【作者】 高文艳；

【导师】 王长洪；

【作者基本信息】 中国人民解放军军医进修学院 ， 中西医结合临床， 2009， 博士

【摘要】 腹泻型肠易激综合征发病和病机的理论研究:论文首先总结了祖国医学对腹泻型肠易激综合征(D-IBS)的认识,包括对症状、病名及病位描述、病因病机及证治沿革和当代中医对D-IBS病因和发病机制的认识;继之对西医学对D-IBS病因和发病机制的认识做一简述,最后将导师对D-IBS发病和病机的认识和创新进行阐述。导师认为脾胃虚弱为致病之本,肝脾不调为病机关键,脾肾两虚是重要的病机演化。从而导师认为脾胃虚弱、肝脾不调、脾肾阳虚在D-IBS发病中几乎具有同等的地位,因此,导师治疗中从分析基本病机入手,肝脾肾同调成为导师治疗D-IBS的重要治疗方法,也是导师治疗该病的创新之所在。王长洪教授治疗腹泻型肠易激综合征学术思想总结:王长洪教授在治疗D-IBS方面积累了大量的临床经验。王长洪教授根据D-IBS的病机特点,临证常施以疏肝健脾法、健脾燥湿法、温肾固本法、肝脾肾同调等法,并依据病机演变灵活应用,临证施治又有斟酌变化。治疗中同时注重患者情志的调摄和心理疏导及饮食的调理。王教授在治疗慢性泄泻用药方面独具自己的用药规律,如温清并举,主从有别;温燥勿过,贵在相宜;宜通少涩,贵在有度;久泻不止,酌用渗利等,并喜用多组药对。健脾调肝温肾方治疗腹泻型肠易激综合征的临床研究:本试验选择D-IBS患者80例进行前瞻性随机、西药治疗平行对照的临床试验。治疗组和对照组各40例,治疗组口服健脾调肝温肾方,对照组口服匹维溴铵片。观察及检测项目:(1)观察并记录治疗前、治疗第14天和28天腹痛或腹部不适、大便情况及伴随的相关症状;(2)检测治疗前后直肠敏感性;(3)应用SF-36和IBS-00L对患者的生活质量进行测评。停药4周后对治愈和显效病人进行随访。结果发现,腹痛或腹部不适、腹胀及排便急迫感在治疗的各时点记分,组间差别均无统计学意义;大便次数和大便性状在治疗过程中各时点记分,组间差别无统计学意义,但对PPS分析,第28天记分下降值两组间差别有统计学意义(P＜0.05),治疗组优于对照组;粘液便在治疗的第28天,两组间记分差别有统计学意义,治疗组优于对照组。各症状的两组终点记分与基线比较的差别均有高度统计学意义。综合疗效:PPS:治疗组和对照组的痊愈率为24.32%v19.44%,总有效率为81.08%v80.56%;FAS:治疗组和对照组的痊愈率为22.50%v1 7.5%,总有效率为80.00%v77.50%,两组比较无显著统计学意义。远期疗效:对两组痊愈和显效的病例随访,治疗组和对照组分别有4例和12例复发或加重,两组间有显著差异(P＜0.05)。直肠敏感性的变化:治疗后,治疗组和对照组的直肠感知阈值、排便阈值和疼痛阈值均有改善,且有统计学意义(P＜0.05)。生活质量:SF-36:治疗后,治疗组在躯体疼痛、总体健康、活力、社会功能和心理健康方面的积分均有明显提高(P＜0.05);治疗组在躯体疼痛、心理健康和社会功能方面的疗效优于对照组(P＜0.05)。IBS-QOL:治疗后,治疗组患者的烦躁焦虑、健康担忧、饮食限制、社会反应及人际关系方面积分均有显著改善(P＜0.05);治疗组在改善烦躁焦虑、人际关系方面疗效优于对照组(P＜0.05)。因此,通过本实验研究认为,健脾调肝温肾方治疗D-IBS有效,且在改善大便次数、性状及粘液便方面优于匹维溴铵片,在远期疗效方面也优于匹维溴铵,同时可改善患者生活质量。治疗机理可能通过调整肠道敏感性而起作用。该方值得进一步研究开发及推广应用。更多还原

【Abstract】 The theoretical study of etiopathogenisis and pathogenesis on diarrheapredominant irritable bowel syndrom（D-IBS）:This article discuss the etiopathogenisis and pathogenesis of D-IBS from three directions:Traditional Chinese medicine,Western medicine and professor wang-changhong’s.Professor Wang considered that D-IBS had the intimate relationship with liver,spleen and kidney and regard that weakness of the spleen and stomach is the foundation of pathopoiesis,hepatosplenic disorder is the key point of pathogenesis,asthenia of both the spleen and kidney is the important pathogenesis evolution.Academic thought of professor wang-changhong in treating D-IBS: Professor wang had accumulated experience of treatment on D-IBS.Invigorate the spleen and coordinating liver,invigorate the spleen and deprive the evil wetness,warming the kidney and firm the foundation and regulating the functions of Liver,Spleen and Kidney at the same time were important means of professor wang treating D-IBS.Professor Wang likes to use the method of regulating the functions of Liver,Spleen and Kidney at the same time best clinically.Professor Wang always following the rule of medication on D-IBS as follows:warming and clearing hot Simultaneously;to deprive the evil wetness,the method of warm should be administered,but should not warm too much;promoting blood flow and dissipate phlegm should be apply if the course last long time,and so on.The clinical study of jianpitiaoganwenshenfangon D-IBS:We verify the efficacy of jianpitiaoganwenshenfang（JTW） on D-IBS with the researching of clinical,and analysis the treatment mechanism of JTWS on D-IBS with observating the influence of JTW on rectal sensitivity.A prospective,randomized controlled trial was conducted.80 patients were divided into 2 groups randomly. Treatment group（n=40） took the JTW,control group（n=40） took pinaverium bromide tablet.The therapeutic course for both groups was 4 weeks.Items should be observed or detected as follows:（1） observe and record the symptom of D-IBS at pretherapy,the 14^th day and the 28^th day;（2）detect the rectum sensitivity at before and after treatment;（3）survey the quality of life by SF-36 and IBS-QOL at before and after treatment.After drug withdrawal 4 weeks,followed up the patients that cured and excellence.Improving of symptom:There no statistical significance between two group on scores of abdominal pain or abdominal discomfort,abdominal distention and defecation urgency at 14^th day and 28^th day. The difference on score of degression at 14^th day and 28^th day hadn’t statistical significance;there no statistical significance between two group on scores of frequency of defecation and character of defecation at 14^th day and 28^th day.PPS analysis showed that the difference of score of degression at 28^th day had the statistical significance（P＜0.05）,treatment group was better than control group;the difference of the score of mucus stool at 28^th day had the statistical significance（ P＜0.05） too,treatment group was better than control group.The scores of every symptom of end point were different from of baseline statistically,therapeutic effect of synthetic:FAS analysis showed that the total effective rates of the treatment group and the controlled group were 80.00%and 77.50%respectively （P＞0.05）.PPS analysis showed that they were 81.08%and 80.56%respectively （P＞0.05）.No significant difference between two groups was detected.Protective efficacy:he patients that cured and excellence were followed up after drug withdrawal.There were 4 cases and 12 cases recidivating or aggravation in treatment group and control group respectively.There is significant difference on recurrence rates between two group（P＜0.05）.quality of life:SF-36:the accumulated points on bodily pain,general health,vitality,social functioning and mental health increased significantly in treatment group after treatment（P＜0.05） .treatment group is better than control group on improving bodily pain,mental health and social functioning（P＜0.05）。IBS-QOL:the accumulated points on dysphoria,food avoidance,health worry,social reaction and relationship increased significantly in treatment group after treatment（P＜0.05）.treatment group is better than control group on improving dysphoria and relationship（ P＜0.05）.JTW is effective in treating D-IBS and better than pinaverium bromide tablet on improving frequency and character of stool,mucus stool.Its prostective efficacy is better than pinaverium bromide tablet too.Meanwhile,it can improve patients’ quality of life.The mechanism of treatment is adjusting the sensitivity of intestines.JTW is worth investigating and generalization.更多还原