【摘要】：目的:觀察導(dǎo)師李桂賢教授臨床善用的加味柴芍六君顆粒治療肝郁脾虛證IBS-D的臨床有效性及安全性,并從理論上探討該方治療腸易激綜合征的作用機(jī)制。方法:將廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院脾胃科門診符合IBS-D肝郁脾虛證的60例患者,隨機(jī)分為治療組及對照組,每組各30例。對照組給予馬來酸曲美布汀膠囊合復(fù)合乳酸菌膠囊治療,治療組在對照組用藥基礎(chǔ)上配合中藥加味柴芍六君顆粒進(jìn)行治療,兩組均治療4周。療程結(jié)束后,分別對兩組進(jìn)行門診或電話隨訪。結(jié)果:1.治療組中醫(yī)證候積分與對照組比較,差異有統(tǒng)計學(xué)意義(P0.05),治療組療效明顯優(yōu)于對照組。2.治療組治療后痊愈8例,顯效14例,有效5例,無效3例,總有效率為90.0%;對照組治療后痊愈4例,顯效7例,有效11例,無效6例,總有效率為78.6%,差異有統(tǒng)計學(xué)意義(P0.05),治療組療效明顯優(yōu)于對照組。3.治療后兩組患者在治療腹瀉、腹痛腹脹、噯氣、倦怠乏力、神疲懶言、食欲不振、寐差、口渴癥狀的有效率上,有顯著性差異(P0.05),治療組在治療上述癥狀療效上優(yōu)于對照組。兩組患者腸鳴癥狀治療有效率無明顯差異(P0.05)。4.治療后治療組患者IBS-SSS總積分及腹痛程度、腹痛時間、腹脹程度、大便滿意度、生活影響度療效上均優(yōu)于對照組(P0.05)。5.治療后治療組患者生活質(zhì)量總積分及各維度單項積分均優(yōu)于對照組(P0.05)。6.療程結(jié)束3個月對兩組病人進(jìn)行電話或門診隨訪,治療組復(fù)發(fā)5例,未復(fù)發(fā)22例,復(fù)發(fā)率18.5%;對照組復(fù)發(fā)11例,未復(fù)發(fā)11例,復(fù)發(fā)率50.0%。經(jīng)統(tǒng)計兩組復(fù)發(fā)率有顯著性差異(P0.05),治療組復(fù)發(fā)率明顯低于對照組。結(jié)論:加味柴芍六君顆粒聯(lián)合西藥治療肝郁脾虛證IBS-D療效確切,安全性好,復(fù)發(fā)率低且無不良反應(yīng),能明顯緩解IBS-D腹瀉、腹脹、腹痛、腸鳴、噯氣、倦怠乏力、神疲懶言、食欲不振、寐差、口渴癥狀,提高IBS-D患者的生活質(zhì)量。
[Abstract]:Objective: to observe the clinical efficacy and safety of modified Chaixiaoxiujun granule, a tutor of Professor Li Guixian, in the treatment of IBS-D with liver stagnation and spleen deficiency, and to explore theoretically the mechanism of the treatment of irritable bowel syndrome. Methods: sixty patients with IBS-D liver depression and spleen deficiency syndrome were randomly divided into treatment group and control group, each group with 30 cases in the outpatient department of spleen and stomach of the first affiliated Hospital of Guangxi University of traditional Chinese Medicine. The control group was treated with trimebutine maleate capsule combined with lactic acid bacteria capsule, and the treatment group was treated with traditional Chinese medicine plus Chaixiaoniujun granule on the basis of drug use in the control group. Both groups were treated for 4 weeks. After the course of treatment, the two groups were followed up by telephone or outpatient. The result is 1: 1. The treatment group compared with the control group TCM syndrome score, the difference was statistically significant (P0.05), the treatment group was significantly better than the control group. 2. In the treatment group, 8 cases were cured, 14 cases were effective, 5 cases were effective, 3 cases were ineffective, the total effective rate was 90.0%, while in the control group, 4 cases were cured, 7 cases were markedly effective, 11 cases were effective, 6 cases were ineffective. The total effective rate was 78.6, the difference was statistically significant (P0.05), the curative effect of the treatment group was significantly better than that of the control group. 3. After treatment, there were significant differences between the two groups in the effective rate of treating diarrhea, abdominal pain, belching, fatigue, listlessness, anorexia, insomnia and thirst (P0.05). The therapeutic effect of the treatment group was better than that of the control group. There was no significant difference between the two groups (P0.05). After treatment, the total score of IBS-SSS, the degree of abdominal pain, the time of abdominal pain, the degree of abdominal distension, the degree of stool satisfaction and the degree of influence of life in the treatment group were better than those in the control group (P0.05). After treatment, the total score of quality of life and the single score of each dimension in the treatment group were superior to those in the control group (P0.05). 6. The two groups were followed up by telephone or outpatient at the end of 3 months. The recurrence rate was 18.5in the treatment group (n = 5), but in the control group (n = 11), no recurrence occurred (n = 11), the recurrence rate was 50.0%. There was significant difference in the recurrence rate between the two groups (P0.05), and the recurrence rate in the treatment group was significantly lower than that in the control group. Conclusion: Jiawei Chaixiaolijun granule combined with western medicine is effective and safe in the treatment of liver depression and spleen deficiency syndrome IBS-D with low recurrence rate and no adverse reactions. It can obviously relieve IBS-D diarrhea, abdominal distension, abdominal pain, bowel ringing, belching, fatigue, fatigue and laziness, and can relieve IBS-D diarrhea, abdominal distension, abdominal pain, intestinal pain, belching, fatigue, fatigue and laziness. Loss of appetite, poor sleep, thirst symptoms, improve the quality of life of patients with IBS-D.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

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