疏肝健脾法治疗肝郁脾虚型功能性消化不良疗效观察

对３８例肝郁脾虚型功能性消化不良以疏肝健脾基本方加减治疗（中药组），并以西药组（３１例）作对照，结果表明，在自、他觉症状的改善、远、近期疗效等方面均明显以中药组为优。其机理与疏肝健脾类中药对植物神经功能紊乱具双向调节作用、能消除消化道局部炎症、促进胃排空、抑制胆汁返流、清除幽门螺旋菌等有关.视健脾守方治疗等可降低复发率。     

疏肝健脾法治疗肝郁脾虚型功能性消化不良疗效观察

对３８例肝郁脾虚型功能性消化不良以疏肝健脾基本方加减治疗（中药组）并以西药组（３１例）作对照，结果表明，在自、他觉症状的改善，远、远期疗效等方面均明显以中药组为优。其 与疏肝健脾类中药对植物神经功能紊乱具双向调节作用，能消除消化道局部炎症、促进胃排空、抑制胆汁返流、清除幽门螺旋菌等有关。重视健脾守方治疗等可降低复发率。     

健脾疏肝和胃法治疗功能性消化不良42例

[目的]观察健脾疏肝和胃法治疗功能性消化不良(FD)的效果.[方法]84例FD患者随机分为2组,各42例,治疗组采用健脾疏肝和胃法治疗,并据证化裁;对照组用复方阿嗪米特、莫沙必利、法莫替丁等治疗.疗程4周.[结果]治疗组和对照组的有效率分别为92.5％和73.1％,2组比较差异无统计学意义(P＞0.05).2组上腹痛、餐后饱胀、腹胀、嗳气、胃部烧灼感均较治疗前明显缓解(P＜0.05);治疗组治疗后上腹痛、胃部烧灼感、嗳气、腹胀症状较对照组缓解明显(P＜0.05).[结论]健脾疏肝和胃法治疗FD在改善症状方面优于复方阿嗪米特、莫沙必利、法莫替丁等,但总体疗效相当.     

疏肝和胃汤对功能性消化不良大鼠血胃动素和胃泌素的影响

目的:观察疏肝和胃汤对功能性消化不良(FD)大鼠血中胃动素(MOT)和胃泌素(GAS)的影响,从该方对胃肠激素的调节作用方面揭示其促胃动力作用机制.方法:采用夹尾激怒法制作FD大鼠模型.实验设立了空白对照组,模型组,疏肝和胃汤大、中、小剂量组及对照组,各组治疗后取血,应用放射免疫法检测血中MOT及GAS的含量.结果:模型组血中MOT、GAS含量显著降低,经治疗后,疏肝和胃汤组及对照组均明显升高,与模型组比较差异有统计学意义(P＜0.05～0.01),而疏肝和胃汤组及对照组之间差异无统计学意义.结论:疏肝和胃汤升高血中MOT和GAS的含量,并通过其效应而发挥促胃动力作用,可能是该方促进胃排空的作用机制之一,其机制可能与莫沙比利有相似之处.     

疏肝健脾汤治疗功能性消化不良152例疗效观察

功能性消化不良（ＦＤ）又称非溃疡性消化不良（ＮＵＤ）,发病机制尚未完全阐明,至今未有肯定和统一的治疗方法。笔者根据其临床特点,应用疏肝健脾法自拟疏肝健脾汤治疗本病１５２例,并与西沙必利治疗７０例进行对比观察,现报告如下。１　资料与方法１．１　临床资料：将２２２例ＦＤ患者随机分为两组,治疗组１５２例,男６８例,女８４例;年龄１６～８０岁,平均４０．８７岁;病程１个月～３０年,平均５．３２年。对照组７０例,男３２例,女３８例;年龄１８～７６岁,平均４１．０２岁;病程０．５～２５年,平均５．４９年。两…     

功能性消化不良患者血浆胃动素及胃肠动力的改变

功能性消化不良 (ＦＤ)是一种常见的临床综合征 ,其发病机制不清 ,但其的大多数症状发生在进餐 2ｈ后 ,即胃肠道的消化间期。胃肠道的消化间期由于胃肠蠕动呈周期性改变 ,也称消化间期运动周期 (ＩＤＭＣ) ,ＩＤＭＣ分为Ⅰ、Ⅱ、Ⅲ 3期 ,其中胃窦部ＩＤＭＣⅢ期即移行性肌电复合波 (ＭＭＣ)的作用最重要 ,它可诱发胃强烈收缩 ,排除胃内不易消化的食物颗粒。ＭＭＣ的产生是由呈周期性改变的胃动素大量释放入血而引起的[1] ,所以检测ＦＤ患者血浆胃动素水平以及通过监测胃窦十二指肠动力 ,观察ＭＭＣ是否缺失及胃窦部ＭＭＣ收缩幅度和持续时间…     

疏肝和胃法治疗功能性消化不良102例

目的观察疏肝和胃法治疗功能性消化不良的疗效。方法将162例功能性消化不良病人随机化分为治疗组102例，以疏肝和胃法组方内服中药治疗；对照组60例，予吗丁啉口服治疗。结果治疗组总有效率95．1％，对照组总有效率68．33％，治疗组明显优于对照组。结论以疏肝和胃法组方治疗功能性消化不良有显著疗效，值得临床推广应用。     

六味安消胶囊对功能性消化不良患者胃动素的影响

功能性消化不良 ( FD)确切的病因尚未完全明确 ,目前认为胃肠道功能障碍、胃肠激素、内脏感觉过敏、精神因素、应激因素与 FD有密切关系。本文通过观察 ,初步探讨六味安消胶囊 (贵州信邦制药股份有限公司生产 )治疗 FD时胃动素 ( MTL)的变化。1　对象与方法1 .1　研究对象 :FD组 40例 ,男 2 4例 ,女 1 6例 ,年龄 2 0～ 60岁 ,平均 42 .3岁。符合下列条件 :1持续性或反复发作性上腹饱胀为必备条件 ;2可具有下列症状 1项或数项 ,即上腹隐痛、肠胀气、嗳气、食欲不振、恶心、呕吐、便秘 ;3上述症状持续 1个月以上 ;4近期 (半个月内 )均经…     

和胃汤对功能性消化不良患者胃动素和胃泌素的影响

笔者根据多年临床经验,采用自拟和胃汤治疗功能性消化不良( FD)患者,疗效显著。本研究通过观察FD患者胃动素( MTL)、胃泌素( GAS)及临床症状方面的变化,以探讨和胃汤治疗FD患者的作用机制,现报告如下。1　资料与方法1 .1　临床资料:本组病例60例,均来自大连市中医医院门诊患者,均符合卫生部1 993年中药临床指导原则《治疗慢性胃脘痛胃肠动力障碍性疾病的临床研究指导原则》的诊断标准。将60例病例随机分为两组:治疗组30例,其中男1 8例,女1 2例;年龄2 0～65岁,平均40 .5岁;病程6个月～1 0年。对照组30例,其中男1 6例,女1 4例;年龄2 2～6…     

老年非溃疡性消化不良患者血清胃泌素、血浆胃动素及生长抑素的检测及其意义

本文采用放射免疫法对３１例老年非溃疡性消化不良（ＮＵＤ）患者和２０例对照者在空腹状态下进行了血清胃泌素、血浆胃动素及生长抑素的测定。结果显示：老年人ＮＵＤ组胃泌素浓度为８５．７２±２２．０３ｐｇ／ｍｌ，较对照组的９０．４２±１５．０６ｐｇ／ｍｌ，差异无显著性（Ｐ＞０．０５）；胃动素浓度为４２７．７４±９５．８５ｐｇ／ｍｌ，较对照组的５４５．７３±１１５．８０ｐｇ／ｍｌ，差异有显著性（Ｐ＜０．０５）；生长抑素浓度为６９．４７±１８．７５ｐｇ／ｍｌ，较对照组的５４．７６±１３．３２ｐｇ／ｍｌ，差异有显著性（Ｐ＜０．０５）。提示胃动素，生长抑素在老年人ＮＵＤ发病机理中起一定作用，而胃泌素则无明显作用。     

舒胃汤对功能性消化不良大鼠胃动素及胃窦Cajal间质细胞的影响

[目的]探讨舒胃汤对功能性消化不良( functional dyspepsia,FD)肝郁脾虚证大鼠胃排空、胃动素(Motilin,MOT)、胃窦Cajal间质细胞(interstitial cells of Cajal,ICO的影响.[方法]将60只大鼠随机分为舒胃汤低剂量组(低剂量组)、舒胃汤高剂量组(高剂量组)、木香顺气丸组(中成药组)、莫沙必利组、对照组、模型组,每组10只.采用夹尾刺激方法制造FD模型,造模后第3天各组给予相应药液灌胃,对照组、模型组给予蒸馏水灌胃,持续14d.实验结束后检测胃排空,免疫组化法检测MOT水平,电镜观察胃窦ICC超微结构.[结果]模型组与对照组大鼠比较胃排空延迟,MOT水平明显升高(均P＜0.05).与模型组比较,给药各组大鼠胃排空改善(均P＜0.05);高剂量组和莫沙必利组MOT降低(均P＜0.05);透射电镜观察高剂量组胃窦部ICC与模型组比较结构明显改善,接近对照组.[结论]舒胃汤能够促进胃排空,下调MOT水平,改变胃窦ICC超微结构,恢复胃肠道运动功能可能是舒胃汤治疗FD的作用机制之一.     

胃痛消痞方对脾胃虚寒型功能性消化不良大鼠胃肠动力和胃动素的影响

目的:观察胃痛消痞方对功能性消化不良(FD)大鼠胃肠动力、血浆胃动素(MOT)的影响.方法:将66只大鼠以食醋灌胃建立FD模型,随机分为空白组、模型组、中药(低、中、高)剂量组、多潘立酮组;分别用生理盐水、不同浓度的胃痛消痞方、多潘立酮,每日2次灌胃治疗14 d:观测各组大鼠血浆MOT水平、小肠推进比、胃内排空率.结果:与模型组比较,各浓度胃痛消痞方均能明显提高血浆MOT含量、提高小肠推进比,差异有统计学意义(MOT含量:104.57 pmol/L±14.05 pmol/L,124.90 pmol/L±15.21 pmol/L,125.84 pmol/L±27.67 pmol/L vs 81.95 pmol/L±12.02 pmol/L,P<0.01;小肠推进比:55.62%±2.92%,56.91%±4.65%.59.04%±3.24%vs 51.80%±3.57%,P<0.01),空白组、中药中、高剂量组之间小肠推进比无明显差异(P>0.05),但均高于多潘立酮组(P<0.01);能提高胃排空率,与多潘立酮组无统计学差异(P>0.05).结论:胃痛消痞方能通过提高血浆中MOT水平,从而促进脾胃虚寒型FD大鼠的胃肠动力.     

失眠伴便秘型肠易激综合征患者睡眠特征及胃动素、生长抑素的临床观察

目的观察失眠伴便秘型肠易激综合征患者的睡眠特征及胃动素、生长抑素水平,为临床治疗提供依据。方法对同期连续就诊的失眠伴便秘型肠易激综合征患者及失眠不伴便秘型肠易激综合症患者（各12例）进行多导睡眠检测,同时设立健康志愿者（8人）作为对照。采用多导睡眠仪对上述试验者进行整晚监测,第二天晨起用放免法测定血浆胃动素、生长抑素水平。结果失眠伴便秘和不伴便秘组的睡眠时间、深睡眠时间、深睡眠比例、快眼动（REM）时间以及睡眠效率均较正常对照组显著减少;在总记录时间、REM次数、REM比例三组无显著性差异。失眠伴便秘患者胃动素较正常对照组明显升高（271．89pg／mL±51．25pg／mLvs240．85pg／mL±41．41pg／mL,P〈0．05）,升高幅度较失眠不伴便秘患者（315．49Pg／mL±19．32pg／mL）低;其生长抑素水平亦较对照组明显升高（505．49pg/mL±30．49pg／mLvs438．32pg／mL±23．67pg／mL,P〈0．05）。结论失眠与便秘型肠易激综合征关系密切。失眠伴有便秘型肠易激综合征患者胃动素、生长抑素水平增高。     

Visceral perception in health and functional dyspepsia

The symptoms of functional dyspepsia are still unexplained. To evaluate the possible role of abnormal visceral perception, we studied the symptomatic responses and the pressure variations during progressive gastric distension in 10 female healthy control subjects (mean age 33.6 years) and in 10 female patients with functional dyspepsia (mean age 35.2 years). A rubber balloon was positioned 4 cm below the lower esophageal sphincter (LES) and inflated with progressively larger volumes of air by steps of 50 ml; pressures at the gastric fundus and at the LES were continuously recorded by perfused manometric catheters. Each subject was studied on two separate occasions after randomized double-blind administration of either placebo or 20 mg of domperidone. Symptomatic responses and the manometric data were analyzed at the time of the initial recognition of distension (bloating step) and at the time of reporting pain or up to a maximum of 700 ml of balloon inflation (pain or 700-ml step). On placebo, the volumes of gastric distension were more than two times lower in patients than in control subjects at the bloating step (185±32 ml vs 470±40 ml,P=0.001) and at the pain or 700-ml step (265±54 ml vs 600±34 ml,P<0.005), while the pressure gradients (pressure at inflation steps minus baseline pressure before beginning inflation) were not statistically different between the two groups. On domperidone, the volumes at each of the two steps did not change in comparison to results on placebo except in healthy controls at the bloating step (470±40 ml on placebo vs 355±35 ml on domperidone,P<0.001); however, there was a trend for pressure gradients to increase on domperidone in comparison to results on placebo. We conclude that patients with functional dyspepsia have a lower threshold both to the initial symptomatic recognition and to perception of pain during gastric distension and that domperidone might have an effect on the threshold of these conscious visceral sensations. This increased visceral perception may alone or with other abnormalities of the gastroduodenal tract explain the symptoms of functional dyspepsia.This study was supported in part by a grant from Janssen Pharmaceutica Inc., Canada.     

Does Helicobacter pylori infection affect gastric emptying in patients with functional dyspepsia?

The objectives of the study were first, to determine if gastric emptying was altered in patients with functional dyspepsia with and without Helicobacter pylori infection compared with normal healthy volunteers; and second, to determine if there were further alterations in gastric emptying when the infection was eradicated. Gastric emptying was measured using a ^99mtechnetium radiolabelled solid meal and gastric emptying time was measured as t_1/2, viz. time taken for half the radiolabelled meal to be emptied from the stomach. The mean gastric emptying time for H. pylori-positive patients (n= 20) was 56.4±24.8 min; H. pylori-negative patients (n= 19) 67.8±31.8 min; and normal controls (n= 20) 58.8 ± 18.8 min. No significant difference was obtained between the groups (ANOVA; P= 0.348). Thirteen of 18 H. pylori-positive patients successfully eradicated the infection following treatment with omeprazole 40 mg o.m. and amoxycillin 500 mg t.d.s. for 2 weeks. The mean difference in the gastric emptying time before and H. pylori eradication was 23.9 + 13.2 min (P= 0.556). There was no significant difference in the frequency of specific dyspeptic symptoms as well as the overall mean symptom score between the H. pylori-positive and -negative patients. Gastric emptying was not different between patients with functional dyspepsia and normal controls. Helicobacter pylori infection does not appear to affect gastric emptying in patients with functional dyspepsia.     

Impact of functional dyspepsia on quality of life

Little information on functional status and well-being is available in patients with functional gastrointestinal disease. We aimed to evaluate whether quality of life is poorer in patients with functional dyspepsia. A consecutive sample of 73 patients with functional dyspepsia completed a validated questionnaire prior to endoscopy. Organic disease controls comprised 658 outpatients attending endoscopy. Quality of life was measured using the validated Medical Outcomes Survey (which assessed physical, role, and social functioning; mental health; health perception; and any bodily pain) and the Brief Symptom Inventory (for current anxiety and depression); additional specific gastrointestinal items were also included. A stepwise logistic regression analysis was used to assess the association between diagnostic group and the quality of life measures, adjusting for potential confounders. Patients who reported more interruptions in their daily activities due to abdominal pain and who had fewer limitations of physical functioning were more likely to have functional dyspepsia (vs other disease,P<0.01). Mental health, social functioning, and health perception also tended to be poorer in functional dyspepsia. We conclude that quality of life may be more impaired in patients with functional dyspepsia than in patients with other conditions, who present for upper endoscopy.This work was supported in part by grant AG09440 from the National Institutes of Health.     

功能性消化不良中医辨证论治的临床疗效观察

[目的]观察中医辨证论治治疗功能性消化不良(FD)的临床效果。[方法]采用随机、双盲、多中心、安慰剂对照临床研究,共收集273例FD患者,根据中医辨证论治将其分为湿热壅滞证、脾虚气滞证、肝胃气滞证和肝胃郁热证,每证分为治疗组、对照组,分别予相应中药配方颗粒、中药模拟剂治疗。[结果]基线资料单项症状比较得出:餐后饱胀症状以湿热壅滞证积分最高(P<0.05),上腹痛症状以肝胃郁热组积分最高(P<0.05)。各证型分组疗效比较得出:脾虚气滞证治疗组14d、28d有效率显著高于对照组(63.3%∶41.9%、80.0%∶41.9%);其他各证型治疗组与对照组比较差异无统计学意义。脾虚气滞证、湿热壅滞证、肝胃气滞证、肝胃郁热证中治疗组与对照组28d治疗前后症状积分均显著改善(P<0.05)。安全性评价各证型中治疗组与对照组均无严重不良反应。[结论]中医辨证论治治疗湿热壅滞证、脾虚气滞证、肝胃气滞证和肝胃郁热证功能性消化不良安全、疗效确切。     

功能性消化不良的心理评估及治疗策略

功能性消化不良（FD）病因及机制较为复杂,部分与抑郁、焦虑、躯体化及多种类型心理异常有关。对综合医院 疑诊心理因素相关FD患者可采用HADS（医院焦虑抑郁量表）或PHQ-9（患者健康问卷抑郁量表）和GAD-7（广泛性 焦虑量表）进行初步筛查。也可采用90项症状清单（SCL-90）对存在的多种心理相关的症状进行较全面筛查。汉密 尔顿抑郁量表（HAMD）、汉密尔顿焦虑量表（HAMA）可用于判断抑郁,焦虑存在与否及程度,并可作为治疗前后疗效 的评估。PHQ-15量表可更全面评估躯体化症状和筛查躯体障碍与心理症状的共病情况。生活事件量表（LES）可判 断某事件对患者发病的正性或负性影响,判定患者症状是否与心理障碍有关。心理因素相关FD的治疗可应用促动 力药、抑酸药联合心理干预及中枢作用药物治疗,中医药对该类疾病也有一定的疗效。