本文選題：胃食管反流病 + 脾虛濕阻型��； 參考：《河南中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:通過(guò)觀察胃食管反流病(脾虛濕阻型)患者治療前后中醫(yī)證候評(píng)分、臨床安全性、不良反應(yīng)發(fā)生率及疾病復(fù)發(fā)率等指標(biāo)的變化,研究健脾滲濕湯方的臨床療效,對(duì)其全面的客觀的評(píng)估、并試從理論上闡述其治療機(jī)制,為該方在中醫(yī)臨床上的應(yīng)用提供參考。方法:選擇符合納入標(biāo)準(zhǔn)并經(jīng)排除標(biāo)準(zhǔn)篩選后的68例患者,均來(lái)自洛陽(yáng)市第二中醫(yī)院2015年4月至2015年9月肝膽脾胃科就診的門診患者,共入組64例,采用分層隨機(jī)分組,分為治療組32例,對(duì)照組32例。對(duì)照組給予一般治療加用奧美拉唑腸溶膠囊(奧克,常州四藥制藥有限公司,生產(chǎn)批號(hào)為:120605),20mg/粒,每次20mg,每日2次,口服。治療組在對(duì)照組治療的基礎(chǔ)上給予健脾滲濕湯方(麩炒白術(shù)12g,黨參12g,炒山藥24g,茯苓12g,雞內(nèi)金15g,炒白扁豆24g,桔梗10g,薏苡仁24g,麩炒麥芽30g,川厚樸12g,炙甘草6g,砂仁6g)治療,方藥均由洛陽(yáng)市第二中醫(yī)院統(tǒng)一煎制,采用YFY13/3A型號(hào)的煎藥機(jī)煎藥,每1劑煎取400ml,分裝為2袋,每袋200ml,每次1袋,每日2次,早晚加熱后口服;兩組療程均為4周;分別觀察并記錄兩組患者治療前后的臨床癥狀、中醫(yī)證候積分等方面的變化。治療結(jié)束后第3個(gè)月末回訪患者,比較兩組患者的遠(yuǎn)期療效。結(jié)果:臨床療效觀察顯示:1.本研究納入病例64例,脫落4例,試驗(yàn)結(jié)束后治療組30例,對(duì)照組30例,兩組治療前一般情況如性別、年齡、病程等方面無(wú)明顯差異(P0.05),具有可比性;2.總體療效比較:治療組總有效率96.67%明顯優(yōu)于對(duì)照組總有效率76.67%,兩組療效差異有顯著性統(tǒng)計(jì)學(xué)意義(P0.05)3.治療組在改善患者燒心、反酸、胸骨后疼痛、脘腹痞滿等方面的療效明顯優(yōu)于對(duì)照組,但兩組在改善神疲乏力、食欲不振兩方面經(jīng)統(tǒng)計(jì)學(xué)分析,無(wú)明顯差異。4.治療結(jié)束后第3個(gè)月末隨訪,治療組的復(fù)發(fā)率明顯低于對(duì)照組,說(shuō)明加用健脾滲濕湯在治療胃食管反流病(脾虛濕阻型)的遠(yuǎn)期療效方面更有優(yōu)勢(shì)。結(jié)論:健脾滲濕湯方用于胃食管反流病(脾虛濕阻型),具有健脾行氣、化濕和胃的作用,能夠有效改善胃食管反流病患者的臨床癥狀,且能明顯降低遠(yuǎn)期復(fù)發(fā)率,在治療過(guò)程中未發(fā)現(xiàn)明顯的肝、腎功能損害,臨床療效確切,安全無(wú)不良反應(yīng),能減輕患者經(jīng)濟(jì)負(fù)擔(dān),值得臨床推廣。
[Abstract]:Objective: to observe the changes of TCM syndrome score, clinical safety, adverse reaction rate and disease recurrence rate before and after treatment in patients with gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). The comprehensive objective evaluation and the theoretical explanation of its therapeutic mechanism are discussed in order to provide a reference for the clinical application of the prescription in traditional Chinese medicine (TCM). Methods: Sixty-eight patients who met the inclusion criteria and were screened by exclusion criteria were selected from outpatient department of liver, gallbladder, spleen and stomach in Luoyang second traditional Chinese Medicine Hospital from April 2015 to September 2015. A total of 64 patients in the group were randomly divided into three groups. The patients were divided into treatment group (n = 32) and control group (n = 32). The control group was given general treatment plus omeprazole enteric-coated capsules (Oak, Changzhou four Medicines Pharmaceutical Co., Ltd.). The production lot number was 20 mg / granule, 20 mg / granule, 20 mg per time, twice a day, orally. On the basis of the treatment in the control group, the treatment group was treated with Jianpi osmosis decoction (12g of bran, 12g of Codonopsis, 24g of Chinese yam, 12g of Poria cocos, 15g of chicken Neijin, 24g of fried lentil, 10g of Platycodon grandiflorum, 24g of Coix seed, 30g of gluten fried malt, 12g of Sichuan magnolia, 6g of grilled licorice, 6g of sand kernel). The prescriptions were made by the second Chinese Medicine Hospital of Luoyang City. The decoction was made by YFY13/3A type decoction machine, 400 ml per dose, divided into 2 bags, 200 ml per bag, 1 bag per bag, 2 times a day, after heating in the morning and evening, the two groups were treated for 4 weeks. Observe and record the changes of clinical symptoms and TCM syndromes before and after treatment. The long-term outcomes of the two groups were compared at the end of the third month after treatment. Results: clinical observation showed that 1. 1. 64 cases were included in the study, 4 cases dropped out, 30 cases in the treatment group and 30 cases in the control group after the end of the trial. There was no significant difference between the two groups in general conditions such as sex, age and course of disease before treatment, and there was no significant difference between the two groups in such aspects as sex, age, course of disease, etc. The total effective rate of the treatment group was 96.67%, which was significantly better than that of the control group (76.67%). The difference between the two groups was statistically significant (P 0.05). The curative effect of the treatment group was better than that of the control group in improving heart burning, regurgitation, pain after sternum and abdominal fullness, but there was no significant difference between the two groups in improving fatigue and loss of appetite. The recurrence rate of the treatment group was significantly lower than that of the control group at the end of the third month after treatment, which indicated that the combination of Jianpi and Yishi decoction had more advantages in the treatment of gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). Conclusion: the decoction of invigorating spleen and infiltrating dampness can be used in gastroesophageal reflux disease (spleen deficiency and dampness obstruction type). It has the functions of invigorating spleen, removing dampness and stomach. It can effectively improve the clinical symptoms of patients with gastroesophageal reflux disease, and can obviously reduce the long term recurrence rate. No obvious damage of liver and kidney function was found in the course of treatment, the clinical effect was definite, safe and no adverse reaction, it can reduce the economic burden of the patients, and it is worth popularizing in clinic.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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