健脾和胃法治疗脾气虚型慢性咽炎的临床观察与机理探讨

【作者】 矫璐璐；

【导师】 刘大新；

【作者基本信息】 北京中医药大学 ， 中西医结合耳鼻喉科学， 2012， 硕士

【摘要】 目的：慢性咽炎属中医“喉痹”范畴,本着发挥中医整体观念的优势,本文着重从咽与脾胃,慢性咽炎与消化系统疾病关系角度,对慢性咽炎进行深入探讨,并对脾气虚型胃咽合病的患者服用四君子汤加减基础上联合应用微波、雾化治疗前后进行观察,旨在评价四君子汤加减对慢性咽炎患者临床疗效及证候改善情况,并从现代医学角度来探讨从脾胃论治咽炎的作用机理,为临床治疗提供理论依据和有效的新思路,探索中医治疗慢性咽炎的有效方法。资料与方法：将来自北京中医药大学东方医院耳鼻喉科门诊脾气虚型慢性咽炎患者80例纳入观察病例,随机分为治疗组(口服四君子汤加减加用微波、雾化)、对照组(微波、雾化),每组各40例。治疗组、对照组治疗14天,观察两组治疗前后总体疗效、症状积分有无显著性差异及脾气虚型咽胃合患者相关特点。结果：(1)临床疗效上,治疗组愈显率50.00%,总有效率90.00%；对照组愈显率31.5%,总有效率79.00%,治疗组与对照组经统计学分析具有极显著性差异(X2cmh=6.6649,p=0.0098<0.01),说明治疗组总有效率明显高于对照组,说明四君子汤加减组疗效率明显高于对照组；两组治疗后症状积分经统计学分析有显著性差异(t=-2.049,p=0.044<0.05),说明治疗组症状积分改善情况明显好于对照组。将治疗组治疗前后咽异物感、咽干、咽痒、咽灼热感、咽痛症状积分经统计学分析均有显著性差异(p<0.05),说明经四君子汤加减治疗后对以上症状均有所改善。治疗前后咽粘膜症状积分经统计学分(P=0.003<0.01),说明对咽粘膜也有一定治疗效果；(2)病情程度与治愈率,经X2cmh检验(X2cmh=4.4643,p=0.0346<0.05)有统计学意义,提示病情越轻,治疗组中药治愈效果越好；(3)治疗组咽炎病程与疗效无统计学意义(P=0.958>0.05),说明四君子汤加减治疗慢性咽炎与病程因素无关,对病程较长者仍有较好疗效；(4)脾气虚型咽胃合病者以31-50岁青、中年人多见,在80例患者中,该年龄段的患者人数达到53人(66%)；(5)脾气虚型咽胃合病者,消化系统疾病出现的频率依次是：返流性食管炎19例(23.75%),其次是,胃溃疡11例(13.75%),十二指肠溃疡9例(11.25%),十二指肠炎8例(10%),慢性胃炎浅表性8例(10%),浅表性胃炎伴糜烂8例(10%),多种消化系统病并存也有5例(6.25%)。结论：(1)四君子汤加减对慢性咽炎患者确有明显的治疗作用,在改善咽炎的临床症状和提高治愈率方面,具有明显的优势,因此值得临床推广应用。(2)四君子汤加减对慢性咽炎病人的咽异物感、咽干、咽痒、灼热感、咽痛等症状及咽粘膜有明显改善,可改善病人生存质量。(3)四君子汤加减治疗慢性咽炎效果与病情因素有关。(4)四君子汤加减治疗慢性咽炎与病程因素无关,对病程较长者仍有较好疗效。(5)脾气虚型咽胃合病者以中青年为主。慢性咽炎的发作与返流性食管炎具有很强关性。更多还原

【Abstract】 Objective:From the Traditional Chinese medicine point of view, chronic pharyngitis is the inflammation of the throat. To develop the overall concept advantage of the Traditional Chinese medicine, this article concentrates on the study of pharyngitis from the relationship between the pharynx and the stomach, the chronic pharyngitis and the digestive diseases. Furthermore, we started the clinical monitoring process to the treatment of the pharynx disease patients with spleen deficiency.The patients took the Si Jun Zi Decoction combined with microwave and atomization therapy during the process. The target is to evaluate the clinical efficiency of the improved Si Jun Zi Decoction and Syndrome. The second target is to evaluate the activity mechanism from the aspect of spleen and stomach.According to the theoretical basis and new ideas, the research offers an effective method of Chinese medicine treatment of chronic pharyngitis.Materials and Methods:This monitoring process was for eighty chronic pharyngitis patients from Beijing Traditional Medicine University lack of the spleen—qi. All the patients were divided into the treatment team (Improved Sijunzitang combined with microwave and fog inhalation therapy) and the comparison team (microwave and fog inhalation therapy),40patients in each team. We monitored the overall efficiency of the two teams and the improved symptom scores of the different treatment meathods after fourteen days.We also had to confirm if there is a statistically significant, deficiency of the spleen—qi type and pharynx, stomach together patient relevant characteristics.Results:(1) The significant rate of the treatment team was approximate50.00%, and the cure rate was90.00%. The significant rate of control team were31.5%, the cure rate was79.00%. Comparing with control team, treatment team has a significant difference (X2cmh=6.6649, p=0.0098<0.01), it indicates that the treatment group was superior to the control group of the cure rate. After the treatment, the symptom scores had a significant differences in statistical analysis (t=-2.049, p=0.044<0.05). The study also shows the improved Si Jun Zi Decoction with microwave and fog inhalation could improve the feelings of foreign body sensation of pharynx, the syndromes of dry throat, dry cough, pharyngal hot feel ing, hoarseness and the statistical analysis was significant (p<0.05), and the same good curative effect to Pharyngeal mucosa (p=0.0003<0.01)(2)Through the X2cmh test, we found that the severity with cure rate had a significant differences in statistical analysis(X2cmh=4.4643,p=0.0346<0.05), it implied that the lighter condition was, the better curative effect was(3)There was no statistical significance between pharyngitis course with efficacy for the treatment team(P=0.958>0.05). The course of the disease did’ t affect the therapeutic effect (P=0.958>0.05), so there was still a good effect for the longer course.(4)Among the80patients lack of the spleen-qi type and pharynx, stomach together patient,31to50years old in middle-aged patients, the number in this age to53individuals (66%).(5) Patient lack of the spleen-qi type and pharynx stomach whose digestive system disease occurrence frequency were:Reflux esophagitis in19cases (23.75%), followed by gastric ulcer,11cases (13.75%),9cases of duodenal ulcer (11.25%), duodenitis in8cases (10%), chronic superficial gastritis, in8cases (10%), the shallow form nature gastritis accompanied by an erosion in8cases (10%),5patients (6.25%) who had a variety of digestive system disease coexistConclusion:(1)Improved Sijunzitang has obvious therapeutic effect to the chronic pharyngitis patients. The obvious advantages is not only for improvement of pharyngitis clinical symptoms, but also for increasing the cure rate.Therefore, it is worthy of clinical application.(2)Improved Si Jun Zi Decoction with microwave and fog inhalation could improve the feelings of foreign body sensation of pharynx, the syndromes of dry throat, dry cough, pharyngal hot feeling, hoarseness and the statistical analysis was significant, and the same good curative effect to Pharyngeal mucosa. So it could obviously improve the quality of life.(3)The severity has the influence to the cure rate.(4) The course of the disease did’t affect the therapeutic effect, and there was still a good effect to the long term patient.(5)Deficiency of the spleen—qi type and pharynx, stomach together patients, dominated by middle-aged, The onset of chronic pharyngitis and reflux esophagitis have a closely correlation.更多还原