益气健脾法治疗化疗后腹泻的临床观察
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摘要
目的：观察中医益气健脾法指导下自拟方剂(驻舟汤)治疗化疗后腹泻的临床疗效,并初步探讨其作用机理。
方法：将60例符合纳入标准的病人按照配对随机原则分为治疗组和对照组各30例。治疗组服用驻舟汤加减,每日一付水煎服,早晚分服,每次150ml；对照组用西药止泻药易蒙停,每次2－4mg,每日3次；两组疗程均为4周。
结果：症状疗效：治疗组对于腹痛或腹部不适、大便次数、大便性状、生活质量等症状的改善优于对照组(P<0.05),上述结果表明,驻舟汤对化疗后腹泻的不适症状有良好的治疗作用。症状积分：治疗前治疗组和对照组积分比较,t=0.422,P>0.05,无统计学意义,具有可比性；治疗组治疗前和治疗后积分比较,t=13.35,P<0.05,有统计学意义,疗效显著；对照组治疗前和治疗后积分比较,t=6.91,P<0.05,有统计学意义,疗效显著；治疗后治疗组和对照组积分比较,t=-2.53,P<0.05,有统计学意义,治疗组疗效优于对照组。总体疗效：治疗后治疗组愈显率和对照组相比有统计学差异(x2=4.01,P<0.05)。两组总有效率比较有统计学差异(u=3.68,P<0.05),说明治疗组的总体临床疗效优于对照组。
结论：
1.采用中医益气健脾法指导下自拟方剂(驻舟汤)治疗化疗后腹泻疗效显著。
2.中医益气健脾法指导下自拟方剂(驻舟汤)治疗化疗后腹泻疗效优于西药易蒙停,可以在临床推广
3.脾胃虚弱是化疗后腹泻的中医病机,益气健脾法是治疗化疗后腹泻的重要方法。
Objective:Observe the clinical curative effect about the prescription (stop boat soup) treatment chemotherapy diarrhea under the guidance of the method Chinese spleen method, and discusses its mechanism.
Methods:60 patients with criteria in accordance with the principle of patients matched divided into the treatment group and control group,30 cases of each. Taking stop boat soup in treatment group, daily pay water decocting, sooner or later, points, Every time 150ml. With western medicine in little ant diarrheal, every 2-4mg,3 times a day. Two groups of course for four weeks.
Results:Efficacy:Treatment for abdominal pain or discomfort is defecate frequency, quality of life, defecate traits, such symptoms improved better than control P< 0.05, and the results show that, prescription stop boat soup after chemotherapy for diarrhea symptoms have good curative effect. Symptom scores:Before treatment group and control group integral, t=0.422, P> 0.05, no statistical significance, comparable, Treatment group and after comparison, t= 13.35, P< 0.05. statistical significance, curative effect is distinct, Before and after the treatment group therapy, t= 6.91, P< 0.05, statistical significance, curative effect is distinct, The treatment group and control group integral, t=-2.53, P< 0.05, a statistically significant effect, the treatment group than in control group. Overall efficacy:the treatment group and control group compared to the rates are statistically significant x2= 4.01, P< 0.05. Two group total effectiveness is statistically significant u= 3.68, P< 0.05, indicating that the treatment group than in control group total clinical curative effect.
Conclusion:
1.prescription (stop boat soup) under the guidance of the method Chinese spleen method is better than western medicine little effect at the chemotherapy diarrhea treatment, In clinical promotion.
2.after chemotherapy spleen is weak diarrhea TCM pathogenesis, spleen yiqi chemotherapy treatment method is an important method of diarrhea.
3.Using prescription (stop boat soup) under the guidance of the method Chinese spleen method treatment with chemotherapy diarrhea effect.
方法：将60例符合纳入标准的病人按照配对随机原则分为治疗组和对照组各30例。治疗组服用驻舟汤加减,每日一付水煎服,早晚分服,每次150ml；对照组用西药止泻药易蒙停,每次2－4mg,每日3次；两组疗程均为4周。
结果：症状疗效：治疗组对于腹痛或腹部不适、大便次数、大便性状、生活质量等症状的改善优于对照组(P<0.05),上述结果表明,驻舟汤对化疗后腹泻的不适症状有良好的治疗作用。症状积分：治疗前治疗组和对照组积分比较,t=0.422,P>0.05,无统计学意义,具有可比性；治疗组治疗前和治疗后积分比较,t=13.35,P<0.05,有统计学意义,疗效显著；对照组治疗前和治疗后积分比较,t=6.91,P<0.05,有统计学意义,疗效显著；治疗后治疗组和对照组积分比较,t=-2.53,P<0.05,有统计学意义,治疗组疗效优于对照组。总体疗效：治疗后治疗组愈显率和对照组相比有统计学差异(x2=4.01,P<0.05)。两组总有效率比较有统计学差异(u=3.68,P<0.05),说明治疗组的总体临床疗效优于对照组。
结论：
1.采用中医益气健脾法指导下自拟方剂(驻舟汤)治疗化疗后腹泻疗效显著。
2.中医益气健脾法指导下自拟方剂(驻舟汤)治疗化疗后腹泻疗效优于西药易蒙停,可以在临床推广
3.脾胃虚弱是化疗后腹泻的中医病机,益气健脾法是治疗化疗后腹泻的重要方法。
Objective:Observe the clinical curative effect about the prescription (stop boat soup) treatment chemotherapy diarrhea under the guidance of the method Chinese spleen method, and discusses its mechanism.
Methods:60 patients with criteria in accordance with the principle of patients matched divided into the treatment group and control group,30 cases of each. Taking stop boat soup in treatment group, daily pay water decocting, sooner or later, points, Every time 150ml. With western medicine in little ant diarrheal, every 2-4mg,3 times a day. Two groups of course for four weeks.
Results:Efficacy:Treatment for abdominal pain or discomfort is defecate frequency, quality of life, defecate traits, such symptoms improved better than control P< 0.05, and the results show that, prescription stop boat soup after chemotherapy for diarrhea symptoms have good curative effect. Symptom scores:Before treatment group and control group integral, t=0.422, P> 0.05, no statistical significance, comparable, Treatment group and after comparison, t= 13.35, P< 0.05. statistical significance, curative effect is distinct, Before and after the treatment group therapy, t= 6.91, P< 0.05, statistical significance, curative effect is distinct, The treatment group and control group integral, t=-2.53, P< 0.05, a statistically significant effect, the treatment group than in control group. Overall efficacy:the treatment group and control group compared to the rates are statistically significant x2= 4.01, P< 0.05. Two group total effectiveness is statistically significant u= 3.68, P< 0.05, indicating that the treatment group than in control group total clinical curative effect.
Conclusion:
1.prescription (stop boat soup) under the guidance of the method Chinese spleen method is better than western medicine little effect at the chemotherapy diarrhea treatment, In clinical promotion.
2.after chemotherapy spleen is weak diarrhea TCM pathogenesis, spleen yiqi chemotherapy treatment method is an important method of diarrhea.
3.Using prescription (stop boat soup) under the guidance of the method Chinese spleen method treatment with chemotherapy diarrhea effect.
引文
[1]陈湘君、金实、周亚滨《中医内科学》 (供七年制中医类专业用),上海科学技术出版社.
[2]丁世幸.肠易激综合征证治浅谈.光明中医,2008；23(1)：66－67.
[3]李新一,自拟抑肝扶脾汤治疗腹泻型肠易激综合征32例.北京中医,2005,24(6)：328-329.
[4]王敏,金炜,吴炯.孙建华辨治肠易激综合征经验.上海中医药杂志,2008；42(2)：44－45.
[5]严付红,调肝扶脾益肾汤治疗腹泻型肠易激综合征38例.河南中医,2006,26(1)：59－60.
[6]郑柏著,七味白术散治疗腹泻型肠易激综合征37例.福建中医药,2005,8：36(4).
[7]罗伟,肠宁汤治疗肠易激综合征52例.中医研究200013(4)：46.
[8]刘国强.资生丸治疗肠易激综合征80例.国医论坛,2003,18(2)：21-22.
[9]王国耀,痛泻要方加味治疗肠易激综合征76例[J].实用中医药杂志.2004；20(2)：68.
[10]Chey WY, Jin Ho,Lee MH, et al. Colonic motility abnor-mality in patients with Irritable bowel syndrome exhibiting abdominal Pain and dianbea[J].AM J Gastroenterol,2001,96(5):1499-1506.
[11]Small PK, London MA, Han CM, et al. Large scale ambulatory study of post prandial jejuna motility in irritable bowel syndrome (J). Scand J Gastroenterol, 1997,32:39.
[12]梁荣新,张志雄等.肠易激综合征患者乙状结肠动力的研究.广西医学,2004,26(1)：30-32.
[13]Gralnekl M, Hays RD, Kilbourne A, et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology,2000,119:654-660.
[14]Ohman L Simren, M. New insights into the Pathogenesis and PathoPhysiology of irritable bowel syndrome (J). Dig Liver Dis,2007,39:201-15.
[15]Van Oudenhove L, Demyttenaere K Tack J et al. Central nervous system involvement in functional gastrointestinal disorders (J).Best Pract Res Clin Gastroenterol,2004,18:663-680.
[16]Walker EA, Roy-Byrne PP, Katon W.J. Irritable bowel syndrome and Psychiatric illness (J). Am J Psychiatry,1990,147(5):565-5720.
[17]Blomhoff Svein M D, Spetalen Signe M D, Jacobsen Morten B, et al. Phobic anxiety changes the function of brain-gut axis in irritable bowel syndrome. Alneriean Psychosomatic Society,2001,63(6):959.
[18]Spiller RC, Jenkine D, Thomley JP, et al. Increased rectal mucosal enteroendocrine cells T lymphocytes and increased gut Permeability following acute campylobacter enteritis and in Post dysenteric irritabe bowel syndrome. Gut.2000; 47(6):804-811.
[19]韩炜,李君曼.肠易激综台征发病的内分泌机制.临床荟萃,2000,15(16)：761.
[20]杨云生,周殿元,张万岱等.肠易激综合征患者肠道电活动和胃肠激素.第四军医大学学报,1999,20(9)：818.
[21]张志雄,梁荣新等.肠易激综合征乙状结肠推动性运动与胃肠胰胆囊收缩素、胃动素的相关性.诊断学理论与实践,2006,5(1)：24－26.
[22]张茹.肠易激综合征血浆及乙状结肠茹膜中VIP及Ss的含量.中国内镜杂志,2004,10(3)：41-43.
[23]郭传勇,李定国,陆汉明.胃肠激素在肠易激综合征病理生理的作用,国外医学生理、病理科学与临床分册,1994,14(1)35-36.
[24]Dunlop Simon P, Spiller Robin C. Nutritional issues in irritable bowel syndrome. Current Opinion in Clinical Nutrition & Metabolic Care,2001,4(6):537.
[25]Mayer EA, Gerhardt GF, Basic and clinical aspects of visceral hyperalgesia. Gastmenterology,1994,107:271.
[26]Blomhoff Svein MD, Spetalen Signe MD, Jacobsen Morten B, et al. Phobic anxiety changes the function of brain-gut axis in irritable bowel syndrome. Alneriean Psychosomatic Society,2001,63(6):959.
[27]Oliver MR, Tan DT, Scott RB et al, Colonic motor response to IGE-mediated mast cell degranulation in the Hooded-Lister rat (J), Neurogastroenterol Motile,1996, 8(2):121-130.
[28]李兆申,董文珠,邹多武等.肠易激综合征粘膜肥大细胞的实验研究.解放军医学杂志.2002；27(7)：628－630.
[29]令狐强,杨云生.肠易激综合征患者外周血.淋巴细胞亚群分析.中华消化杂 志.2002：11(4)：423-425.
[30]王伟岸.肠易激综合征的发病机制.胃肠病学和肝病学杂志2001年6月第10卷第2期.99-102.
[31]吴文江.肠易激综合征发病机制与实验研究思路.中国中医药信息杂志2002年6月第9卷第6期.74-76.
[32]金杭斌.神经—免疫—内分泌网络与肠易激综合征.国际消化病杂志2006第26卷第1期40-44.
[33]朱磊,清肠化湿、益气健脾法序贯治疗溃疡性结肠炎疗效观察及调控PPAR-γ NF-kB的实验研究.南京中医药大学硕士学位论文.2009,6.
[34]耿慧苗,益气健脾法联合化疗治疗中晚期大肠癌的临床观察.山东中医药大学硕士学位论文.2009,4.
[35]安慧娟,益气健脾解毒方联合mDCF方案治疗中晚期胃癌临床研究.南京中医药学硕士学位论文.2009,7.
[36]雷晓红,余守雅.参苓白术散加味治疗恶性肿瘤放化疗后腹泻.2007,10-1419-02.
[37]武志霞,参苓白术散加味治疗恶性肿瘤放化疗后腹泻21例,2007,28-5.
[38]白明贵,做了益气健脾活血方联合化疗对中晚期胃癌患者QOL影响的临床研究.南京中医药学硕士学位论文2009,7.
[39]杨静,做了益气健脾、和胃降浊法与奥沙利铂/5—FU方案化疗联合治疗晚期胃癌的临床研究.南京中医药学硕士学位论文.2002,10.
[2]丁世幸.肠易激综合征证治浅谈.光明中医,2008；23(1)：66－67.
[3]李新一,自拟抑肝扶脾汤治疗腹泻型肠易激综合征32例.北京中医,2005,24(6)：328-329.
[4]王敏,金炜,吴炯.孙建华辨治肠易激综合征经验.上海中医药杂志,2008；42(2)：44－45.
[5]严付红,调肝扶脾益肾汤治疗腹泻型肠易激综合征38例.河南中医,2006,26(1)：59－60.
[6]郑柏著,七味白术散治疗腹泻型肠易激综合征37例.福建中医药,2005,8：36(4).
[7]罗伟,肠宁汤治疗肠易激综合征52例.中医研究200013(4)：46.
[8]刘国强.资生丸治疗肠易激综合征80例.国医论坛,2003,18(2)：21-22.
[9]王国耀,痛泻要方加味治疗肠易激综合征76例[J].实用中医药杂志.2004；20(2)：68.
[10]Chey WY, Jin Ho,Lee MH, et al. Colonic motility abnor-mality in patients with Irritable bowel syndrome exhibiting abdominal Pain and dianbea[J].AM J Gastroenterol,2001,96(5):1499-1506.
[11]Small PK, London MA, Han CM, et al. Large scale ambulatory study of post prandial jejuna motility in irritable bowel syndrome (J). Scand J Gastroenterol, 1997,32:39.
[12]梁荣新,张志雄等.肠易激综合征患者乙状结肠动力的研究.广西医学,2004,26(1)：30-32.
[13]Gralnekl M, Hays RD, Kilbourne A, et al. The impact of irritable bowel syndrome on health-related quality of life. Gastroenterology,2000,119:654-660.
[14]Ohman L Simren, M. New insights into the Pathogenesis and PathoPhysiology of irritable bowel syndrome (J). Dig Liver Dis,2007,39:201-15.
[15]Van Oudenhove L, Demyttenaere K Tack J et al. Central nervous system involvement in functional gastrointestinal disorders (J).Best Pract Res Clin Gastroenterol,2004,18:663-680.
[16]Walker EA, Roy-Byrne PP, Katon W.J. Irritable bowel syndrome and Psychiatric illness (J). Am J Psychiatry,1990,147(5):565-5720.
[17]Blomhoff Svein M D, Spetalen Signe M D, Jacobsen Morten B, et al. Phobic anxiety changes the function of brain-gut axis in irritable bowel syndrome. Alneriean Psychosomatic Society,2001,63(6):959.
[18]Spiller RC, Jenkine D, Thomley JP, et al. Increased rectal mucosal enteroendocrine cells T lymphocytes and increased gut Permeability following acute campylobacter enteritis and in Post dysenteric irritabe bowel syndrome. Gut.2000; 47(6):804-811.
[19]韩炜,李君曼.肠易激综台征发病的内分泌机制.临床荟萃,2000,15(16)：761.
[20]杨云生,周殿元,张万岱等.肠易激综合征患者肠道电活动和胃肠激素.第四军医大学学报,1999,20(9)：818.
[21]张志雄,梁荣新等.肠易激综合征乙状结肠推动性运动与胃肠胰胆囊收缩素、胃动素的相关性.诊断学理论与实践,2006,5(1)：24－26.
[22]张茹.肠易激综合征血浆及乙状结肠茹膜中VIP及Ss的含量.中国内镜杂志,2004,10(3)：41-43.
[23]郭传勇,李定国,陆汉明.胃肠激素在肠易激综合征病理生理的作用,国外医学生理、病理科学与临床分册,1994,14(1)35-36.
[24]Dunlop Simon P, Spiller Robin C. Nutritional issues in irritable bowel syndrome. Current Opinion in Clinical Nutrition & Metabolic Care,2001,4(6):537.
[25]Mayer EA, Gerhardt GF, Basic and clinical aspects of visceral hyperalgesia. Gastmenterology,1994,107:271.
[26]Blomhoff Svein MD, Spetalen Signe MD, Jacobsen Morten B, et al. Phobic anxiety changes the function of brain-gut axis in irritable bowel syndrome. Alneriean Psychosomatic Society,2001,63(6):959.
[27]Oliver MR, Tan DT, Scott RB et al, Colonic motor response to IGE-mediated mast cell degranulation in the Hooded-Lister rat (J), Neurogastroenterol Motile,1996, 8(2):121-130.
[28]李兆申,董文珠,邹多武等.肠易激综合征粘膜肥大细胞的实验研究.解放军医学杂志.2002；27(7)：628－630.
[29]令狐强,杨云生.肠易激综合征患者外周血.淋巴细胞亚群分析.中华消化杂 志.2002：11(4)：423-425.
[30]王伟岸.肠易激综合征的发病机制.胃肠病学和肝病学杂志2001年6月第10卷第2期.99-102.
[31]吴文江.肠易激综合征发病机制与实验研究思路.中国中医药信息杂志2002年6月第9卷第6期.74-76.
[32]金杭斌.神经—免疫—内分泌网络与肠易激综合征.国际消化病杂志2006第26卷第1期40-44.
[33]朱磊,清肠化湿、益气健脾法序贯治疗溃疡性结肠炎疗效观察及调控PPAR-γ NF-kB的实验研究.南京中医药大学硕士学位论文.2009,6.
[34]耿慧苗,益气健脾法联合化疗治疗中晚期大肠癌的临床观察.山东中医药大学硕士学位论文.2009,4.
[35]安慧娟,益气健脾解毒方联合mDCF方案治疗中晚期胃癌临床研究.南京中医药学硕士学位论文.2009,7.
[36]雷晓红,余守雅.参苓白术散加味治疗恶性肿瘤放化疗后腹泻.2007,10-1419-02.
[37]武志霞,参苓白术散加味治疗恶性肿瘤放化疗后腹泻21例,2007,28-5.
[38]白明贵,做了益气健脾活血方联合化疗对中晚期胃癌患者QOL影响的临床研究.南京中医药学硕士学位论文2009,7.
[39]杨静,做了益气健脾、和胃降浊法与奥沙利铂/5—FU方案化疗联合治疗晚期胃癌的临床研究.南京中医药学硕士学位论文.2002,10.