柴胡疏肝散合左金丸治療胃食管反流病伴焦慮抑郁狀態(tài)的療效觀察
發(fā)布時間：2018-07-22 19:38
【摘要】：目的:胃食管反流病(Gastroesophageal Reflux Disease,GERD)是消化科常見疾病,隨著人們生活習慣和飲食結構的改變,其發(fā)病率呈逐漸升高的趨勢,且越來越多的胃食管反流病患者伴隨精神心理障礙,如焦慮、抑郁等,使西藥如質子泵抑制劑、促胃動力藥物等的療效大大降低,而且多數(shù)患者需長期維持用藥。本研究旨在觀察柴胡疏肝散合左金丸加味聯(lián)合西藥治療胃食管反流病伴焦慮抑郁狀態(tài)的臨床療效,為中醫(yī)治療胃食管反流病的有效性和安全性提供臨床依據(jù),并為胃食管反流病患者提供更安全有效的治療策略。方法:1.將2016年1月至2016年12月于北京中醫(yī)藥大學東直門醫(yī)院消化科門診就診,經(jīng)填寫焦慮自評量表(Self-rating Anxiety Scale,SAS)和抑郁自評量表(Self-rating Depression Scale,SDS)證實存在焦慮或抑郁狀態(tài)的證屬肝胃郁熱型的胃食管反流病患者78例,按就診的先后順序隨機分為治療組和對照組,其中治療組39例,3例失訪,最終療效評價36例,對照組39例,5例失訪,最終療效評價34例。2.治療組予以雷貝拉唑鈉腸溶膠囊20mg,每日晨起空腹口服,并予以中藥柴胡疏肝散合左金丸加味,基本藥物組成柴胡15g,炒枳殼15g,白芍15g,生甘草10g,川芎10g,炙香附10g,陳皮10g,川楝子10g,莪術10g,酒大黃2g,黃連6g,吳茱萸1g。中藥顆粒劑,每日一劑,分早晚口服。對照組僅予雷貝拉唑鈉腸溶膠囊20mg 口服,晨起空腹口服。療程8周。服藥期間兩組患者均戒煙酒,低脂飲食,忌生冷、辛辣刺激食物,睡前3小時不進食。治療期間密切觀察患者癥狀、體征變化及藥物相關的不良反應。3.統(tǒng)計學方法:數(shù)據(jù)統(tǒng)計分析應用SPSS19.0統(tǒng)計軟件進行分析處理,計量資料用X±S(均值±標準差)表示,治療前后變化若符合正態(tài)分布,采用t檢驗,計數(shù)資料采用卡方檢驗,不符合正態(tài)分布者,用非參數(shù)檢驗。P0.05為無統(tǒng)計學差異,P0.05為有統(tǒng)計學差異。結果:1.經(jīng)治療后,治療組和對照組患者的癥狀總積分均有明顯下降,且治療組積分低于對照組,差異有統(tǒng)計學意義(P0.05);2.兩組患者各單項癥狀包括反酸、燒心、反食、噯氣、上腹不適、胸悶、納差及咽部不適積分均有明顯降低(P0.05),且治療組積分低于對照組,差異有統(tǒng)計學意義(P0.05);治療組胸骨后疼痛癥狀積分明顯降低(P0.05),對照組則無明顯差異(P0.05)03.經(jīng)治療后,兩組RE患者的胃鏡下分級均有明顯改善,治療組總有效率高于對照組,差異有統(tǒng)計學意義(P0.05);4.經(jīng)治療后兩組患者的SAS、SDS評分較治療前明顯降低,且治療組積分低于對照組,差異有統(tǒng)計學意義(P0.05)。5.治療期間兩組患者均未發(fā)生服藥后癥狀加重、新發(fā)不適或與藥物相關的嚴重不良反應。結論:柴胡疏肝散合左金丸加味聯(lián)合雷貝拉唑治療胃食管反流病伴焦慮抑郁狀態(tài),能有效改善患者臨床癥狀和精神心理異常,并促進黏膜愈合,比單純使用西藥有明顯優(yōu)勢,且無明顯不良反應。
[Abstract]:Objective: gastroesophageal reflux disease (GERD) is a common disease in digestive department. With the change of people's living habits and diet structure, the incidence of GERD is increasing gradually, and more patients with gastroesophageal reflux disease are accompanied by mental and psychological disorders. For example, anxiety and depression have greatly reduced the efficacy of western drugs such as proton pump inhibitors and gastric motility drugs, and most patients need to maintain their medication for a long time. The purpose of this study was to observe the clinical efficacy of Chaihu Shugan Powder combined with Zuo Jin Pill combined with western medicine in the treatment of gastroesophageal reflux disease with anxiety and depression, and to provide clinical basis for the efficacy and safety of traditional Chinese medicine in the treatment of gastroesophageal reflux disease. And to provide a more safe and effective treatment strategy for patients with gastroesophageal reflux disease. Method 1: 1. From January 2016 to December 2016 at the Department of Digestive Medicine, Dongzhimen Hospital, Beijing University of traditional Chinese Medicine, Seventy-eight patients with gastroesophageal reflux syndrome with anxiety or depression were randomly divided into treatment group and control group by filling out self-rating Anxiety scale SAS and self-rating depression scale SDS. Among them, 39 cases in the treatment group had lost visit, 36 cases in the final curative effect evaluation, 39 cases in the control group and 35 cases in the control group, and 34 cases in the final curative effect evaluation. The treatment group was treated with Rabeprazole sodium enteric-coated capsule 20mg daily from an empty stomach and was treated with Chaihu Shugan Powder and Zuojin Pill. The essential drugs consisted of Bupleurum Bupleurum 15g, Fructus Aurantii 15g, Radix Paeoniae Alba 15g, Glycyrrhiza uralensis 10g, Ligusticum chuanxiong 10g, Roxburghum chinensis 10g, Zedoary 10g, Rhubarb 2g, Coptis chinensis 6g, Evodia officinalis 1 g. Traditional Chinese medicine granules, one dose a day, oral in the morning and evening. The control group was treated only with Rabeprazole sodium enteric-coated capsule 20mg and with fasting oral administration in the morning. The course of treatment was 8 weeks. Patients in both groups quit alcohol and tobacco, low fat diet, avoid cold, spicy and stimulating food, do not eat 3 hours before bedtime. During treatment, the changes of symptoms, signs and adverse drug reactions were closely observed. 3. 3. Statistical method: the data were analyzed by SPSS 19.0 statistical software. The measurement data were expressed as X 鹵S (mean 鹵standard deviation). If the changes before and after treatment were in accordance with normal distribution, t test was used, and the counting data were chi-square test. There was no statistical difference with nonparametric test (P 0.05) and there was statistical difference (P 0.05) in those who did not accord with normal distribution. The result is 1: 1. After treatment, the total symptom score of the treatment group and the control group were significantly decreased, and the treatment group score was lower than that of the control group, the difference was statistically significant (P0.05). The symptoms of the two groups included acid reflux, heartburn, food reversion, belching, upper abdominal discomfort, chest tightness, anorexia and pharynx discomfort (P0.05), and the scores in the treatment group were lower than those in the control group. The difference was statistically significant (P0.05); the score of post-sternal pain in the treatment group was significantly lower (P0.05), while in the control group there was no significant difference (P0.05). After treatment, the two groups of RE patients were significantly improved under gastroscopy, the total effective rate in the treatment group was higher than that in the control group, the difference was statistically significant (P0.05). After treatment, the SDS scores of the two groups were significantly lower than those before treatment, and the score of the treatment group was lower than that of the control group, the difference was statistically significant (P0.05). During the treatment, there were no symptoms aggravation, new discomfort or serious adverse drug-related reactions in both groups. Conclusion: Chaihu Shugan Powder combined with Rabeprazole can effectively improve the clinical symptoms and mental and psychological disorders and promote mucosal healing in patients with gastroesophageal reflux disease and anxiety and depression. It has obvious advantages over western medicine alone in the treatment of patients with gastroesophageal reflux disease and anxiety and depression. There was no obvious adverse reaction.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259
[Abstract]:Objective: gastroesophageal reflux disease (GERD) is a common disease in digestive department. With the change of people's living habits and diet structure, the incidence of GERD is increasing gradually, and more patients with gastroesophageal reflux disease are accompanied by mental and psychological disorders. For example, anxiety and depression have greatly reduced the efficacy of western drugs such as proton pump inhibitors and gastric motility drugs, and most patients need to maintain their medication for a long time. The purpose of this study was to observe the clinical efficacy of Chaihu Shugan Powder combined with Zuo Jin Pill combined with western medicine in the treatment of gastroesophageal reflux disease with anxiety and depression, and to provide clinical basis for the efficacy and safety of traditional Chinese medicine in the treatment of gastroesophageal reflux disease. And to provide a more safe and effective treatment strategy for patients with gastroesophageal reflux disease. Method 1: 1. From January 2016 to December 2016 at the Department of Digestive Medicine, Dongzhimen Hospital, Beijing University of traditional Chinese Medicine, Seventy-eight patients with gastroesophageal reflux syndrome with anxiety or depression were randomly divided into treatment group and control group by filling out self-rating Anxiety scale SAS and self-rating depression scale SDS. Among them, 39 cases in the treatment group had lost visit, 36 cases in the final curative effect evaluation, 39 cases in the control group and 35 cases in the control group, and 34 cases in the final curative effect evaluation. The treatment group was treated with Rabeprazole sodium enteric-coated capsule 20mg daily from an empty stomach and was treated with Chaihu Shugan Powder and Zuojin Pill. The essential drugs consisted of Bupleurum Bupleurum 15g, Fructus Aurantii 15g, Radix Paeoniae Alba 15g, Glycyrrhiza uralensis 10g, Ligusticum chuanxiong 10g, Roxburghum chinensis 10g, Zedoary 10g, Rhubarb 2g, Coptis chinensis 6g, Evodia officinalis 1 g. Traditional Chinese medicine granules, one dose a day, oral in the morning and evening. The control group was treated only with Rabeprazole sodium enteric-coated capsule 20mg and with fasting oral administration in the morning. The course of treatment was 8 weeks. Patients in both groups quit alcohol and tobacco, low fat diet, avoid cold, spicy and stimulating food, do not eat 3 hours before bedtime. During treatment, the changes of symptoms, signs and adverse drug reactions were closely observed. 3. 3. Statistical method: the data were analyzed by SPSS 19.0 statistical software. The measurement data were expressed as X 鹵S (mean 鹵standard deviation). If the changes before and after treatment were in accordance with normal distribution, t test was used, and the counting data were chi-square test. There was no statistical difference with nonparametric test (P 0.05) and there was statistical difference (P 0.05) in those who did not accord with normal distribution. The result is 1: 1. After treatment, the total symptom score of the treatment group and the control group were significantly decreased, and the treatment group score was lower than that of the control group, the difference was statistically significant (P0.05). The symptoms of the two groups included acid reflux, heartburn, food reversion, belching, upper abdominal discomfort, chest tightness, anorexia and pharynx discomfort (P0.05), and the scores in the treatment group were lower than those in the control group. The difference was statistically significant (P0.05); the score of post-sternal pain in the treatment group was significantly lower (P0.05), while in the control group there was no significant difference (P0.05). After treatment, the two groups of RE patients were significantly improved under gastroscopy, the total effective rate in the treatment group was higher than that in the control group, the difference was statistically significant (P0.05). After treatment, the SDS scores of the two groups were significantly lower than those before treatment, and the score of the treatment group was lower than that of the control group, the difference was statistically significant (P0.05). During the treatment, there were no symptoms aggravation, new discomfort or serious adverse drug-related reactions in both groups. Conclusion: Chaihu Shugan Powder combined with Rabeprazole can effectively improve the clinical symptoms and mental and psychological disorders and promote mucosal healing in patients with gastroesophageal reflux disease and anxiety and depression. It has obvious advantages over western medicine alone in the treatment of patients with gastroesophageal reflux disease and anxiety and depression. There was no obvious adverse reaction.
【學位授予單位】：北京中醫(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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