、黃連6g、藿香10g、佩蘭10g、煨訶子10g、芡實10g、石榴皮10g、炙甘草6g),每日一劑以水煎服,分早、晚兩次于飯后半小時溫服,每次150ml;穴位艾灸(神闕、關(guān)元、天樞),每日一次。對照組予以蒙脫石散(哈藥集團世一堂制藥廠生產(chǎn),國藥準字H20093375),每日3次,每次1袋(3g),水沖服;復方谷氨酰胺腸溶膠囊(地奧集團成都藥業(yè)股份有限公司生產(chǎn),國藥準字:H51023598),每日3次,每次2粒,口服。治療期間囑患者飲食清淡,忌生冷、辛辣刺激之品,保持心情舒暢,勿服用與本病治療相關(guān)的其他藥物。兩組療程均為4周,治療過程中若對照組患者出現(xiàn)大便秘結(jié)癥狀則停用蒙脫石散。治療前后對兩組病例各進行1次安全性觀察指標的檢查,并記錄治療前后兩組患者的癥狀、體征變化情況,綜合評價健脾固腸湯配合穴位艾灸治療肝郁脾虛型IBS-D的臨床療效。療程結(jié)束后對痊愈及顯效患者進行4周隨訪,了解病情復發(fā)情況。3.所有數(shù)據(jù)資料采用SPSS21.0軟件進行分析。計量資料采用t檢驗;計數(shù)資料采用x2檢驗;等級資料采用秩和檢驗。結(jié)果:1.治療組臨床痊愈10例、顯效10例、有效13例、無效2例,總有效率94.29%;對照組分別為5例、8例、14例、7例,總有效率為79.41%。兩組數(shù)據(jù)經(jīng)比較后差異有統(tǒng)計學意義(P0.05),表明治療組比對照組臨床療效更好。2.治療前兩組患者的中醫(yī)癥狀總積分無顯著差異(P0.05),具有可比性;治療后兩組患者的中醫(yī)癥狀總積分均低于治療前,其中治療組中醫(yī)癥狀總積分與對照組相比下降明顯,差異有統(tǒng)計學意義(P0.05),表明治療組能更好的改善中醫(yī)癥狀。3.治療組在糞便性狀、腹痛、腹脹及情志異常癥狀的改善上明顯優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05);在其他癥狀的改善上療效相當,差異無統(tǒng)計學意義(P0.05)。4.經(jīng)隨訪4周后,治療組復發(fā)率為20.00%,對照組復發(fā)率為69.23%,兩組數(shù)據(jù)差異有統(tǒng)計學意義(P0.05),表明治療組遠期療效優(yōu)于對照組。5.在治療過程中,兩組病例均未出現(xiàn)明顯不良反應。結(jié)論:兩組治療方案對于本病的治療均有明顯效果,但健脾固腸湯配合穴位艾灸的療效更加顯著,尤其是在排便頻率、腹痛腹脹、情志異常等主癥的改善方面優(yōu)勢突出,能有效改善生活質(zhì)量,降低疾病復發(fā)率,是一種療效顯著、安全性高、副作用少、易于操作和接受的治療方法,可推廣應用于臨床。
[Abstract]:Objective: diarrhea type intestinal using tutor Jianpi Decoction Combined with acupuncture moxibustion treatment of solid bowel syndrome of liver stagnation and spleen deficiency on the irritable bowel syndrome (IBS-D), to evaluate the clinical efficacy and safety, for the promotion of the basis on clinical application. Methods: 1. from April 2015 -2016 year in October in Hubei Provincial Traditional Chinese Medical Hospital of the spleen and stomach department of expert outpatient service, diagnosed with diarrhea type irritable bowel syndrome (IBS-D), 72 cases of patients with TCM is liver and spleen deficiency. The 72 patients were randomly divided into two groups, treatment group 36 cases, control group 36 cases. Finally 69 patients completed clinical trials and included in the statistical analysis, the treatment group and control group were 35 cases and 34 cases. The two groups of patients were statistically in age, gender, disease duration, no statistically significant difference in the total score of clinical symptoms, with comparable treatment of.2. (P0.05) By strengthening the spleen and intestinal Decoction group (focal white atractylodes rhizome 15g, white peony root 20g, wind 10g, Poria 15g, Coix 30g, orange peel 10g, 10g of Radix Aucklandiae, Rhizoma Coptidis 6G, agastache 10g, Perrin 10g, 10g 10g for Myrobalam, Gorgon fruit, pomegranate peel 10g, licorice 6g), a daily agent with water decoction, divided early, late in two after half an hour. Every time, 150ml; Acupoint Moxibustion (Shenque, Guanyuan, Tianshu), once a day. The control group was given (Montmorillonite powder production, Shiyitang pharmaceutical factory of Harbin Pharmaceutical Group Zhunzi H20093375), 3 times a day, each time 1 bags (3G), Compound Glutamin Entersoluble Capsules (production with water; Chengdu pharmaceutical Limited by Share Ltd, thepilot Zhunzi: H51023598), 3 times daily, 2 capsules each time, oral diet during treatment. Patients have light, avoid cold, spicy food, maintain good mood, do not take other drugs associated with this disease treatment. Two groups were treated for 4 weeks, treatment if the process of control group patients The emergence of constipation symptoms. Montmorillonite powder is disabled before and after treatment in the two groups, the 1 safety observation index examination, and record the symptoms of the two groups of patients before and after treatment, changes of symptoms, comprehensive evaluation of strengthening the spleen and intestinal decoction combined with clinical curative effect of Acupoint Moxibustion in the treatment of liver stagnation and spleen deficiency type IBS-D after treatment for 4 weeks. Follow up of cure and effective patients understand the disease recurrence.3. all the data were analyzed by SPSS21.0 software. The measurement data using t test; x2 test with count data; ranked data using rank sum test. Results: 10 cases were cured and 1. treatment group, 10 cases were markedly effective, 13 cases effective, 2 cases ineffective, the total the efficiency of 94.29%; the control group were 5 cases, 8 cases, 14 cases, 7 cases, the total efficiency of 79.41%. was statistically significant difference after two groups of data comparison (P0.05), showed that the treatment group than the control group clinical curative effect better.2. treatment There was no significant difference between the total scores of the two groups before symptoms of traditional Chinese medicine (P0.05), comparable; the total score after treatment two groups of patients with symptoms were lower than those before treatment, the treatment group symptom total score decreased significantly compared with the control group, the difference was statistically significant (P0.05), showed that the symptoms of.3. treatment the treatment group were better in the stool, abdominal pain, abdominal distension and abnormal emotional symptoms improved significantly better than the control group, the difference was statistically significant (P0.05); efficacy in other symptoms, there was no statistically significant difference (P0.05) by.4. after 4 weeks of follow-up, the recurrence rate of treatment group 20%, control group the recurrence rate was 69.23%, there were significant differences between the two groups (P0.05), the data show that the treatment group curative effect is better than that of control group.5. in the course of treatment, two cases had no obvious adverse reactions. Conclusion: the two treatment programs for the Treatment of disease has obvious effect, but the effect of strengthening the spleen and intestinal decoction combined with moxibustion is more significant, especially in the frequency of defecation, abdominal pain, emotional abnormalities and other main symptoms improved to highlight the advantages, can effectively improve the quality of life, reduce the recurrence rate, a significant effect, high safety, less side effects easy to operate, and to accept the treatment, can be widely used in clinic.

【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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