针药结合治疗反流性食管炎疗效观察

Therapeutic effects of the integrated acupuncture and Chinese herbal medicine on reflux esophagitis

目的:比较化浊解毒降逆方结合针刺治疗反流性食管炎与西药奥美拉唑以及单纯服用中药的临床疗效差异。方法:将90例反流性食管炎患者随机分为3组,脱落病例4例,最后针药组29例、西药组29例、中药组28例纳入统计。针药组口服化浊解毒降逆中药方并针刺内关、足三里、中脘、肝俞、胆俞、太冲,中药每日1剂,针刺每日1次;西药组口服奥美拉唑胶囊20 mg,每日2次;中药组单纯口服化浊解毒降逆方。3组均治疗8周,随访6个月。观察3组患者治疗前后反流性疾病问卷(RDQ)评分、胃镜下食管黏膜的变化,并评定临床证候疗效以及复发率。结果:治疗4周、8周后3组RDQ积分均较治疗前下降(均P<0.05),治疗4周后针药组RDQ积分低于西药组(P<0.05),治疗8周后针药组RDQ积分低于西药组与中药组(均P<0.05);随访6个月,针药组复发率低于其他两组(均P<0.05);治疗8周后针药组证候总有效率及胃镜总有效率均优于西药组与中药组(均P<0.05)。结论:化浊解毒降逆方结合针刺治疗反流性食管炎疗效确切,可改善症状,保护胃黏膜,减少复发率,疗效优于单纯中药和西药奥美拉唑。

Objective To compare the differences in the clinical therapeutic effects on reflux esophagitis among the combined therapy of huazhuo jiedu jiangni decoction（the decoction for resolving the turbid, detoxification and reducing the pathologic upward qi in short） and acupuncture, omeprazole and Chinese herbal medicine. Methods Ninety patients were randomized into 3 groups, 4 cases of them were dropped off. Finally, there were 29 cases in the combined therapy group with acupuncture and the decoction, 29 cases in the western medication group and 28 cases in the Chinese herbal medicine group in the statistical analysis. In the combined therapy group with acupuncture and the decoction, the decoction was prescribed for oral administration. Additionally, acupuncture was applied to Neiguan（PC 6）, Zusanli（ST 36）, Zhongwan（CV 12）,Ganshu（BL 18）, Danshu（BL 19） and Taichong（LR 3）. The decoction was applied one dose a day and acupuncture was once a day. In the western medication group, omeprazole capsules, 20 mg were prescribed for oral administration, twice a day. In the Chinese herbal medicine group, the decoction was simply applied. The treatment was 8 weeks in the 3 groups and the follow-up visit was 6 months. The score of reflux disorder questionnaire（RDQ） and the changes in esophageal mucosa under gastroscope were observed before and after treatment; the clinical therapeutic effects and recurrence rate were evaluated in the 3 groups. Results In 4 and 8 weeks of treatment, RDQ scores in the 3 groups were all reduced as compared with those before treatment（all P〈0.05）. In 4 weeks of treatment, RDQ score in the combined therapy group with acupuncture and Chinese herbal medicine was lower than that in the western medication group（P〈0.05）. In 8 weeks of treatment, RDQ score in the combined therapy group with acupuncture and Chinese herbal medicine was lower than those in the western medication group and the Chinese herbal medicine group（both P〈0.05）. In follow-up visit for 6 months, the recurrence rate in the combined therapy group with acupuncture and the decoction was lower than those in the other two groups（both P〈0.05）.In 8 weeks of treatment, the total effective rate for clinical symptoms and that observed under gastroscope in the combined therapy group with acupuncture and the decoction were all better than those in the western medication group and the Chinese herbal medicine group（all P〈0.05）. Conclusion The combined therapy of huazhuo jiedu jiangni decoction and acupuncture achieve the definite therapeutic effects on reflux esophagitis, relieve the symptoms, protect gastric mucosa and reduce the ecurrence rate. The therapeutic effects are better than the simple application of either Chinese herbal medicine or omeprazole.