和降胶囊治疗反流性食管炎（寒热错杂证）的临床疗效观察

【作者】 郝永彪；

【导师】 李军祥；

【作者基本信息】 北京中医药大学 ， 中医内科学， 2007， 硕士

【摘要】 本文分为理论研究、临床研究两部分。理论研究部分，对古今中医医学文献关于反流性食管炎的病因病机、病名诊断、治法方药的研究及近10年来中西医治疗反流性食管炎的概况进行总结和分析，探讨了RE的发生发展规律，寻找中医药在治疗中的优势。临床研究部分，将符合中医寒热错杂证诊断标准的反流性食管炎患者60例，随机分为两组，治疗组30例，对照组30例，治疗组给予和降胶囊治疗，每次4粒，每日3次，口服。对照组选用奥美拉唑肠溶片，每次20mg，每日2次，餐前30分钟口服。两组均4周为1个疗程，共观察2个疗程。治疗结束后，判断治疗效果。研究结果：临床疗效，治疗组临床痊愈10例，显效15例，有效4例，无效1例，总有效率为96.7％，对照组临床痊愈9例，显效13例，有效6例，无效2例，总有效率为93.3％，两组总有效率比较，无显著性差异(P＞0.05)，表明两药在临床综合疗效改善方面作用相似。从主症上看，烧心与反酸的总有效率比较，经秩和检验，两组无显著性差异。而对照组对反酸的痊愈率明显高于治疗组，表明对照组对反酸症状作用比较突出。两组次症症状比较：嗳气倒饱、口苦症状、大便稀溏疗效比较，经秩和检验，P＜0.01，有极显著性差异，表明治疗组对此三症状改善优于对照组；余次症组间症状疗效比较，经秩和检验，P＞0.05，无显著性差异，表明两药在改善其余次症症状疗效方面作用相似。通过研究表明：1情志失和和饮食不节是反流性食管炎的主要致病因素。2反流性食管炎的症状特点以烧心、反酸为主要症状，兼见嗳气倒饱、胃脘疼痛、喜温喜按、胸骨后灼痛、口苦、纳食减退、疲乏无力等，舌质多表现为红或暗红，舌苔薄黄或黄腻，脉象多见弦或滑。3本病病机以寒热错杂、气机升降失调为要点；平调寒热、和胃降逆为本病治疗大法。4和降胶囊能有效治疗反流性食管炎，近期疗效与奥美拉唑无差异。5研究表明：和降胶囊在改善嗳气倒饱、口苦、大便稀溏等临床症状、起效时间快方面优于奥美拉唑对照组。6疗效机理体现在：(1)改善临床症状，调节机体整体功能；(2)促进胃、食管排空和食管损伤组织的再生与修复，加强抗反抗防御机制；(3)抑制胃酸和胆汁分泌，对抗攻击因子作用。更多还原

【Abstract】 This study includes mainly two parts: theoretical research and clinicalresearch.In the part of theoretical research, the author sums up and analyses thepathogenic factor studying the diagnosis and pathogenesis in historical documentsof Reflux Esophagitis(RE), and sums up the therapeutic methods of RE in recentyears so as to look for a better way.In the clinical research, 60 patients with reflux esophagitis diagnosed byendoscopy were randomly divided into two groups. The treatment group (n=30)took hejiang capsules 3 ones bid; the control group (n=30) received only cimitidinomeprazole 20mg bid; all the cases were treated for 8 weeps. The symptoms andgastroscopic feature were observed and recorded. In the treatment group, 10 casesrecovered, 15 cases significantly improved, 4 cases improved, 1 ineffectual case.The total effective rate of the treatment group is 96.7%. In the control group, 9cases recovered, 13 cases significantly improved, 6 cases improved, 2 ineffectualcases. The total effective rate of the control group is 93.3%. After 8weekstreatment, all the symptoms are improved significantly in both two groups. Themajor symptoms of reflux acid are improved more significantly in control groupthan treatment group.But in the treatment roup, the minor symptoms of eructationmouth bitter and diarrhea symptoms are improved significantly than in the controlgroup.The above scientific researches indicate:1 Eating and emotion are two main aspects of the causes of RE.2 The two primary symptoms of semiological characteristics are heartburnacid regurgitation. And a patient of RE often shows red or dark red tongue withyellow greasy or thin coating, taut or smooth pulse.3 The chief pathogenesis is syndrome of combined with cold and heat anddysfunctional of Qi. The main treating method is regulate the cold and heat, andregulate the converse of Qi.4 The finding of the present study indicated that decoction for coordinatingthe function of the liver and the stomach is obviously superior to that of improvingthe parts of RE symptoms and efficacy of decreasing the recurrence rate exceedsthat of omeprazole.5 The mechanism shows as follows:a)improving clinical symptoms,regulating whole function of the body.b)promoting the gastric and esophagus emptying and accelerate regeneration and recondition of tissue of esophagus,strengthen the defensive function of counteracting reflux.c)constrict secreting ofstomach acid and bile counteracing assailant factor.更多还原