Observation on therapeutic efficacy of integrated traditional Chinese and western medicine in treatment of peptic ulcer complicated hemorrhage Mei kejing. Guangzhou the Samd Hospital, Guangdong 510150
Abstract Objective: To explore the therapeutic efficacy of integrated traditional Chinese and western medicine (ITCWM) in treatment of peptic ulcer complicated hemorrhage. Methods; Forty cases of peptic ulcer complicated hemorrhage were divided randomly into treatment group (20 cases) and control group (20 cases). Treatment group was treated with modified “huang tu” decoction(黄土汤),“xiao yao” powder(逍遥散)，“gui pi ”decoction(归脾汤) or “xie xin” decoction(泻心汤) on the basis of western medicine, control group was treated with cemetidine intravenous drip, aluminum hydroxide gelatin(per os) and infusion or blood transfusion to expand the blood volume, Results: Ten cases were improved obviously, 8 cases were improved and total effective rate was 90.0% in treatment group; 4 cases were improved obviously, 10 cases were improved and total effective rate was 70.0% in control group. It was obvious difference between 2 groups(P<0.01). Conclusions: ITCWM treatment has obvious efficacy on peptic ulcer complicated hemorrhage. It was superior to western medicine treatment alone.Key words peptic ulcer complicated hemorrhage integrated traditional Chinese and western medicine therapy
消化性溃疡并出血的病死率约为7%—10%，入院后反复出血的患者病死率高，随年龄的增长、病死率增高[1]。我们对20例消化性溃疡并中度出血者采用中西医结合方法治疗，疗效较好，报告如下。
1 资料与方法
1.1 病例：本组40例均为经临床症状、体征及X线钡餐检查确诊为消化性溃疡并出血患者，均为中度出血，出血量800—1000ml。40例随机分为治疗组和对照组各20例。治疗组男16例，女4例；年龄25—49岁6例，50—60岁14例；十二指肠球部溃疡18例，胃溃疡2例。对照组男15例，女5例；年龄25—49岁8例，50—60岁12例；十二指肠球部溃疡17例，胃溃疡3例。2组患者均除外溃疡位于胃小弯或十二指肠后壁者。
1．2 辨证分型：①胃中积热型：口臭，口渴，上腹胀闷，呕血、血色鲜红或呈咖啡色、血中可夹食物残渣，便秘或柏油样便，舌质红、苔黄腻，脉实。②肝火犯胃型：胸胁胀痛，口苦，烦躁，呕血紫暗或鲜红，球结膜充血，大便黑色，舌质红、苔黄、脉弦数。③脾虚不摄型：神疲懒言，心悸，头晕，食欲减退，便血紫暗或稀溏，而色无华，唇甲淡白，舌质淡、苔白，脉细弱；若神疲怯寒，便血日久，舌质淡、苔白，脉沉细者为脾虚中寒。
1．3 治疗方法：对照组：（1）迅速补充血容量：输新鲜全血，输入失血量的1/2，其余由林格氏液、葡萄糖补足，并注意水、电解质的平衡，酸中毒者及时纠正。每输血1000ml，静注10%葡萄糖酸钙10ml；（2）下胃管：留胃管120小时，观察胃液的颜色和胃液PH值的变化；（3）控制出血：10%葡萄糖250ml加西咪替丁0.3g静滴，每6小时1次；出血停止后改为口服西咪替丁，每日3次，每次200mg，睡前加服1次400mg。氢氧化铝凝胶每日4次，每次口服15ml。
治疗组：在对照组西医治疗的基础上加服中药。胃中积热型2例以泻心汤治之。方药：大黄6g，黄连5g ，黄芩15g。肝火犯胃型2例以丹栀逍遥散治之。方药：柴湖10g，当归12 g，白芍15 g，茯苓12 g，白术10 g，丹皮10 g，栀子3 g，甘草3 g，生姜3片，薄荷1.5 g。脾虚不摄型2例以归脾汤治之。方药：党参10 g，黄芪10 g，白术10 g，茯神10 g，酸枣仁10 g，桂圆肉7g,木香1.5 g ，当归6g，远志3 g，炙甘草3 g，生姜3片，红枣3枚。脾虚中寒型14例以黄土汤治之。方药：灶心土30 g，白术10 g，甘草3 g，干地黄16 g，阿胶13 g（烊化），附子10 g，黄芩10 g。除泻心汤不加大黄外，以上方中均加大典、田七各6 g，白芨10 g，乌贼骨15 g。以上方药剂量为一般用量，临床可按年龄、体质和病情加减。每日服2次，每次1剂，水煎服。