黑龙江省牡丹江市宁安市人民医院 157400
摘要:目的:探讨莫沙必利联合香砂六君子汤治疗糖尿病胃轻瘫(DGP)的效果。方法:选取2017年1月至2018年1月我院康复科门诊治疗的DGP患者70例,按治疗方法不同分为西医组和中西医组各35例。两组予控制饮食、适量运动和控制血糖等基础治疗。西医组予枸橼酸莫沙必利胶囊口服,中西医组在西医组基础上加用香砂六君子汤治疗,两组均连用8周。随访半年观察复发率。结果:中西医组总有效率(94.3%)明显高于西医组的(77.1%);随访半年的复发率(6.1%)明显低于西医组(25.9%)。两组不良反应发生率均较轻,且无较大差异。结论:莫沙必利联合香砂六君子汤治疗DGP疗效明显优于单用莫沙必利,且能降低复发率,用药安全性较好。
关键词:莫沙必利;香砂六君子汤;糖尿病胃轻瘫
Analysis of the effect of mosapride combined with Xiangsha Liujunzi decoction in the treatment of diabetic gastroparesis
Abstract: Objective: To investigate the effect of mosapride combined with Xiangsha Liujunzi Decoction on diabetic gastroparesis (DGP). METHODS: Seventy patients with DGP who were treated in the outpatient department of our hospital from January 2017 to January 2018 were enrolled. According to different treatment methods, they were divided into Western medicine group and 35 cases of Chinese and Western medicine group. The two groups were given basic treatments such as controlled diet, moderate exercise, and blood sugar control. The western medicine group was given mosapride citrate capsule orally. The Chinese and Western medicine group was treated with Xiangsha Liujunzi Decoction on the basis of the western medicine group, and the two groups were used for 8 weeks. The recurrence rate was observed during the follow-up period of six months Results: The total effective rate of the Chinese and Western medicine group (94.3%) was significantly higher than that of the western medicine group (77.1%). The recurrence rate (6.1%) during the follow-up period was significantly lower than that of the western medicine group (25.9%). The incidence of adverse reactions in both groups was lighter and there was no significant difference. Conclusion: The efficacy of mosapride combined with Xiangsha Liujunzi Decoction in treating DGP is significantly better than that of mosapride alone, and it can reduce the recurrence rate and the safety of medication is better.
Key words: mosapride; Xiangsha Liujunzi decoction; diabetic gastroparesis
糖尿病胃轻瘫(DGP)是糖尿病较常见的慢性并发症之一,主要表现为胃张力和胃排空障碍,但临床症状常不典型,诊断及治疗较困难。以往临床上常采用莫沙必利等促胃肠动力药治疗,虽有一定疗效,但远期效果欠佳,停药后易复发。香砂六君子汤出自《太平惠民和剂局方》,具有健脾化湿、行气消痞、和胃畅中之功效,对治疗DGP有一定效果[1]。本文观察莫沙必利联合香砂六君子汤治疗DGP的效果,现报道如下。
1.资料与方法
1.1一般资料
选取2017年1月至2018年1月我院康复科门诊治疗的DGP患者70例。其中男36例,女34例;年龄51~84岁,平均(68.1±5.1)岁;病程1~8年,平均(3.5±0.7)年;空腹血糖6.7~9.5mmol/L,平均(6.9±0.9)mmol/L。根据治疗方法不同分为中西医组与西医组,各35例。两组患者性别、年龄、病程和空腹血糖水平等资料接近。
1.2方法
两组予饮食、运动调整和血糖控制等基础治疗。西医组予枸橼酸莫沙必利胶囊1粒,每日3次,餐前30min口服。中西医组在西医组基础上加用香砂六君子汤,组成:生山楂、麦门冬、人参、陈皮、焦六神曲、鸡内金和白芍各10g,白术、黄芪、木香、川芎、丹参和半夏各15g,砂仁、甘草各6g。水煎服,每日1剂,取汁200ml,分早晚两次口服。两组均连用8周。
2.结果
中西医组总有效率(94.3%)明显高于西医组的(77.1%);随访半年的复发率(6.1%)明显低于西医组(25.9%)。两组不良反应发生率均较轻,且无较大差异。
3.讨论
DGP的发病机制较复杂,多数学者认为与微血管改变、脑肠肽分泌异常、胃动力障碍、高血糖毒性作用、心理作用等因素相关,其中胃肠动力障碍在发病中起重要作用。研究发现,高血糖可引起DGP患者的胃自主神经损伤,神经轴突节段性脱髓鞘,使得胃基本电节律破坏,胃底收缩能力减弱,胃蠕动减慢,引起胃排空障碍。因此,增强胃肠动力障碍是目前治疗DGP的新方向[3]。莫沙必利是一种高选择性5-羟色胺受体激动药,可激活胃肠道胆碱能神经促进乙酰胆碱释放,加快胃肠排空,而且不影响胃酸分泌,对DGP疗效确切,但远期效果不足,病情易复发。中医认为,DGP属“消渴兼痞满”范畴,多由消渴日久致脾气虚弱,脾胃升降失调引起,治疗当以理气健脾和行气消痞为主。香砂六君子汤中人参、黄芪能补脾益气;白术可健运脾胃、扶助运化;陈皮、半夏降气化痰;丹参、川芎、白芍活血化瘀、养血缓中;木香化滞助运;砂仁理气和胃止呕;生山楂消食化积;鸡内金、焦神曲健脾和胃;麦门冬养阴益胃,诸药合用,共奏健脾益胃、消食化积之功效。
本文结果表明,中西医组总有效率明显高于西医组,且半年后复发率低于西医组。提示莫沙必利联合香砂六君子汤治疗DGP疗效优于单用莫沙必利治疗,并能降低其复发率,而且两组治疗期间不良反应轻,说明联合用药安全性较好。
参考文献:
[1]张永魁,赵新亮.香砂六君子汤治疗糖尿病性胃轻瘫48例[J].河南中医,2011,31(1):80.
[2]中华医学会糖尿病学分会.中国2型糖尿病防治指南(2007年版)[J].中华医学杂志,2008,88(18):1227.
[3]孔艳华,祝捷,郜同心.糖尿病胃轻瘫发病机制的研究进展[J].中国医药导报,2012,9(33):25.
论文作者:郭宁
论文发表刊物:《医师在线(学术版)》2019年第03期
论文发表时间:2019/4/10
标签:西医论文; 君子论文; 中西医论文; 两组论文; 效果论文; 血糖论文; 胃肠论文; 《医师在线(学术版)》2019年第03期论文;