摘要
一、研究目的：
慢性浅表性胃炎(Chronic Superficial Gastritis, CSG)是消化系统的常见病,属慢性胃炎中的一种,该病是指胃粘膜呈慢性浅表性炎症。患者可有不同程度的消化不良症状,表现为上腹部痛或不适,上腹胀,早饱,暖气,恶心,泛酸,偶有呕吐,一般症状轻微,有的甚至无明显症状,可在胃镜检查时发现。该病是临床上的常见多发病,其发病原因不一,可因自身免疫、饮食因素、嗜酒、喝浓咖啡,或因幽门螺杆菌感染等引起。目前己公认幽门螺杆(Helicobacter pylori, H. pylori, Hp)是慢性活动性胃炎的病原菌。在我国属于高感染地区,在普通人群中Hp感染率为50%—80%。在中医属“胃脘痛”、“嘈杂”的范畴,病因较多,病机较为复杂。
现代医学对慢性浅表性胃炎的治疗仍然没有特效方法,多为对症治疗,如保护胃粘膜,减少胃酸分泌,促进胃肠蠕动,抑制幽门螺杆菌感染等,疗效有限且副作用明显。而针灸以其独特的经络腧穴理论和辨证施治理念在治疗慢性胃炎中取得了确切的疗效,而且无毒副作用,越来越受到人们的认可。
本研究通过观察针刺配合药物治疗与单纯药物治疗慢性浅表性胃炎的临床疗效,为临床针刺治疗慢性浅表性胃炎提供循证医学证据。
二、研究方法：
查阅并整理慢性浅表性胃炎相关的相关的临床研究资料,参考并采纳各临床研究所采用的研究方法、诊断标准、治疗方法、疗效评价及统计方法之所长,结合实际情况,制定出科学的研究方法。
临床病例均来自广州中医药大学第一附属医院针灸科与脾胃科收治的病人,2012年4月至2013年3月共收集60例符合标准的慢性浅表性胃炎患者,按患者就诊顺序采用数字随机的方法,按1：1比例,分为治疗组、对照组各30例。对照组予中药的辩证治疗,治疗组取穴四神聪、神庭、印堂、中脘、关元、天枢、内关、足三里、三阴交。治疗前后均采用治疗前后使用SF-36生存质量量表、焦虑自评量表(SAS)、抑郁自评量表(SDS)经行评价,所收集的数据使用SPSS19.0统计软件经行统计分析。
三、研究结果：
(1)治疗组与对照组总有效率分别为90.0%和80.0%,经统计学分析后,提示两组总疗效差异无显著意义。其中,治疗组病例30例,治愈5例,显效14例,有效8例,无效3例,对照组病例30例,治愈3例,显效14例,有效7例,无效6例。说明针刺调神方用于治疗慢性浅表性胃炎有效,能提高临床的治愈率及有效率。治疗组与对照组治疗前后症状积分变化,经统计学分析后,所有P值均小于0.05,说明治疗组与对照组治疗前后症状积分差异均有显著意义。根据对治疗组与对照组治疗后症状积分比较,发现胃脘疼痛(P=0.000<0.05)、嗳气(P=0.004<0.05)、大便异常(P=0.024<0.05)两组差异有显著意义,提示治疗组在改善患者症状方面疗效优于对照组。(2)SF-36生存质量量表积分,治疗组与对照组生存质量改善情况方面,两组的生理功能(PF)、生理职能(RF)、躯体疼痛(BP)、总体健康(GH)、活力(VT)社会功能(SF)、情感职能(RE)、精神健康(MH)八个维度的积分,与治疗前相比,P值均小于0.05,提示两组治疗后,患者生存质量均有所提高。根据两组治疗后生存质量改善情况比较,结果显示,两组总体健康、社会功能、精神健康三个维度的积分差异(P<0.05)有显著意义,提示治疗组较对照改善更为明显。(3)焦虑自评量表(SAS),治疗组与对照组治疗前后分别进行比较,P值均小于0.05,提示两组治疗后,焦虑情况改善。(4)抑郁自评量表(SDS),治疗组与对照组治疗前后分别进行比较,P值均小于0.05,提示两组治疗后,抑郁情况改善。
四、研究结论
针刺调神方能提高慢性浅表性胃炎的治愈率及有效率,治疗组与对照组有明显差异；两组均能提高患者生存质量,总体健康、社会功能、精神健康提示治疗组较对照改善更为明显；治疗后焦虑自评量表、抑郁自评量表评分统计提示治疗组与对照组均能改善患者焦虑、抑郁情况。
Objective
Chronic Superficial Gastritis (Chronic Superficial Gastritis, CSG) is a common disease of the digestive system, and one of the Chronic Gastritis, the disease refers to inflammation of gastric mucosa in Chronic Superficial. Patients can have different degree of symptoms of indigestion, characterized by abdominal pain or discomfort, bloating, early satiety, central heating, nausea, pantothenic acid, with occasional vomiting, generally mild, some even has no obvious symptoms, and can be found in gastroscopy. The disease is clinically common, frequently-occurring disease, its etiology is differ, but due to dietary factors, autoimmune, other factors such as alcohol, drink coffee, or caused by helicobacter pylori infection. Been recognized as pylorus screw (Helicobacter pylori, Hp) is a pathogen of chronic active gastritis. High in our country belongs to the affected areas, in the general population in Hp infection rate was50%-80%. In traditional Chinese medicine is a " epigastric pain","noisy" category, cause, pathogenesis is more complicated.
Modern medicine in the treatment of chronic superficial gastritis, there is still no specific method for symptomatic treatment, such as protection of gastric mucosa, reduce the gastric acid secretion, promoting gastrointestinal peristalsis, inhibition of helicobacter pylori infection and curative effect of limited and side effect is obvious. With its unique meridians and acupuncture theory and the concept of evidence-based medicine in the treatment of chronic gastritis achieved definite curative effect, and non-toxic side effects, more and more getting people's approval.
This study through the observation of acupuncture and medication and simple drug treatment of chronic superficial gastritis clinical efficacy, for clinical acupuncture and ear pressure provide evidence-based medical evidence for the treatment of chronic superficial gastritis.
Methods
Consult has related to chronic superficial gastritis clinical research data, reference and adoption of the institute of clinical research methods, diagnostic criteria, treatment methods, efficacy evaluation and statistical method, combined with the actual situation, to develop a scientific research method.
Clinical cases were from the first affiliated hospital of guangzhou university of traditional Chinese medicine acupuncture and spleen treated patients, between April2012and March2013collected60cases accord with standard of chronic superficial gastritis patients, according to the digital random method is used for the order to the patient, according to1:1proportion, divided into the treatment, group and control group30cases each. Control group to the Chinese medicine dialectical treatment, the treatment group find out four god astute, court, Yin tang, chung wan, guan yuan, days pivot, clearance, st36, three vaginal intercourse. Before and after treatment by using SF36the survival quality before and after the treatment scale, self rating anxiety scale (SAS), depression self rating scale (SDS) in evaluation, the collected data using SPSS19.0statistical software through the statistical analysis.
Result
(1) Treatment group and control group total effective rate were90.0%and80.0%respectively, after statistics analysis, the tip in the two groups no significant difference in curative effect. Among them, the treatment group of30cases patients were cured,5cases,14cases had marked effect,8cases,3cases failed,30cases of control group cases,3were cured,14cases were markedly effective, effective7cases,6cases. That acupuncture works, god party used in the treatment of chronic superficial gastritis, can improve the cure rate and effective rate. Treatment group and control group before and after treatment symptoms integral, after statistical analysis, all P values were less than0.05, the treatment group and control group before and after treatment symptoms integral differences were significant. According to the treatment group compared with control group after treatment symptoms integral, found that the diagnosis of pain (P=0.000<0.05), gas (P=0.0039<0.05), abnormal stool (P=0.024<0.05) in the two groups have significant difference, the treatment group in improving symptoms curative effect is superior to the control group.(2) SF-36scale scores in living standards, improve quality of life in treatment group and control group, two groups of physiological function (PF), physiological function (RF), body pain (BP), general health (GH) and vitality (VT)(SF), social function, emotional function (RE), mental health (MH) in eight dimensions integrals, compared with before treatment, P values were less than0.05, the tip in the two groups after treatment, the patients quality of life improved. According to improve quality of life compared the two groups after treatment, the overall health, social function, according to the results of two groups, the difference of three dimensions of the integration of mental health (P<0.05) has a significant meaning, prompt treatment group improved more significantly than control.(3) self rating anxiety scale (SAS), the treatment group compared with the control group before and after treatment, respectively, P values were less than0.05, suggest the two groups after treatment, anxiety conditions improve. Treatment group compared with control group after treatment scores, P value is less than0.05, the treatment group than the control group significantly improve the situation.(4), depression self rating scale (SDS), the treatment group compared with the control group before and after treatment, respectively, P values were less than0.05, suggest the two groups after treatment, anxiety conditions improve. Treatment group compared with control group after treatment scores, P value is less than0.05, the treatment group than the control group significantly improve the situation.
Conclusion
Regulating spirit in acupuncture can improve the cure rate of chronic superficial gastritis and efficient, treatment group and control group had significant differences; Both group therapy can improve the patients survival, overall health, social function, mental health, the treatment group improved more significantly than control; Treatment group and control group all can improve the patients'anxiety, depression, anxiety, after treatment the self-assessment scale, depression self rating scale score statistics suggest the treatment group than the control group improved significantly.
引文
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