健脾和胃温阳利膈方治疗胃食管反流病38例疗效观察
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摘要
目的观察健脾和胃温阳利膈方治疗胃食管反流病(GERD)的疗效,初步探讨健脾和胃温阳利膈方治疗GERD的作用机制和优势靶点。方法采用随机、单盲、阳性药平行对照研究,将80例GERD患者按随机数字表法分为观察组和对照组,分别用健脾和胃温阳利膈方加减以及奥美拉唑治疗,2组疗程均为6周。分别于治疗前及治疗2、4、6周结束时,记录主要中医临床症状及中医证候积分、西医主要单项症状及西医症状积分;分别在治疗前和治疗6周结束时记录健康状况调查表;观察组在治疗前和治疗6周结束后行食道24 h pH监测。结果治疗6周结束后,观察组在反流积分、睡眠改善情况积分、需额外服药方面积分以及GerdQ总积分4个方面疗效均优于对照组(P<0.05);观察组中医证候疗效总有效率94.7%,对照组总有效率88.9%,观察组疗效优于对照组(P<0.05);观察组反流、嗳气频作、咽紧不利、胸背胀痛改善情况及中医证候总积分疗效优于对照组(P<0.05);治疗后,观察组食道24 h pH在反流次数、长反流(>5 min)次数、最长反流持续时间、总计、立位、卧位pH<4时间(百分比)及DeMeester计分疗效与治疗前比较,差异有统计学意义(P<0.05);观察组SF-36总积分与对照组比较,差异有统计学意义(P<0.05)。结论健脾和胃温阳利膈方治疗GERD具有良好的临床疗效,能够显著改善患者食道24 h pH监测反流水平,有助于GERD患者的身心健康。
Objective To observe the clinical curative effect of Methods of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm in treating gastro-esophageal reflux disease(GERD)and explore the mechanism of action and advantages of targets.It has significant meaning for the prevention and treatment of GERD with effectiveness.Methods 80 patients were randomly divided into two groups in a single blind control study.The treatment group received the decoction of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm and the control group received the Omeprazole.The course of treatment was 6 weeks.The scores of symptoms were recorded before the treatment,2 weeks,4 weeks and 6 weeks after treatment.The score of SF-36 was recorded before the treatment and 6 weeks after the treatment.The treatment group checked the esophagus 24 hours pH monitoring and inspection.Results(1)Comprehensive evaluation showed that the treatment group was better than the control group in reflux,sleeping,taking the medicine and the total score of GerdQ 6 weeks after treatment(P<0.05).(2)In aspects of syndromes of TCM:the effective rate of the treatment group was 94.7%,while the control group was 88.9%.The difference between two groups had statistical significance(P<0.05).The treatment group was better than the control group in reflux,belching,pharyngeal tight adverse,chest pain and the total score 6 weeks after treatment(P<0.05).(3)The esophagus 24 hours pH monitoring and inspection:the treatment group after the treatment was better than that before the treatment in the number of reflux,time of reflux,De Meester and so on(P<0.05).(4)SF-36:the treatment group was better than the control group in the total score 6 weeks after treatment(P<0.05).It showed that the treatment group was better than that of control group in patients' physical and mental health.Conclusion The therapy of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm treating has good clinical curative effect on improving the level of reflux which contribute to the physical and mental health of patients with GERD.
Objective To observe the clinical curative effect of Methods of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm in treating gastro-esophageal reflux disease(GERD)and explore the mechanism of action and advantages of targets.It has significant meaning for the prevention and treatment of GERD with effectiveness.Methods 80 patients were randomly divided into two groups in a single blind control study.The treatment group received the decoction of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm and the control group received the Omeprazole.The course of treatment was 6 weeks.The scores of symptoms were recorded before the treatment,2 weeks,4 weeks and 6 weeks after treatment.The score of SF-36 was recorded before the treatment and 6 weeks after the treatment.The treatment group checked the esophagus 24 hours pH monitoring and inspection.Results(1)Comprehensive evaluation showed that the treatment group was better than the control group in reflux,sleeping,taking the medicine and the total score of GerdQ 6 weeks after treatment(P<0.05).(2)In aspects of syndromes of TCM:the effective rate of the treatment group was 94.7%,while the control group was 88.9%.The difference between two groups had statistical significance(P<0.05).The treatment group was better than the control group in reflux,belching,pharyngeal tight adverse,chest pain and the total score 6 weeks after treatment(P<0.05).(3)The esophagus 24 hours pH monitoring and inspection:the treatment group after the treatment was better than that before the treatment in the number of reflux,time of reflux,De Meester and so on(P<0.05).(4)SF-36:the treatment group was better than the control group in the total score 6 weeks after treatment(P<0.05).It showed that the treatment group was better than that of control group in patients' physical and mental health.Conclusion The therapy of invigorating spleen and harmonizing stomach with warming yang and dredging diaphragm treating has good clinical curative effect on improving the level of reflux which contribute to the physical and mental health of patients with GERD.
引文
[1] 袁耀宗,邹多武,汤玉茗,等.胃食管反流病的蒙特利尔定义和分类(基于循证医学的全球共识)[J].中华消化杂志,2006,26(10):686-689.
[2] 潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19(4):223.
[3] 许国铭.重新认识、深入研究胃食管反流病[J].中华消化杂志,2003,23(1):5-6.
[4] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9):844-847.
[5] Vakil N,van Zanten SV,Kahrilas P,et al.The Montreal definition and classification of gastroesophageal reflux disease a global evidence-based consensus[J].Am J Gastroenterol,2006,101(8):1900-1920.
[6] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009年,深圳)[J].中医杂志,2010,51(9):844-847.
[7] 李乾构,周学文,单兆伟,等.中医消化病诊疗指南[M].北京:中国中医药出版社,2006:90-94.
[8] 吴燕华.胃食管反流病的中医诊治进展 [J].中医学报,2010,25(2):378-380.
[9] 孙振球,徐勇勇.医学统计学[M].北京:人民卫生出版社,2014.
[10] Jones R,Junghard O,Dent J,et al.Development of the GerdQ,a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care[J].Aliment Pharmacol Ther,2009,30(10):1030-1038.
[11] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:124-129.
[12] Zerbib F,des Varannes SB,Roman S,et al.Normal values and day-to-day variability of 24h ambulatory oesophageal impedance-pH monitoring in a BelgianFrench cohort of healthy subjects[J].Aliment Pharmacol Ther,2005,22(10):1011-1021.
[13] 官小莉,汪晖.胃食管反流病患者生存质量测评量表的研究进展[J].中华护理杂志,2015,50(1):97-101.
[14] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(5):321-326.
[15] 朱生樑,李勇,朱晓燕,等.胃食管反流病证型研究[J].上海中医药杂志,2002,36(12):12-13.
[16] 曾升海,张少瑜.胃食管反流病的中医药治疗体会[J].中华临床医学杂志,2007,8(1):80-81.
[17] 袁兵,刘洪书,岳秀英.胃食管反流病的辨证论治[J].四川中医,2008,26(9):79-80.
[18] 田耀洲,滑永志.经方治疗胃食管反流病[J].江苏中医药,2007,39(9):55-57.
[19] 徐景藩.关于诊治胃食管反流病的几点管见[J].江苏中医药,2010,42(1):1-2.
[20] 赵荣莱.胃食管反流病临床进展和中医治疗[J].中国医药导报,2010,7(17):5-6.
[21] 陈誩,刘汶.中医对胃食管反流病的认识和辨证[J].北京中医药,2008,27(4):245-247.
[22] 翟兴红,赵荣莱.诊治反流性食管炎经验撷英[J].中华中医药杂志,2009,24(4):474-475.
[2] 潘国宗,许国铭,郭慧平,等.北京上海胃食管反流症状的流行病学调查[J].中华消化杂志,1999,19(4):223.
[3] 许国铭.重新认识、深入研究胃食管反流病[J].中华消化杂志,2003,23(1):5-6.
[4] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009,深圳)[J].中医杂志,2010,51(9):844-847.
[5] Vakil N,van Zanten SV,Kahrilas P,et al.The Montreal definition and classification of gastroesophageal reflux disease a global evidence-based consensus[J].Am J Gastroenterol,2006,101(8):1900-1920.
[6] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗共识意见(2009年,深圳)[J].中医杂志,2010,51(9):844-847.
[7] 李乾构,周学文,单兆伟,等.中医消化病诊疗指南[M].北京:中国中医药出版社,2006:90-94.
[8] 吴燕华.胃食管反流病的中医诊治进展 [J].中医学报,2010,25(2):378-380.
[9] 孙振球,徐勇勇.医学统计学[M].北京:人民卫生出版社,2014.
[10] Jones R,Junghard O,Dent J,et al.Development of the GerdQ,a tool for the diagnosis and management of gastro-oesophageal reflux disease in primary care[J].Aliment Pharmacol Ther,2009,30(10):1030-1038.
[11] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:124-129.
[12] Zerbib F,des Varannes SB,Roman S,et al.Normal values and day-to-day variability of 24h ambulatory oesophageal impedance-pH monitoring in a BelgianFrench cohort of healthy subjects[J].Aliment Pharmacol Ther,2005,22(10):1011-1021.
[13] 官小莉,汪晖.胃食管反流病患者生存质量测评量表的研究进展[J].中华护理杂志,2015,50(1):97-101.
[14] 中华中医药学会脾胃病分会.胃食管反流病中医诊疗专家共识意见(2017)[J].中国中西医结合消化杂志,2017,25(5):321-326.
[15] 朱生樑,李勇,朱晓燕,等.胃食管反流病证型研究[J].上海中医药杂志,2002,36(12):12-13.
[16] 曾升海,张少瑜.胃食管反流病的中医药治疗体会[J].中华临床医学杂志,2007,8(1):80-81.
[17] 袁兵,刘洪书,岳秀英.胃食管反流病的辨证论治[J].四川中医,2008,26(9):79-80.
[18] 田耀洲,滑永志.经方治疗胃食管反流病[J].江苏中医药,2007,39(9):55-57.
[19] 徐景藩.关于诊治胃食管反流病的几点管见[J].江苏中医药,2010,42(1):1-2.
[20] 赵荣莱.胃食管反流病临床进展和中医治疗[J].中国医药导报,2010,7(17):5-6.
[21] 陈誩,刘汶.中医对胃食管反流病的认识和辨证[J].北京中医药,2008,27(4):245-247.
[22] 翟兴红,赵荣莱.诊治反流性食管炎经验撷英[J].中华中医药杂志,2009,24(4):474-475.