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  本文關鍵詞： 慢性非萎縮性胃炎 肝胃不和 痞滿 臨床療效　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

【摘要】：慢性非萎縮性胃炎是指由多種病因所引起的胃黏膜的慢性炎癥,具有發(fā)病率高、病情纏綿難愈的特點,臨床多表現(xiàn)為上腹部隱痛和(或)飽脹不適、暖氣、反酸、呃逆、惡心、消瘦等癥狀。當今社會生活、工作壓力大,多數患者常因情緒刺激導致病情反復,影響生活質量,在疾病進展的后期,隨著胃粘膜固有腺體萎縮及腸腺的化生,少數可進一步發(fā)展成慢性萎縮性胃炎,甚至發(fā)生癌變�？梢娫摬〔粌H長期困擾患者日常生活,在疾病進展后期也會對患者的生命安全構成嚴重的危害,因此如何改善患者臨床癥狀,提高生活質量是治療該病的重中之重,中醫(yī)藥特色療法在治療該病上優(yōu)勢明顯,療效顯著,本研究旨在探索疏肝和胃法治療此類疾病的臨床價值。目的:通過治療前后患者中醫(yī)證候積分及慢性胃炎PRO量表各領域積分的變化,探討疏肝和胃法治療慢性非萎縮性胃炎的臨床療效,為進一步的臨床應用及推廣提供依據。方法:選擇2016年2月一 2017年1月間在廣東省中西醫(yī)結合醫(yī)院門診及住院部就診,經胃鏡檢查確診為慢性非萎縮性胃炎,中醫(yī)辨證為痞滿肝胃不和型,符合入選標準及排除標準的患者70例。隨機分為治療組(疏肝和胃法組)和對照組(多潘立酮組),每組各35例。治療組:以柴枳和胃湯口服治療,每日1劑,分早餐后和晚餐后兩次溫服;對照組:多潘立酮,10mg 口服每日3次,治療療程均為2周。分別記錄所有入組人員治療前后中醫(yī)證候積分、慢性胃炎PRO量表評分。對所有資料作詳細記錄并分析其臨床療效。結果:1.研究開始前對兩組患者在入組年齡、性別、受教育程度等一般情況、中醫(yī)證候積分、生存質量各領域積分進行比較,兩組間的差異無統(tǒng)計學意義(P0.05),說明治療前兩組一般情況具有可比性。2.臨床總療效評價:療程結束后,治療組共納入34例,痊愈10例,顯效12例,有效8例,無效4例,總有效率88.24%;對照組共納入33例,痊愈5例,顯效4例,有效13例,無效11例,總有效率66.67%。經治療后兩組患者療效分級經兩獨立樣本非參數檢驗(秩和檢驗)及Fisher卡方檢驗,差異均有統(tǒng)計學意義(P0.05),治療組療效優(yōu)于對照組。3.中醫(yī)證候積分:通過治療后,治療組和對照組中醫(yī)證候積分均有改善(P0.01),對兩組治療后中醫(yī)證候積分和治療前后積分差值進行比較,治療組對肝胃不和型中醫(yī)證候改善優(yōu)于對照組,差異具有統(tǒng)計學意義(P0.05)。4.PRO量表積分:治療組和對照組經治療后在生存質量生理領域、獨立性領域、心理領域、環(huán)境領域四個領域方面均較治療前有緩解(P0.01),對生理領域及心理領域治療后評分、治療前后評分差值進行比較,兩組差異具有統(tǒng)計學意義(P0.05),而在獨立性領域及環(huán)境領域方面,治療后的評分及治療前后的評分差值比較無統(tǒng)計學意義(P0.05)。5.兩組患者服藥期間均未發(fā)生不良事件。結論:運用疏肝和胃法治療肝胃不和型慢性非萎縮性胃炎療效滿意,改善臨床證候療效優(yōu)于多潘立酮,該方可以改善患者的生存質量,其中在生理領域及心理領域方面治療作用優(yōu)于多潘立酮。兩組患者在治療過程未發(fā)生不良事件,提示療效安全、顯著,可供臨床參考。
[Abstract]:Chronic non atrophic gastritis is a chronic inflammation caused by various etiological factors of gastric mucosa, with a high incidence, characteristics of disease lingering, clinical symptoms were abdominal pain and (or) distention, heating, acid reflux, hiccups, nausea, weight loss and other symptoms. In today's social life, work pressure a large majority of patients, often due to emotional stimuli leading to repeated illness, affecting the quality of life, in the late stage of disease progression, with gastric mucosa gland atrophy and intestinal gland metaplasia, few can further develop into chronic atrophic gastritis, and even cancer. The disease is not only long plagued the daily life of patients with disease progression, in the late stage may constitute a serious harm to the life safety of patients, so how to improve clinical symptoms, improve the quality of life is the priority among priorities of the treatment of the disease, the characteristics of traditional Chinese medicine therapy in the treatment of the disease have obvious advantages, curative effect, The purpose of this study was to explore the clinical value of Shuganhewei therapy for this disease. Objective: through changes before and after treatment of TCM syndrome in patients with chronic gastritis score and PRO scale in all areas of integration, to explore the clinical effect of Shuganhewei therapy for chronic non atrophic gastritis, provide the basis for further clinical application and promotion. Methods: a February 2016 January 2017 in Guangdong Province Traditional Chinese medicine hospital outpatient and inpatient treatment, diagnosed by endoscopy for chronic non atrophic gastritis, syndrome of incoordination between the liver and stomach fullness, met the inclusion criteria and 70 patients. In addition to the standard were randomly divided into treatment group (Shuganhewei group) and the control group (domperidone group), 35 cases in each group. The treatment group were treated with CHAIZHI and Stomach Decoction, 1 dose daily, divided after breakfast and after dinner two times / day; control group: domperidone, 10mg orally 3 times a day, treatment The process for 2 weeks. All subjects were recorded before and after treatment of TCM syndrome, chronic gastritis PRO scale. To make a detailed record of all data and analyze its clinical curative effect. Results: 1. study before the start of the two groups of patients in the group of age, gender, education level, general situation of traditional Chinese medicine the syndrome integral, the integral quality of life in all areas were compared, there was no significant difference between the two groups (P0.05), indicating the two groups before treatment, generally comparable.2. total clinical efficacy evaluation: after the end of treatment, the treatment group included 34 cases, 10 cases were cured, 12 cases markedly effective, effective in 8 cases, 4 cases were invalid, the total efficiency of 88.24%; the control group included 33 cases, 5 cases were cured, 4 cases were cured, 13 cases effective, 11 cases ineffective, the total efficiency of 66.67%. after treatment in patients with grade two groups by two independent samples nonparametric test (Wilcoxon test) and Fisher chi square test, have statistical difference The significance of.3. (P0.05), the control group of TCM syndromes curative effect in treatment group than: after the treatment, the treatment group and the control group of TCM syndrome score were improved (P0.01), comparison of the two groups after treatment before and after treatment of TCM syndrome integral and the integral of the treatment group than the control group of Chinese medicine liver stomach disharmony the improvement in the symptoms, the difference was statistically significant (P0.05).4.PRO scores: treatment group and control group after treatment in the quality of life in the physiological field, psychological field independence, field, four field of environmental field was significantly higher than before treatment (P0.01), alleviate the score in the treatment of physical and psychological domain after treatment after the score difference comparison, with significant difference between two groups (P0.05), and independence in the field and environment field, score difference scores before and after treatment and after treatment, there is no statistical significance (P0.05).5. two group service There were no adverse events during the treatment. Conclusion: the curative effect of Shuganhewei Decoction in treating liver stomach disharmony chronic non atrophic gastritis, improve clinical syndromes curative effect is better than domperidone, the prescription can improve the quality of life of patients, the treatment in the physical domain and psychological effect is better than domperidone. Two groups of patients in the treatment process no adverse events, clinical safety tips, significantly, for clinical reference.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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