本文選題：胃食管反流病 + 肝胃郁熱證�。� 參考：《安徽中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的本研究主要觀察清胃降逆方治療肝胃郁熱型胃食管反流病患者的臨床療效及血管活性腸肽的影響。方法本研究選擇70例符合診斷標(biāo)準(zhǔn)的胃食管反流病患者,嚴(yán)格按照隨機(jī)化原則,分為治療組和對照組,每組各35例。兩組均給予雷貝拉唑和莫沙必利口服,治療組在此基礎(chǔ)上加用清胃降逆方水煎劑,治療期間均停用其它藥物,治療8周,觀察患者治療前后的中醫(yī)證候積分、電子胃鏡下食管黏膜的變化及血管活性腸肽水平的變化情況,并進(jìn)行統(tǒng)計(jì)學(xué)分析比較。結(jié)果(1)臨床綜合療效:治療組臨床痊愈15例,顯效者有10例,有效者為7例,無效者3例,總有效率為91.43%;對照組臨床痊愈10例,顯效者8例,有效有6例,無效為11例,總有效率為68.57%。兩組進(jìn)行比較,治療組明顯優(yōu)于對照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(2)中醫(yī)證候療效比較:(1)各項(xiàng)癥狀的綜合療效比較:兩組在燒心、反酸、胸骨后灼痛三個主要癥狀的比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。而在脘腹脹滿、胃部嘈雜、口干口苦、心煩易怒、噯氣等次要癥狀癥狀上,治療組優(yōu)于對照組(P0.05),差異有統(tǒng)計(jì)學(xué)意義。(2)中醫(yī)證候總積分比較:兩組內(nèi)治療前后比較,在主要癥狀總積分、次要癥狀總積分及綜合癥狀總積分上差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組組間治療后比較,在主要癥狀的總積分上,差異無統(tǒng)計(jì)學(xué)意義(P0.05),在次要癥狀總積分及綜合癥狀總積分兩個方面上,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。(3)各項(xiàng)癥狀積分的比較:各組在治療后優(yōu)于治療前,差異有統(tǒng)計(jì)學(xué)意義(P0.05);經(jīng)過2個療程治療后,在反酸、燒心癥狀的改善程度上,兩組的治療效果相當(dāng)(P0.05),在其他臨床癥狀的緩解程度上,治療組明顯優(yōu)于對照組(P0.05)。(3)電子胃鏡下黏膜象比較:經(jīng)治療后,兩組在改善黏膜炎癥方面,內(nèi)鏡下黏膜象表現(xiàn)與治療前均有不同程度地改善,但治療組明顯優(yōu)于對照組(P0.05)。(4)血清血管活性腸肽比較:治療后,兩組血清VIP均下降,而治療組血清VIP的水平下降明顯,與對照組比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論清胃降逆方聯(lián)合西藥可以明顯改善肝胃郁熱型胃食管反流病患者的臨床癥狀和內(nèi)鏡下食管黏膜炎癥的程度,同時也能夠降低血清VIP的水平,臨床上值得進(jìn)一步研究及應(yīng)用。
[Abstract]:Objective to observe the clinical effect of Qingwei Jiangni recipe in treating gastroesophageal reflux disease with liver and stomach stagnation and the effect of vasoactive intestinal peptide. Methods 70 patients with gastroesophageal reflux disease (GERD) who met the diagnostic criteria were randomly divided into treatment group (n = 35) and control group (n = 35). Both groups were given rabeprazole and mosapride orally. The treatment group was treated with Qingwei Jiangni decoction on this basis. During the treatment, other drugs were stopped and treated for 8 weeks. The TCM syndromes scores before and after treatment were observed. The changes of esophageal mucosa and the level of vasoactive intestinal peptide under electronic gastroscopy were analyzed and compared statistically. Results (1) Clinical comprehensive curative effect: in the treatment group, 15 cases were cured, 10 cases were effective, 7 cases were effective, 3 cases were ineffective, and the total effective rate was 91.43%, while in the control group, 10 cases were cured, 8 cases were effective, 6 cases were effective, 11 cases were ineffective. The total effective rate was 68.57. Two groups were compared, the treatment group was significantly better than the control group, the difference was statistically significant (P0.05). (2) TCM syndrome efficacy comparison: (1) comparison of the comprehensive efficacy of symptoms: the two groups in heart burning, acid regurgitation, sternal pain after the comparison of three main symptoms, The difference was not statistically significant (P0.05). However, the treatment group was superior to the control group (P0.05) in the secondary symptoms of abdominal distension, gastric noise, dry mouth, irritability, belching and other minor symptoms. (2) comparison of the total score of TCM syndromes: comparison between the two groups before and after treatment, There were significant differences in the total scores of main symptoms, secondary symptoms and comprehensive symptoms between the two groups (P0.05); after treatment, there were significant differences in the total scores of major symptoms between the two groups. The difference was not statistically significant (P0.05). The difference was statistically significant in the total score of secondary symptoms and the total integral of comprehensive symptoms (P0.05). (3). The difference was statistically significant (P0.05); after two courses of treatment, the improvement of the symptoms of regurgitation and heartburn was similar between the two groups (P0.05), and the degree of remission of other clinical symptoms was similar (P0.05). The treatment group was better than the control group (P0.05). (3) compared with the electronic gastroscope mucosal image: after treatment, the two groups in improving mucosal inflammation, endoscopic mucosal image and before treatment were improved in varying degrees. But the treatment group was significantly better than the control group (P0.05). (4) serum vasoactive intestinal peptide comparison: after treatment, the two groups serum VIPs decreased significantly, compared with the control group, the difference was statistically significant (P0.05). Conclusion Qingwei Jiangni prescription combined with western medicine can obviously improve the clinical symptoms and the degree of endoscopic esophagomucosal inflammation in patients with gastroesophageal reflux with liver and stomach stagnation heat, and can also reduce the level of serum VIP, which is worthy of further study and application.
【學(xué)位授予單位】：安徽中醫(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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