【摘要】：目的采用臨床觀察研究,驗(yàn)證自擬處方安腸湯治療腹瀉型腸易激綜合征肝郁脾虛型的臨床療效及安全性,并從理論和臨床研究?jī)煞矫嫦到y(tǒng)地探討疏肝健脾法治療腹瀉型腸易激綜合征的臨床療效。方法選取符合納入標(biāo)準(zhǔn)的60例患者隨機(jī)分為治療組和對(duì)照組,每30例。治療組與安腸湯口服,1日1劑,分早晚兩次服用。對(duì)照組與馬來酸曲美布汀膠囊口服,1粒1次,3次/日。兩組均連續(xù)用藥8周為一療程。8周后分別進(jìn)行兩組中醫(yī)癥候療效比較、前后IBS-SSS量表積分、前后IBS-QOL量表積分、前后PRO量表積分比較。治療結(jié)束后隨訪8周,觀察患者的復(fù)發(fā)情況。結(jié)果1.綜合療效:治療組中治愈6例,顯效8例,有效12例,無效4例,總有效率86.7%;對(duì)照組中治愈2例,顯效8例,有效8例,無效12例,總有效率60%。兩組療效經(jīng)Ridit分析,有顯著性差異(P0.05),治療組總有效率高于對(duì)照組。2.治療組治療前后IBS-SSS量表積分比較,有顯著性差異(P0.01);對(duì)照組治療前后IBS-SSS量表積分比較,有明顯差異(P0.05);治療后對(duì)照組與治療組IBS-SSS量表積分比較,有顯著性差異(P0.01)。3.兩組治療前中醫(yī)各項(xiàng)癥狀積分比較無明顯差異(P0.05),具有可比性;治療組治療前、后中醫(yī)各癥狀積分均有明顯改善(P0.05),對(duì)照組除了腹痛較前有不同程度改善,其余癥狀較前無明顯改善(P0.05)。4.治療前兩組中醫(yī)癥候總積分無明顯差異(P0.05),具有可比性,治療前后組內(nèi)總積分有差異(P0.05),具有可比性,說明兩組治療均有效,治療后兩組總積分比較有顯著性差異(P0.05),具有可比性,說明治療組在緩解中醫(yī)癥候療效優(yōu)于對(duì)照組。5.治療前兩組IBS-QOL量表8個(gè)維度積分組間比較無顯著性差異(P0.05),組間具有可比性。對(duì)照組僅在健康憂慮、家庭關(guān)系2個(gè)維度治療前后積分有差異,其余維度無明顯差異,而治療組僅在家庭關(guān)系、異性概念治療前后積分無顯著差異(P0.05),其余均表現(xiàn)出顯著性差異(P0.05)。6.治療前兩組PRO量表6個(gè)維度積分比較均無顯著性差異(P0.05),提示兩組該量表的基線具有可比性。治療后兩組量表6個(gè)維度的得分均有降低,但治療組在系統(tǒng)狀態(tài)、反流、排便、消化不良4個(gè)維度積分較對(duì)照組表現(xiàn)出顯著性差異(P0.05),說明治療組在系統(tǒng)狀態(tài)、反流、排便、消化不良4個(gè)領(lǐng)域得到了更大的改善。7.復(fù)發(fā)率比較:兩組患者的不良反應(yīng)癥狀均較輕,呈一過性出現(xiàn),停藥后緩解,均不影響治療。隨訪2個(gè)月的過程中,治療組復(fù)發(fā)率為11.5%,對(duì)照組復(fù)發(fā)率為44.4%,表明安腸湯治療腹瀉型腸易激綜合征能減少?gòu)?fù)發(fā)率,遠(yuǎn)期療效好,值得進(jìn)一步應(yīng)用與推廣。結(jié)論安腸湯治療腹瀉型腸易激綜合征臨床綜合療效優(yōu)于馬來酸曲美布汀膠囊,且遠(yuǎn)期療效好,能減少?gòu)?fù)發(fā)率,改善癥狀,提高患者的生活質(zhì)量,值得進(jìn)一步應(yīng)用與推廣。
[Abstract]:Objective to investigate the efficacy and safety of self-prescribed Anchang decoction in the treatment of diarrhea irritable bowel syndrome with liver depression and spleen deficiency. The clinical effect of soothing liver and invigorating spleen in treating diarrhea irritable bowel syndrome was discussed systematically from both theoretical and clinical aspects. Methods 60 patients who met the inclusion criteria were randomly divided into treatment group and control group, every 30 cases. Treatment group and an Chang Tang oral, 1 dose, divided into morning and evening two times. The control group and trimebutine maleate capsule were taken orally once, 3 times a day. After 8 weeks of treatment, the curative effects of TCM symptoms were compared between the two groups. The scores of IBS-SSS scale, IBS-QOL scale and PRO scale were compared before and after 8 weeks. The patients were followed up for 8 weeks to observe the recurrence. Result 1. In the treatment group, 6 cases were cured, 8 cases were effective, 12 cases were effective, 4 cases were ineffective, and the total effective rate was 86.7%, while in the control group, 2 cases were cured, 8 cases were markedly effective, 8 cases were effective, 12 cases were ineffective, and the total effective rate was 60%. Ridit analysis showed a significant difference between the two groups (P0.05). The total effective rate in the treatment group was higher than that in the control group. There were significant differences in IBS-SSS scale scores before and after treatment in the treatment group (P0.01); in the control group, the IBS-SSS scale scores were significantly different before and after treatment (P0.05); after treatment, there was a significant difference in the IBS-SSS scale scores between the control group and the treatment group (P0.01). There is no significant difference between the two groups before treatment (P0.05), there is comparability; before treatment, after the treatment of TCM symptoms were significantly improved (P0.05), in the control group, in addition to abdominal pain, there were different degrees of improvement. There was no significant improvement in other symptoms (P0.05). Before treatment, there was no significant difference (P0.05) in the total score of TCM symptoms between the two groups (P0.05), and the total score was comparable before and after treatment (P0.05), which showed that the two groups were effective. After treatment, there were significant differences (P0.05) in the total integral between the two groups (P0.05), and there was comparability between the two groups (P0.05). It shows that the curative effect of the treatment group in relieving TCM symptoms is better than that in the control group. 5. 5. Before treatment, there was no significant difference between the two groups in the eight dimensional scores of IBS-QOL scale (P0.05), and there was comparability between the two groups. In the control group, there was only significant difference in health anxiety, family relationship between the two dimensions before and after treatment, while there was no significant difference in the other dimensions, while in the treatment group there was no significant difference in the family relationship, heterosexual concept before and after treatment (P0.05), and the others showed significant differences (P0.05). There was no significant difference in the six dimensional scores of PRO scale between the two groups before treatment (P0.05), indicating that the baseline of the two groups was comparable. After treatment, the scores of the six dimensions of the two groups were all decreased, but the scores of the four dimensions in the treatment group were significantly different from those in the control group (P0.05), which indicated that the treatment group was in the system state, reflux, defecation, and had significant difference in the scores of system state, reflux, defecation, and dyspepsia (P0.05). Four areas of indigestion have improved further. 7. 7%. Comparison of recurrence rate: the symptoms of adverse reactions in both groups were mild and transient, remission after withdrawal of drugs did not affect the treatment. During the follow-up of 2 months, the recurrence rate of the treatment group was 11.5 and that of the control group was 44.4, which indicated that Anchang decoction could reduce the recurrence rate of diarrhea irritable bowel syndrome, and the long-term effect was good, which was worthy of further application and popularization. Conclusion Anchang decoction is better than trimebutine maleate capsule in the treatment of diarrhea irritable bowel syndrome. It can reduce the recurrence rate, improve the symptoms and improve the quality of life of the patients. It is worthy of further application and popularization.
【學(xué)位授予單位】：廣西中醫(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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