本文選題：非糜爛性反流病 + 肝胃不和證�。� 參考：《山西中醫(yī)學(xué)院》2016年碩士論文

【摘要】：目的:本課題旨在觀察加味四逆散治療非糜爛性反流病肝胃不和證的臨床療效,進(jìn)一步探討加味四逆散治療本病的作用機(jī)制,通過臨床研究為治療NERD肝胃不和證探討新方法。方法:1.本研究全部病例選自2014年10月至2015年12月山西中醫(yī)學(xué)院附屬醫(yī)院脾胃病科門診的患者。采用隨機(jī)對(duì)照的方法,選取符合中西醫(yī)納入標(biāo)準(zhǔn)的60例患者,分為治療組30例,對(duì)照組30例。2.治療組給予中藥加味四逆散,1劑/日;對(duì)照組給予枸櫞酸莫沙必利片,5mg/次,3次/日。兩組病人均每周復(fù)診一次,共治療4周,在治療開始前及治療后兩組患者填寫RDQ量表、中醫(yī)證候程度積分表,行食管壓力測(cè)定,對(duì)所有資料進(jìn)行統(tǒng)計(jì)分析,觀察治療前后兩組RDQ量表積分、中醫(yī)證候程度積分及食管壓力測(cè)定值的變化。3.采用SPSS18.0統(tǒng)計(jì)軟件對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1.臨床癥狀改善情況(1)治療組和對(duì)照組患者RDQ積分改善總有效率分別為83.33%和70.00%,兩組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)兩組患者RDQ積分治療前后比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);治療后兩組患者RDQ總積分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)治療組RDQ單項(xiàng)積分進(jìn)行組內(nèi)比較,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組在燒心、泛酸、反流方面的改善差異有統(tǒng)計(jì)學(xué)意義(P0.05);治療后兩組RDQ單項(xiàng)積分分別比較,四個(gè)單項(xiàng)癥狀的改善差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。(4)治療組中醫(yī)證候改善總有效率為86.66%,對(duì)照組為73.00%,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(5)治療前后治療組各單項(xiàng)癥狀差異均有統(tǒng)計(jì)學(xué)意義(P0.05),對(duì)照組在改善反酸、燒心、噯氣、納差、惡心方面差異有統(tǒng)計(jì)學(xué)意義(P0.05),在改善胸痛牽及兩脅、情緒不暢加重方面差異無統(tǒng)計(jì)學(xué)意義(P0.05);兩組進(jìn)行組間比較,在改善反酸、燒心、胸痛牽及兩脅、噯氣、情緒不暢加重方面治療組與對(duì)照組差異有統(tǒng)計(jì)學(xué)意義(P0.05),在納差、惡心方面差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.食管動(dòng)力改善情況(1)治療后治療組與對(duì)照組下食管括約肌壓力(LESP)較治療前均不同程度增加分別為:23.85±3.16mmHg vs 12.24±5.86mmHg;16.69±5.18mmHg vs 11.85±6.38mmHg,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);組間比較治療組優(yōu)于對(duì)照組(P0.05)。(2)治療后治療組與對(duì)照組食管遠(yuǎn)端波幅(PA)較治療前增加分別為:72.70±28.76mmHg vs 54.39±24.13mmHg,P0.05;64.89±25.17mmHg vs57.82±22.33mmHg,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),組間比較治療組優(yōu)于對(duì)照組(P0.05)。(3)治療后治療組與對(duì)照組濕咽成功率均不同程度增加分別為:72.53±23.62%vs 47.50±26.13%;66.71±36.04%vs 46.42±32.61%,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),兩組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(4)治療后治療組與對(duì)照組遠(yuǎn)端收縮積分(DCI)均不同程度增加分別為:974.30±428.81mmHg.cm.s vs732.08±191.60mmHg.cm.s;936.21±331.28mmHg.cm.s vs 694.23±178.36mmHg.cm.s,差異均有統(tǒng)計(jì)學(xué)意義(P0.05),兩組組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.安全性指標(biāo):治療前后兩組均未見明顯異常不良反應(yīng)。結(jié)論:1.兩組患者RDQ量表積分都有明顯改善,加味四逆散組總有效率83.33%,莫沙必利組總有效率70.00%,結(jié)果顯示治療組RDQ量表積分改善優(yōu)于對(duì)照組。通過RDQ量表單項(xiàng)積分也可以看出,加味四逆散改善患者燒心、胸痛、泛酸、反流癥狀的作用優(yōu)于對(duì)照組。2.治療組中醫(yī)證候總有效率86.66%,對(duì)照組中醫(yī)證候總有效率73.33%,治療組總有效率高于對(duì)照組。說明加味四逆散在改善NERD患者中醫(yī)證候方面的總療效優(yōu)于對(duì)照組。3.加味四逆散組在改善患者肝胃不和證,如反酸、燒心、胸痛牽及兩脅、噯氣、情緒不暢加重病情等中醫(yī)證候方面具有明顯的療效,明顯優(yōu)于對(duì)照組。說明加味四逆散能明顯改善NERD患者肝胃不和證候。4.兩組均能提高改善NERD患者的LESP、PA、濕咽成功率、DCI,而加味四逆散在提高患者LESP、PA方面優(yōu)于對(duì)照組。說明NERD患者可能存在食管遠(yuǎn)端動(dòng)力障礙,運(yùn)用加味四逆散提高LES壓力,改善食管運(yùn)動(dòng)障礙以及加強(qiáng)體部運(yùn)動(dòng),起到抗反流的作用,改善患者胃食管反流癥狀。5.試驗(yàn)前后患者的血尿便三大常規(guī)及肝腎功能檢測(cè)均未見異常,未發(fā)生胃腸道過敏反應(yīng)。說明加味四逆散臨床運(yùn)用安全。
[Abstract]:Objective: the purpose of this study is to observe the clinical efficacy of Jiawei four inverse powder in the treatment of liver stomach disharmony of non erosive reflux disease, and to further explore the mechanism of adding flavored four inverse powder in the treatment of this disease and to explore new methods for the treatment of NERD liver stomach disharmony through clinical study. Methods: 1. cases were selected from October 2014 to December 2015 in Shanxi traditional Chinese medicine. The patients in the outpatient department of the spleen and stomach department of the Hospital Affiliated Hospital were randomly selected to select 60 patients conforming to the standard of traditional Chinese and Western medicine, which were divided into 30 cases in the treatment group, and 30 cases in the control group, which were given the traditional Chinese medicine plus four inverse powder, 1 doses / day, and the control group with Mosapride Citrate Tablets, 5mg/ times, 3 times per day. All the two groups were treated once a week, a total of the patients were revisited once a week, a total of the patients were revisited once a week, a total of 60 patients were retreated once a week, a total of the patients were revisited once a week, altogether. After 4 weeks of treatment, before and after the treatment, two groups of patients were filled in RDQ scale, TCM syndrome degree integral table, esophageal pressure measurement, all data were statistically analyzed, two groups of RDQ scale integral before and after treatment, TCM syndrome degree integral and change of esophageal pressure measurement value.3. were applied to all data by SPSS18.0 statistical software. Results: 1. the improvement of clinical symptoms (1) the total effective rate of RDQ integral improvement in the treatment group and the control group was 83.33% and 70% respectively. The two groups were statistically significant (P0.05). (2) the difference between the two groups of patients before and after the RDQ integral treatment was statistically significant (P0.05); the total RDQ score of the two groups after the treatment was compared. Statistical significance (P0.05). (3) the treatment group RDQ single score in group comparison, the difference was statistically significant (P0.05), the control group in the heart, pantothenate, reflux improvement has statistical significance (P0.05); after the treatment, the two groups of RDQ single score, respectively, the difference between the four symptoms of the improvement were statistically significant (P0.05). (4) treatment. The total effective rate of TCM syndrome in the treatment group was 86.66%, the control group was 73%, the difference was statistically significant (P0.05). (5) the difference of single symptom in the treatment group before and after treatment was statistically significant (P0.05). The control group had statistical significance (P0.05) in improving anti acid, heartburn, belching, nausea and nausea, and in improving chest pain and two flank, emotion was not good. There was no statistical significance (P0.05) in the difference between the two groups. The difference between the treatment group and the control group was statistically significant (P0.05) in the improvement of anti acid, heart burning, chest pain and two coerced, belching, and bad mood aggravation. There was no significant difference in nausea (P0.05).2. esophageal motility improvement (1) after treatment group. Compared with the control group, the lower esophageal sphincter pressure (LESP) increased in different degrees, respectively, 23.85 + 3.16mmHg vs 12.24 + 5.86mmHg, 16.69 + 5.18mmHg vs 11.85 + 6.38mmHg, the difference was statistically significant (P0.05), and the comparison group was superior to the control group (P0.05). (2) the distal end of the esophagus (PA) in the treatment group and the control group was compared with the treatment. The anterior increase was 72.70 + 28.76mmHg vs 54.39 + 24.13mmHg, P0.05, 64.89 + 25.17mmHg vs57.82 + 22.33mmHg, and the difference was statistically significant (P0.05). The comparison between the group and the control group was superior to the control group (P0.05). (3) the difference between the treatment group and the control group was 72.53 + 23.62%vs 47.50 + 26.13%, 66.71 + 36.04%. Vs 46.42 + 32.61%, the difference was statistically significant (P0.05), there was no significant difference between the two groups (P0.05). (4) the distal contraction integral (DCI) of the treatment group and the control group increased in varying degrees, respectively, 974.30 + 428.81mmHg.cm.s vs732.08 + 191.60mmHg.cm.s, 936.21 + 331.28mmHg.cm.s vs 694.23 + 178.36mmHg.cm.s, the differences were all There was statistical significance (P0.05). There was no significant difference (P0.05).3. safety index between the two groups. There was no obvious abnormality in the two groups before and after treatment. Conclusion: the scores of the RDQ scale in the 1. two groups were obviously improved, the total effective rate of the Jiawei four converse group was 83.33%, the total effective rate of the mosapride group was 70%, and the result showed the RDQ quantity in the treatment group. The improvement of table integral was better than that of the control group. Through the integral of RDQ form item, it can be seen that the effect of adding four inverse powder to improve the patient's heartburn, chest pain, pantothenic acid and reflux symptoms is better than that of the control group.2., the total effective rate of TCM syndrome in the control group is 73.33%, the total effective rate of the treatment group is higher than that of the control group. It shows that the addition of four inverses in the treatment group is more than that of the control group. The total curative effect of improving the TCM syndrome of NERD patients is better than that of the control group.3. four in the group of the anti dispersal group in improving the syndrome of liver and stomach disharmony of the patients, such as anti acid, heart burning, chest pain, two coerced, belching, and bad mood aggravation of the TCM syndrome, which is obviously better than that in the group. It shows that the addition of four inverse powder can obviously improve the liver of the patients with NERD. Gastric Disharmony Syndrome.4. two can improve the LESP, PA, wet throat success rate of NERD patients, DCI, and the addition of flavored four inverse scatter is superior to the control group in improving the patient's LESP and PA. It shows that the patients with NERD may have the distal esophageal motility disorder, improve the LES pressure, improve the esophageal motility and strengthen the body movement, and play anti reflux in the patients with NERD. The three major routine and liver and kidney function tests before and after the.5. test of the patients with gastroesophageal reflux symptoms were not found to be abnormal and no gastrointestinal anaphylaxis occurred. It was indicated that the clinical application of Jiawei four inverse dispersion was safe.
【學(xué)位授予單位】：山西中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 梁國英;李賀薇;;謝晶日教授論治“胃食管反流病”經(jīng)驗(yàn)[J];中醫(yī)藥信息;2015年02期

2 魏冬梅;;柴胡疏肝散聯(lián)合西藥治療非糜爛性反流性食管炎95例[J];陜西中醫(yī)學(xué)院學(xué)報(bào);2015年02期

3 劉汶;;從痰辨證施治頑固性胃食管反流病體會(huì)[J];環(huán)球中醫(yī)藥;2015年02期

4 張秀蓮;朱生j;劉春芳;程艷梅;;疏肝和胃方改善非糜爛性胃食管反流病主要癥狀的臨床觀察[J];中華中醫(yī)藥雜志;2015年02期

5 楊娜;;非糜爛性胃食管反流病中醫(yī)辨證治療臨床探討[J];中國實(shí)用醫(yī)藥;2015年02期

6 李湘力;王升旭;楊路;林泳;;董氏奇穴治療非糜爛性反流病的臨床療效及患者生存質(zhì)量觀察[J];臨床醫(yī)學(xué)工程;2014年08期

7 吳基炳;伍韻賢;謝利梅;;質(zhì)子泵抑制劑及香砂養(yǎng)胃丸聯(lián)合黛力新治療非糜爛性反流病臨床研究[J];現(xiàn)代醫(yī)藥衛(wèi)生;2014年06期

8 王紀(jì)云;耿嘉蔚;;半夏瀉心湯加減對(duì)非糜爛性反流病癥狀和生活質(zhì)量的影響[J];中藥材;2014年01期

9 顧永鴻;;淺談中醫(yī)對(duì)胃食管反流病的認(rèn)識(shí)與辨證[J];求醫(yī)問藥(下半月);2013年12期

10 段春蘭;馬振華;;非糜爛性反流病患者食管24h pH值及壓力測(cè)定的臨床意義[J];中國實(shí)用醫(yī)藥;2013年20期

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