疏肝饮加减治疗肝郁脾虚型肠易激综合征临床观察

Clinical observation on the effects of Shugan decoction in the treatment of irritable bowel syndrome of liver stagnation and spleen deficiency pattern

[目的]评价疏肝饮治疗肝郁脾虚型腹泻型肠易激综合征(IBS-D)的临床疗效。[方法]将62例肝郁脾虚型IBS-D患者根据治疗方法不同分为治疗组(38例)和对照组(24例),治疗组予疏肝饮煎服治疗,对照组予匹维溴铵片每次50mg,每日3次口服治疗,2组治疗疗程均为4周。比较治疗前后肠易激综合征严重程度(IBS-SSS)积分及中医证候积分,以此判定IBS-SSS疗效及中医证候疗效;观察治疗前后安全性指标,记录不良事件。[结果]4周治疗后,治疗组IBS-SSS总有效率为(86.84%)与对照组(83.33%)相仿(P>0.05)。中医证候疗效治疗组总有效率(84.21%)高于对照组(62.50%)(P<0.05)。2组患者治疗后腹泻、腹痛、腹胀以及肠鸣的证候单项积分较疗前明显下降(P<0.05),而治疗组中的嗳气和对照组中的两胁胀满、倦怠乏力与治疗前比较差异无统计学意义(P>0.05),治疗组患者经治后,急躁易怒、两胁胀满、纳呆食少、倦怠乏力的积分显著低于对照组(P<0.05)。选用焦虑自评量表(SAS)、抑郁自评量表(SDS)对患者的精神心理状态进行评估后发现,IBS-D患者普遍存在焦虑、抑郁状态;治疗组疗后的SDS分值低于对照组(P<0.05)。[结论]疏肝饮在有效缓解IBS-D主症的同时,能够显著改善患者精神心理状态,并具有良好的安全性。

[Objective]To evaluate the clinical efficacy of Shugan decoction in the treatment of diarrheapredominant irritable bowel syndrome(IBS-D)of liver depression and spleen deficiency type.[Methods]A total of 62patients with IBS-D were divided into a treatment group(38cases)and a control group(24cases)according to different treatment methods.The treatment group was treated with Shugan decoction 1dose per day,while the control group received oral administration of Pivaviron tablets 50mg each time,3times a day for 4weeks.The IBS-SSS scores and traditional Chinese medicine(TCM)syndrome scores were compared before and after treatment,and the efficacy of TCM syndrome and IBS-SSS were detected.The safety profiles before and after treatment were observed and recorded.[Results]After 4weeks of treatment,the total efficiency of IBS-SSS in the treatment group(86.84%)was basically similar to the control group(83.33%)(P>0.05).The total efficiency of the TCM syndrome in the treatment group(84.21%)exceeded the control group(62.5%)(P<0.05).The scores of diarrhea,abdominal pain,abdominal distension and borborygmus in the two groups were significantly lower than those before treatment(P<0.05).But there was no significant difference in the score of belching in the treatment group as well as the scores of distention and fullness in both flank and fatigue in the control group(P>0.05).The scores of impatience and irritability,fullness in both flank,poor appetite and fatigue in the treatment group were significantly decreased than those in the control group.The psychological status of IBS-D patients was evaluated by SAS and SDS.The scores of SAS and SDS in the two groups were significantly lower than those before treatment(P<0.05).[Conclusion]Shugan decoction is superior to Pinaverium Bromide in the treatment of IBSD of liver stagnation and spleen deficiency pattern,and it is safe.