归脾汤加减联合奥美拉唑治疗急性非静脉曲张性上消化道出血脾不统血证的临床研究  

Clinical study on modified Guipi Decoction combined with omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding with failure of the spleen to control blood vessels syndrome

作　　者：刘文波[1] 王翼洲[2] 陈士民[1] 杨辉[2] 黄驭 闫玲玲 张芝林 Liu Wenbo;Wang Yizhou;Chen Shimin;Yang Hui;Huang Yu;Yan Lingling;Zhang Zhilin(Department of Spleen and Stomach Diseases,Taihe County Hospital of Traditional Chinese Medicine Affiliated to Anhui University of Chinese Medicine,Fuyang 236600,China;Department of Spleen and Stomach Diseases,the First Affiliated Hospital of Anhui University of Chinese Medicine,Hefei 230000,China)

机构地区：[1]安徽中医药大学附属太和县中医院脾胃病科,阜阳236600 [2]安徽中医药大学第一附属医院脾胃病科,合肥230000

出　　处：《国际中医中药杂志》2023年第2期154-159,共6页International Journal of Traditional Chinese Medicine

基　　金：2020年度安徽高校自然科学研究项目(KJ2020BP439)。

摘　　要：目的评价归脾汤加减联合奥美拉唑治疗急性非静脉曲张性上消化道出血(ANVUGIB)脾不统血证的临床疗效。方法前瞻性队列研究。将符合入选标准的2018年1月-2021年12月太和县中医院120例ANVUGIB脾不统血证住院患者,按随机数字表法分为2组,每组60例。对照组予以大剂量质子泵抑制剂(先予以注射用奥美拉唑静脉注射,后改服奥美拉唑肠溶片)治疗,观察组在对照组基础上服用归脾汤加减。2组均治疗7 d。分别于治疗前后进行中医证候评分,采用比色法测定血红蛋白(Hb)和红细胞压积(HCT)水平,尿素酶-谷氨酸脱氢酶法检测BUN,免疫比浊法测定凝血酶原时间(PT),活化部分凝血活酶时间(APTT)和纤维蛋白原(FIB)水平,记录治疗期间的不良反应,评价临床疗效。结果研究期间,2组各有2例患者退出研究,最终各有58例纳入疗效统计。观察组治疗后主症、次症评分及总评分均低于对照组(t值分别为10.73、4.45、7.98,P<0.05)。观察组治疗后HCT[(41.25±5.03)%比(38.19±5.26)%,t=2.95]、Hb[(81.09±5.23)g/L比(78.39±5.37)g/L,t=2.74]水平高于对照组(P<0.01),BUN[(4.38±0.96)mmol/L比(5.39±1.13)mmol/L,t=5.19]水平低于对照组(P<0.01);PT[(12.48±0.67)s比(13.22±0.73)s,t=5.69]、APTT[(24.66±2.29)s比(27.78±2.04)s,t=7.75]低于对照组(P<0.01),FIB[(3.68±0.62)g/L比(3.41±0.74)g/L,t=2.13]水平高于对照组(P<0.05)。观察组总有效率为93.1%(54/58)、对照组为79.3%(46/58),2组比较差异有统计学意义(χ^(2)=4.64,P=0.031)。治疗期间,对照组不良反应发生率为3.4%(2/58)、观察组为1.7%(1/58),2组比较差异无统计学意义(χ^(2)=0.34,P=0.559)。结论在大剂量奥美拉唑治疗基础上服用归脾汤加减可明显改善ANVUGIB脾不统血证患者的凝血功能,纠正体循环血容量不足的相关症状、体征,提高止血效率,减少再出血风险,且不增加患者用药安全性风险。Objective To investigate the clinical efficacy of modified Guipi Decoction combined with omeprazole in the treatment of acute non-variceal upper gastrointestinal bleeding(ANVUGIB)with failure of the spleen to control blood vessels syndrome.Methods Prospective cohort study.A total of 120 patients from January 2018 to December 2021 Taihe County Hospital of Traditional Chinese Medicine with ANVUGIB of failure of the spleen to control blood vessels syndrome were selected,and the patients were divided into observation group and control group according to the random number table method,with 60 cases in each group.The control group was treated with a large dosage of proton pump inhibitor(omeprazole injection was injected intravenously first,and then omeprazole enteric coated tablets were taken);the observation group took Guipi Decoction on the basis of the control group,and both groups were treated for 7 days.TCM syndrome score,Hemoglobin(Hb)and hematocrit(HCT)levels were measured by colorimetry before and after the treatment.BUN was detected by urease glutamate dehydrogenase method.Prothrombin time(PT),activated partial thromboplastin time(APTT)and fibrinogen(FIB)levels were detected by immunoturbidimetry.The adverse reactions during treatment were recorded and the clinical efficacy was evaluated.Results Two patients in the observation group and two patients in the control group dropped out of the study.After treatment,the scores of main symptoms,secondary symptoms and total scores in the observation group were lower than those in the control group(t values were respectively 10.73,4.45,7.98,P<0.05).After treatment,the levels of HCT[(41.25±5.03)%vs.(38.19±5.26)%,t=2.95],Hb[(81.09±5.23)g/L vs.(78.39±5.37)g/L,t=2.74]in the observation group were higher than those in the control group(P<0.01),and BUN[(4.38±0.96)mmol/L vs.(5.39±1.13)mmol/L,t=5.19]was lower than that in the control group(P<0.01);PT[(12.48±0.67)s vs.(13.22±0.73)s,t=5.69],APTT[(24.66±2.29)s vs.(27.78±2.04)s,t=7.75]were lower than those in the control

关 键 词：归脾汤 上消化道出血 非静脉曲张 临床疗效 脾不统血 奥美拉唑 

分 类 号：R573.2[医药卫生—消化系统]