本文選題：咽喉反流 + 胃食管反流　； 參考：《遼寧中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:咽喉反流(Laryngopharyngeal Reflux,LPR)又稱咽喉反流疾病,是指胃內(nèi)酸性H離子和胃蛋白酶原,大部分隨氣體、小部分隨液體經(jīng)食管到達(dá)喉、咽、氣管、支氣管、中耳、鼻等所引起的臨床癥候群的總稱,由于該病患者所表現(xiàn)的臨床癥狀與一些其他原因引起的咽喉疾病所表現(xiàn)的臨床癥狀比較相似,常常與慢性咽炎、胃食管反流病相混淆,所以咽喉反流診斷率不高,治療效果不佳,越來(lái)越得到耳鼻咽喉科醫(yī)生的高度重視。對(duì)于咽喉反流患者通常于促進(jìn)胃腸動(dòng)力藥和質(zhì)子泵抑制劑治療為首選治療,但隨著臨床研究的長(zhǎng)期進(jìn)行,患者病情的發(fā)展,醫(yī)生不易掌握這些藥物的治療時(shí)間和劑量,長(zhǎng)期使用會(huì)出現(xiàn)減少鈣吸收導(dǎo)致骨質(zhì)疏松和盆骨骨折,提高了肺炎的發(fā)生率以及降低了抗血小板凝集藥的作用等不良反應(yīng)缺點(diǎn),并對(duì)某些咽喉反流患者治療效果不明顯,這些用藥情況就讓我們?cè)谂R床上不斷的探索與研究,目前祖國(guó)醫(yī)學(xué)對(duì)于咽喉反流的研究并不完善,但是我們祖國(guó)醫(yī)學(xué)有著自己的優(yōu)勢(shì),根據(jù)其中醫(yī)辨證論治的特點(diǎn)以及中醫(yī)整體觀念,該病是由于思慮傷脾或肝郁日久,橫逆犯脾,以致脾失健運(yùn),聚濕生痰,痰氣互結(jié)阻于咽喉而發(fā)病,中藥湯劑對(duì)咽喉反流治療具有較好的臨床療效,本研究就是觀察行氣散結(jié)除痰法治療痰氣互結(jié)型咽喉反流的臨床療效。方法:按照隨機(jī)對(duì)照原則,對(duì)符合納入標(biāo)準(zhǔn)的咽喉反流患者70例分為治療組與對(duì)照組各35例,對(duì)照組為口服奧美拉唑腸溶膠囊40mg日二次,治療組為在對(duì)照組基礎(chǔ)上口服行氣散結(jié)除痰之中藥湯劑。治療兩個(gè)療程后進(jìn)行隨訪,通過(guò)對(duì)比患者治療前后的反流癥狀指數(shù)得分以及反流體征檢查得分,以評(píng)估治療效果。結(jié)果:1.兩組患者在性別、年齡、病程的數(shù)據(jù)經(jīng)統(tǒng)計(jì)學(xué)分析均無(wú)顯著性差異(P0.05),提示兩組具有可比性。2.用藥前兩組患者進(jìn)行反流癥狀指數(shù)得分比較無(wú)顯著性差異(P0.05),提示具有可比性;用藥后兩組患者進(jìn)行反流癥狀指數(shù)得分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。用藥前兩組患者進(jìn)行反流體征得分比較無(wú)顯著性差異(P0.05),提示具有可比性;用藥后兩組患者反流體征得分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。用藥前兩組患者進(jìn)行視覺(jué)模擬評(píng)分無(wú)顯著性差異(P0.05),提示具有可比性;用藥后兩組患者進(jìn)行視覺(jué)模擬評(píng)分比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.用藥后,對(duì)照組總有效率為74.29%,治療組總有效率為88.57%,治療組總有效率明顯高于對(duì)照組總有效率,說(shuō)明行氣散結(jié)除痰之中藥湯劑治療痰氣互結(jié)型咽喉反流有效。結(jié)論:運(yùn)用行氣散結(jié)除痰之中藥湯劑治療咽喉反流疾病,突出了中醫(yī)的辨證論治的特點(diǎn),臨床療效較好,值得臨床推廣和應(yīng)用。
[Abstract]:Objective: largopharyngopharyngeal reflux (LPR), also known as throat reflux disease, refers to acidic H ions and pepsinogen in the stomach, most of which follow gas, and a small part of the fluid passes through the esophagus to the larynx, pharynx, trachea, bronchus, middle ear. The general term for clinical syndromes caused by nose and other diseases, because the clinical symptoms of patients with the disease are similar to those of throat diseases caused by some other causes, and are often confused with chronic pharyngitis and gastroesophageal reflux disease. Therefore, the diagnosis rate of pharynx and larynx reflux is not high and the therapeutic effect is not good, which has been paid more and more attention by the doctors of otolaryngology. For patients with pharynx and throat reflux, the first choice is to promote gastrointestinal motility drugs and proton pump inhibitors. However, with the long-term clinical study and the development of the patient's condition, it is difficult for doctors to control the treatment time and dosage of these drugs. Long-term use of calcium may lead to osteoporosis and pelvic fractures, increase the incidence of pneumonia and reduce the role of antiplatelet agglutinin, and the treatment of some patients with pharynx and larynx reflux is not obvious. These medication conditions allow us to continue to explore and study clinically. At present, the study of pharynx and larynx reflux in Chinese medicine is not perfect, but our motherland medicine has its own advantages. According to the characteristics of TCM syndrome differentiation and treatment and the whole concept of TCM, the disease is caused by thinking about the injury of the spleen or liver depression for a long time, transversely invading the spleen, causing the spleen to lose health and transportation, accumulating dampness to generate phlegm, and phlegm and qi intertwining to block the pharynx and larynx. Traditional Chinese medicine decoction has a good clinical effect on pharynx and larynx reflux. This study is to observe the clinical effect of the method of removing phlegm and eliminating phlegm and qi to eliminate phlegm and throat regurgitation. Methods: according to the principle of randomized control, 70 patients with pharynx and larynx reflux were divided into two groups: treatment group (n = 35) and control group (n = 35). The control group was treated with omeprazole enteric-coated capsule (40mg) twice a day. The treatment group was treated with traditional Chinese medicine decoction for removing phlegm. The patients were followed up after two courses of treatment to evaluate the effect of treatment by comparing the scores of reflux symptom index and reflux signs before and after treatment. The result is 1: 1. There was no significant difference in sex, age, course of disease between the two groups by statistical analysis, indicating that the two groups have comparability. 2. There was no significant difference in the score of reflux symptom index between the two groups before medication, indicating comparability, and there was significant difference in the score of reflux symptom index between the two groups after treatment. There was no significant difference in the scores of reflux signs between the two groups before medication, indicating comparability, and there was significant difference in the scores of reflux signs between the two groups. There was no significant difference in visual analogue score between the two groups before medication, indicating comparability, and there was significant difference in visual analogue score between the two groups after medication. The total effective rate was 74.29 in the control group and 88.57 in the treatment group. The total effective rate in the treatment group was significantly higher than that in the control group. Conclusion: the treatment of pharynx and larynx reflux with traditional Chinese medicine decoction for removing phlegm and qi dispersing highlights the characteristics of syndrome differentiation and treatment of traditional Chinese medicine, and the clinical effect is good, and it is worth popularizing and applying in clinic.
【學(xué)位授予單位】：遼寧中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R276.1

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