功能性消化不良中医诊疗规范(草案)

20 0 1年 ,中华中医药学会内科脾胃病专业委员会第 1 3次会议通过了“功能性消化不良 ( FD)中医诊治规范 (草案 )。全文如下。1　概念持续或反复发作的上腹疼痛或不适等消化不良症状 ,经生化、内镜和影像等检查除外器质性疾病者即为 FD。2　诊断标准2 .1　诊断标准 :必须符合以下标准 :1在过去 1年内至少持续 1个月或间断发作累计达 3个月的上腹正中疼痛或不适 (如上腹胀、早饱、嗳气、恶心等 ) ;2上腹痛和不适与排便无关 ,不能在排便后缓解 ,亦未见有粪便次数和性状的改变 ;3生化、内镜、影像等理化检查排除了可解释上述症状的器质性病变…     

泰胃美治疗功能性消化不良疗效观察

目的泰胃美治疗功能性消化不良疗效观察.方法将门诊及住院的60例功能性消化不良病人随机分成2个组,泰胃美组(治疗组)40例,达吉组(对照组)20例进行对照治疗,4w为一个疗程.结果泰胃美组总有效率为89.1%,对照组为64.7%,治疗组疗效优于对照组.结论泰胃美治疗功能性消化不良疗效显著.     

红霉素治疗功能性消化不良的疗效观察

近年发现，红霉素(Erythromyein，EM)有促胃肠动力作用。为观察这一传统抗生素在治疗功能性消化不良(Functional dyspepsia，FD)的临床疗效，我们用小剂量红霉素与吗丁啉对照治疗FD136例，报道如下。     

中医辨证治疗功能性消化不良的临床研究

目的应用中医理论探讨功能性消化不良(functionaldyspepsia,FD)的发病机制和治疗方法.方法 FD患者138例,年龄14岁～78岁;有典型的消化不良症状,符合FD诊断标准:即有持续或反复发作上腹不适或疼痛、餐后饱胀、腹部胀气、嗳气、恶心、反酸等症状;病程持续或累计超过4wk,随访2a～4a无器质性病变发生,即2 a～4 a以来内镜检查正常或排除糜烂、溃疡及肿瘤等器质性病变,实验室、B超及X线等检查排除肝、胆、脾等器质性病变.全部病例随机分为中医治疗组98例,其中男40例,女58例,年龄16岁～72岁,平均年龄42岁±14岁;西药治疗组(对照组)40例,其中男14例,女26例,年龄14岁～78岁,平均年龄40岁±14岁.经统计学处理,两组差异无显著性,具有可比性(P>0.05).中医治疗组采用中医辨证方法进行治疗,98例FD根据中医辨证分为肝胃不和型、脾胃虚弱型、肝胃郁热型、胃阴不足型、气滞血瘀型,疗程结束后,对患者的临床症状改善情况进行比较分析.结果治疗组98例经中医辨证治疗4 wk后,痊愈24例,显效44例,有效21例,无效9例,总有效率91%;对照组40例应用西药进行治疗4 wk后,痊愈7例,显效21例,有效7例,总有效率87.5%,两组临床疗效比较差异无显著性(P>0.05,x2=1.22).结论中医对功能性消化不良的理论阐述具有较好临床指导意义,中医中药对功能性消化不良的治疗具有较好疗效.     

赛乐特治疗功能性消化不良30例临床观察

目的 探讨抗抑郁药物赛乐特治疗功能性消化不良（FD）的临床效果。方法 将60例功能性消化不良病人随机分成两组，抗抑郁组给予赛乐特20mg／d；常规组根据个体化治疗原则，应用消化系统药物。两组均配合支持性心理治疗。治疗时间均为8周。入组者治疗前、后进行焦虑自评量表（SaS）和抑郁自评量表（SDS）测评及FD症状评分。结果 FD病人的SAS和SDS评分与常规组之间存在显著差异（P〈0．01）；治疗8周后抗抑郁组SAS和SDS评分显著低于常规组（P〈0．01），FD评分也明显低于常规组（P〈0．05）。结论 FD病人普遍存在情绪问题，抗抑郁药物适合治疗有抑郁情绪的FD病人，不仅改善情绪状态而且明显改善FD症状，疗效显著。     

功能性消化不良中医治疗进展

功能性消化不良（简称FD）临床常见，其临床亚型已从运动障碍型、反流样型、溃疡样型、吞气症、不定型5型，简化为运动障碍型、溃疡样型及非特异性3型［“。近年对FD的研究．主要集中在运动障碍型。现将其中医治疗进展综述如下。1辨证分型及论治已报告的FD辨证分型有肝郁犯胃（肝胃不和）、肝胃郁热、脾虚气滞（中虚气滞）、湿阻、阴虚、血瘀、脾胃虚弱、肾虚、肝郁脾虚、心脾两虚、寒热错杂等。有人提出，FD辨证分为脾胃虚弱证、气滞血瘀证、食积证、寒热错杂证、混合证，治则为通补兼施、寒热并用，使脾气升运复常，胃气和降，肝气调…     

帕罗西汀治疗功能性消化不良42例临床观察

目的　探讨帕罗西汀治疗功能性消化不良 (FD)的临床疗效。方法　将门诊 84人患FD的患者随机分成治疗组和对照组 ,均予以西沙必利治疗。治疗组加用帕罗西汀口服治疗。结果　治疗 4周后统计结果 ,治疗组显效 43 % ,有效 40 % ,总有效率 83 % ,治疗组与对照组的疗效有显著性差异 ,P <0 0 1。结论　帕罗西汀与西沙必利联合使用可显著提高治疗功能性消化不良的疗效 ,值得推广     

联用帕罗西汀治疗功能性消化不良36例疗效观察

目的观察联用帕罗西汀治疗功能性消化不良（FD）的临床疗效。方法将门诊72例FD患者随机分成治疗组36例和对照组36例,对照组根据个体化原则给予促动力药和（或）心受体阻滞剂或质子泵抑制剂,治疗组在上述基础上加用帕罗西汀口服治疗。结果治疗组显效26例,有效12例,总有效率为91．7％。对照组显效12例,有效14例,总有效率为72．2％。治疗组与对照组比较疗效差异有统计学意义（P〈0．05）。结论联用帕罗西汀可显著提高治疗功能性消化不良的疗效,不良反应少。值得临床推广。     

抗抑郁药治疗功能性消化不良的疗效分析

目的观察抗抑郁药物联用质子泵抑制剂(PPI)和胃肠动力药治疗功能性消化不良的疗效和安全性。方法选择380例功能性消化不良患者,随机分成治疗组和对照组,对照组170例应用常规内科治疗(质子泵抑制剂(PPI)和胃肠动力药),治疗组210例给予常规内科治疗+盐酸多塞平联合治疗,疗程为6周。结果治疗6周后,治疗组的有效率为89.2%,对照组的有效率为43.6%,两组比较,差异有统计学意义(P0.05)。结论联合抗抑郁药治疗功能性消化不良疗效显著,且副作用轻微,值得临床推广。     

功能性消化不良患者胃排空的不均匀性

目的：观察功能性消化不良（FD）患者胃排空的情况。方法：采用核素胃排空试验，连续动态观察16例正常人及70例FD患者胃排空情况。8例FD患者在胃排空试验同时作胃窦十二指肠压力波记录．结果：证实42．9％FD患者胃排空延迟、各时间段胃排空率变异系数为120．7±147．1％，明显高于正常组的73．4±29．7％．结论：FD患者，尤其胃排空延迟者，排空有快慢不均的异常情况。     

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.     

舒肝解郁胶囊治疗伴轻中度抑郁症的功能性消化不良的临床效果观察

[目的]观察舒肝解郁胶囊治疗伴轻中度抑郁症状的功能性消化不良(functional dyspepsia,FD)患者的临床疗效及不良反应。[方法]将245例伴轻中度抑郁症的FD患者随机分为观察组与对照组,采用随机双盲对照研究,2组均服用多潘立酮片、雷贝拉唑片,观察组135例加服舒肝解郁胶囊,对照组110例加服用安慰剂,疗程均为4周。比较2组治疗前后临床疗效、胃肠道症状评定量表(gastrointestinal symptom rating scale,GSRS)积分、医院焦虑抑郁量表(hospital anxiety depression scale,HADS)抑郁症状评分及不良反应。[结果]治疗4周后,观察组显效24例(17.8%),有效81例(60.0%),无效30例(22.2%),总有效率为77.8%;对照组显效4例(3.6%),有效35例(31.8%),无效71例(64.5%),总有效率为35.5%;观察组总有效率显著高于对照组(P0.05)。观察组GSRS积分及HADS抑郁症状评分均显著低于对照组(P0.05)。[结论]舒肝解郁胶囊联合质子泵抑制剂及促胃动力药治疗伴轻中度抑郁症状的FD疗效显著,安全可靠。     

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。     

Drug treatment of functional dyspepsia

Symptomatic improvement of patients with functional dyspepsia after drug therapy is often incomplete and obtained in not more than 60% of patients. This is likely because functional dyspepsia is a heterogeneous disease. Although great advance has been achieved with the consensus definitions of the Rome I and II criteria, there are still some aspects about the definition of functional dyspepsia that require clarification. The Rome criteria explicitly recognise that epigastric pain or discomfort must be the predominant complaint in patients labelled as suffering from functional dyspepsia. However, this strict definition can create problems in the daily primary care clinical practice, where the patient with functional dyspepsia presents with multiple symptoms. Before starting drug therapy it is recommended to provide the patient with an explanation of the disease process and reassurance. A thorough physical examination and judicious use of laboratory data and endoscopy are also indicated. In general, the approach to treat patients with functional dyspepsia based on their main symptom is practical and effective. Generally, patients should be treated with acid suppressive therapy using proton-pump inhibitors if the predominant symptoms are epigastric pain or gastroesophageal reflux symptoms. Although the role of Helicobacter pylori (H pylori) in functional dyspepsia continues to be a matter of debate, recent data indicate that there is modest but clear benefit of eradication of H pylori in patients with functional dyspepsia. In addition, H pylori is a gastric carcinogen and if found it should be eliminated. Although there are no specific diets for patients with FD, it may be helpful to guide the patients on healthy exercise and eating habits.     

多潘立酮对功能性消化不良患者阻抗式胃动力的影响

目的观察多潘立酮对功能性消化不良(FD)餐后不适综合征(PDS组)和上腹疼痛综合征(EPS组)临床症状和胃动力的影响。方法对2008年10月至2009年4月重庆医科大学附属第一医院消化内科门诊57例FD患者行症状分型和评分、检测餐后胃电和胃阻抗,多潘立酮10mg每日3次治疗2周和4周后,再次评分并复查胃动力。结果治疗2周后,PDS组和EPS组餐后饱胀不适、早饱感、上腹痛、上腹烧灼感症状较治疗前显著改善(P0.05);4周后除PDS组上腹烧灼感和EPS组早饱感、上腹痛外余症状均进一步改善(P0.05)。治疗前和治疗后2周及4周PDS组和EPS组的胃电中频百分比差异均有统计学意义(P0.05)。PDS组治疗2周后胃阻抗中频百分比较治疗前显著提高,4周后进一步提高(P0.05);治疗4周后,EPS组胃阻抗中频百分比显著高于治疗前和治疗后2周(P0.05)。结论多潘立酮治疗4周后FD患者的临床症状、胃电和胃阻抗显著改善,明显优于治疗后2周。     

中西医结合治疗功能性消化不良的临床研究

目的探索中西医结合治疗功能性消化不良(Functional Dyspepsia,FD)疗效机理,评估中西医结合治疗FD疗效。方法通过多中心对798例FD患者,随机分成3组,分别用吗丁啉(A组),中药复方(B组)及吗丁啉加中药复方(C组)对其进行治疗,同时检测胃排空率、胃半排空时间、胃电参数、血浆胃动素及胃泌素水平,并观察各组疗效情况。结果 A组治愈46例,显效89例,进步49例,治愈率20.35％,总有效率81.42％;B组治愈58例,显效71例,进步50例,治愈率27.5％,总有效率84.83％;C组治愈187例,显效122例,进步40例,治愈率51.8％,总有效率96.68％,C组治愈率及总有效率都明显高于A、B组,具有统计学意义,胃排空率、胃半排空时间、胃电活动及胃电参数均较治疗前明显改善(P<0.05),胃动素水平较治疗前明显提高(P<0.05),而血浆胃泌素水平治疗前后无明显变化(P>0.05)结论中西医结合组治疗FD无论是总有效率还是治愈率均明显高于单一中约组或吗丁啉组,为日前治疗FD较为理想的方法,其机制主要是通过各个环节改善胃电活动,增加胃动力,从而达到治疗FD目的。     

Role of autonomic dysfunction in patients with functional dyspepsia

BACKGROUND: The role of autonomic dysfunction in patients with functional dyspepsia is not completely understood. AIMS: 1. to prospectively assess abnormalities of autonomic function in patients with functional dyspepsia, 2. to assess whether autonomic dysfunction in these patients is associated with a. visceral hypersensitivity or b. delayed gastric emptying or c. severity of dyspeptic symptoms. PATIENTS: A series of 28 patients with functional dyspepsia and 14 healthy volunteers without gastrointestinal symptoms were studied. METHODS: All patients and controls were submitted to a battery of five standard cardiovascular autonomic reflex tests, dyspeptic questionnaire, gastric barostat tests and gastric emptying tests. RESULTS: 1. Autonomic function tests showed that both sympathetic and parasympathetic scores of dyspeptic patients were significantly higher than in controls; 2. visceral hypersensitivity was confirmed in dyspeptics in response to proximal gastric distension, demonstrating lower pain threshold; 3. delayed gastric emptying occurred more frequently in patients with functional dyspepsia than in controls; 4. epigastric pain and epigastric burning were significantly more prevalent in patients with definite evidence of autonomic dysfunction; 5. No significant association was found between presence of autonomic dysfunction and presence of visceral hypersensitivity or presence of delayed gastric emptying in patients with functional dyspepsia. CONCLUSIONS: We concluded that a possible role of autonomic dysfunction in eliciting dyspeptic symptoms could not be determined from alterations in visceral hypersensitivity or delayed gastric emptying. Autonomic dysfunction might not be the major explanation for symptoms associated with functional dyspepsia.     

功能性消化不良的中医治疗概况

功能性消化不良(functional dyspepsia,FD)是常见的功能性胃肠病之一,临床表现包括上腹疼痛、早饱、餐后不适、上腹烧灼感等。目前FD的诊断主要以功能性胃肠病罗马Ⅳ标准为依据,分为餐后不适综合征(postprandial discomfort syndrome,PDS),上腹痛综合征(epigastric pain syndrome,EPS)以及二者的重叠3个亚型[1]。有研究显示,全球FD的发病率为10%~30%[2]。     

西甲硅油联合莫沙必利治疗功能性消化不良

目的观察西甲硅油联合莫沙必利治疗功能性消化不良的临床疗效。方法将116例功能性消化不良病人，采用随机对照试验方法，随机分为2组。治疗组（西甲硅油联合莫沙必利）口服西甲硅油，每次80mg，每日3次；联合莫沙必利，每次5mg，每日3次。对照组口服莫沙必利，每次5mg，每日3次。2组疗程均为4周。评价症状改善及不良反应。结果西甲硅油联合莫沙必利治疗组总有效率为89．1％，明显优于对照组（75．9％），有显著性差异（P〈0．05）；其中特别对餐后饱胀不适的疗效与对照组比较，有显著性差异（P〈0．01）。治疗后均未发现明显不良反应。结论西甲硅油与莫沙必利联合应用能有效缓解功能性消化不良的症状，疗效明显、安全可靠。