【作者】 林春秀；

【导师】 吴绪平；

【作者基本信息】 湖北中医学院 ， 针灸推拿学， 2009， 硕士

【摘要】 目的慢性浅表性胃炎是临床常见病、多发病,发病率日益增高,对患者日常生活质量影响较大。本病西药治疗疗效欠佳,毒副作用大,针灸治疗独具特色,疗效肯定。本课题通过艾条温和灸治疗慢性浅表性胃炎患者,在临床观察的基础上,观测治疗前后胃粘膜血流量(GMBF)以及血清表皮生长因子(EGF)含量的变化,探讨艾条温和灸治疗慢性浅表性胃炎的作用机理,为温和灸治疗本病提供实验依据。方法60例患者均为湖北省丹江口市中医院中医科门诊或住院病人,均符合中华医学会消化病学分会在江西井冈山举行的慢性胃炎研讨会所拟定的慢性胃炎诊断标准。根据入院先后顺序,查随机数字表,将60例患者随机分为治疗组和对照组,每组各30例。治疗组采用温和灸治疗,取穴:胃俞、内关、中脘、足三里、梁丘、太冲。每穴艾灸5分钟。每日1次,每治疗7日休息1日。对照组口服法莫替丁,每次20mg,每日1次;铝碳酸镁片1g,1日3次,餐后1h嚼服;甲硝唑片,每次0.4g,每日2次;阿莫西林,每次0.5g,每日2次;后两药连服2周后停药。连续治疗1个月后,观察治疗前后两组综合疗效、主要症状及胃粘膜病变改善情况、GMBF及血清EGF含量的变化,并进行比较。结果1.治疗组治愈16例,占53.3%;显效8例,占26.7%;有效4例,占13.3%;无效2例,占6.7%;总有效率93.3%。对照组治愈9例,占30.0%;显效7例,占23.3%;有效6例,占20.0%,无效8例,占26.7%;总有效率73.3%。两组比较,经统计学分析,有显著性差异(P＜0.05),表明治疗组临床综合疗效明显优于对照组。2.治疗组在治疗后患者胃脘痛、上腹胀、嗳气、泛酸及纳呆少食等主要症状均有明显改善,与治疗前相比,经统计学分析,有极显著性差异(P＜0.01)。对照组对上述症状虽有改善,但疗效不及治疗组明显。两组比较,经统计学处理,有显著性差异(P＜0.05),表明治疗组在改善主要症状方面明显优于对照组。3.两组治疗后胃镜检查情况均有明显改善,与治疗前相比,经统计学分析,均有显著性差异(P＜0.05)。但治疗组治疗后,中度和重度例数明显少于对照组,两组比较,经统计学分析,有极显著性差异(P＜0.01)。表明治疗组在胃粘膜病变改善方面明显优于对照组。4.治疗组治疗后,胃大弯、胃小弯、胃前壁、胃后壁GMBF明显增加,与治疗前比较,经统计学分析,有极显著性差异(P＜0.01)。对照组治疗后GMBF也有改善,与治疗前比较,经统计学分析,有显著性差异(P＜0.05)。两组比较,经统计学分析,有显著性差异(P＜0.05)。表明治疗组在改善慢性浅表性胃炎患者GMBF方面明显优于对照组。5.治疗组治疗后,血清EGF含量显著降低,且接近于正常值,与治疗前比较,经统计学分析,有极显著性差异(P＜0.01)。对照组治疗后,血清EGF含量也有降低,与治疗前比较,经统计学分析,有显著性差异(P＜0.05)。两组比较,经统计学分析,有极显著性差异(P＜0.01)。表明治疗组对慢性浅表性胃炎患者血清EGF的调节明显优于对照组。结论1.温和灸治疗慢性浅表性胃炎疗效显著,明显优于对照组。2.温和灸能显著增加GMBF,从而维持胃内的酸碱平衡,促进胃粘液的分泌和胃上皮细胞的更新,促进受损胃粘膜屏障修复。3.温和灸能够显著降低慢性浅表性胃炎患者血清EGF含量,抑制胃粘膜的损伤,促进受损胃粘膜的修复。更多还原

【Abstract】 ObjectiveChronic superficial gastritis is a common ailment and frequently encountered disease in clinic.Its incidence rate has a increasing tendency and it has a bad contribution to people’s quality of daily life.Western medicine treatment below the mark,acupuncture therapy has peculiarity and positive curative effect.In order to approach the mechanism of chronic superficial gastritis which was cured by warming moxibustion therapy,prior treatment and after treatment,we has a clinical observation and detect the gastric mucosal blood flow and blood epidermal growth factor(EGF),and try to build a scientific experiment foundation to support the treatment.Method60 case comes from Danjiangkou traditional Chinese medical hospital of Hubei province,they are consistent with chronic gastritis diagnostic criteria which is studyed out by Chinese Medical Associationat aeminar of chronic gastritis in jinggangshan,jiangxi province.According to the order in which paitients admitted to hospital,and check the random number table,All the cases are randomly divided into two groups,each group 30 cases.The observation group adopts warming moxibustion therapy,we select zhongwan, weisu,neiguan,liangqiu,zusanli,taichong to to treat the patient by warming moxibustion therapy,zusanli is treated for 10 minutes,the rest acupoints are treated for 5 minutes,a vic per day,one day resting after seven days treatment, and going on the next circulation.The control group adopts western medicine: such as Famotidine,20mg ter in die;Talcid,lg ter in die,3 times a day,a hour after the dinner;Metronidazole,0.4g bid and Amoxicillin,0.5g bid after taking two weeks,stop taking.To evaluate therapeutic effect after one month reament. After the treatments of 1 months we will observe general effects,the main symptoms and signs of improvement,improvement in gastric mucosal blood flow and serum epidermal growth factor in the changes before and after treatment.Results1.Observation group:healing rate is 53.3%,excellence rate is 26.7%, utility rate is 13.3%,inefficacy rate is 6.7%,the total effective rate was 93.3%. Control group:healing rate is 30.0%,excellence rate is 23.3%,utility rate is 20.0%,inefficacy rate is 26.7%,the total effective rate was 73.3%.Under statistical treatment,there is a significant difference(P＜0.05),efficacy of the observation group is superior to the control group.2.Warming moxibustion therapy can improve patien’s cardinal symptoms obviously such as gastric abscess,epigastric distention,belching, bepanthen,anorexia(P＜0.01).Compared with control group,there is omly a wild improvement in cardinal symptoms.3.Two groups can both improve gastroscopy obviously(P＜0.01),but post-treatment,observation group has less quantity in Midrange and badrange gastroscopy than control group(p＜0.05).4.After warming moxibustion therapy,mucosal blood flow of curvatura gastrica major,curvatura gastrica minor,paries anterior gastricus,paries posterior gastricus increase greatly(P＜0.01);post-treatment,control group has a mild improvement in mucosal blood flow(p＜0.05),the results shows that observation group has a more excellent improvement in mucosal blood flow than control group and acupuncture treatment can facilitate recovery of gastric mucosa.5.After warming moxibustion therapy,the content of blood serum EGF degrade obviously(p＜0.01),the content of blood serum EGF of control group after treatment also degrade greatly(p＜0.05),but result shows that observation group is more excellent in adjusting content of blood serum EGF than control group.Conclusion1.The clinical curative effect of chronic superficial gastritis by using warming moxibustion therapy is predominance,which is superior than control group obviously.2.Warming moxibustion therapy can increase gastric mucosal blood flow significantly,so as to maintain the acid-base balance of intragastrically,hasten the externalization of gastric mucosa and gastric mucosa of epithelial cells, and promote the reparation of damaged gastric mucosa barrier.3.Warming moxibustion therapy can change the contents of blood serum EGF obviously in chronic superficial gastritis’s patients,and it is gradually recovering to normal value level.The result shows that warming moxibustion therapy suppress the damage of gastric mucosa,and enhanced the anti-oxidation ability of organism,so it can promote the reparation of damaged gastric mucosa promptly.更多还原