| OBJECTIVE:Extraesophageal manifestations of gastroesophageal reflux disease(GERD)show a diversified trend with the progress of clinical examination equipment.In clinical observation of extraesophageal manifestations of GERD patients,cough occurs frequently.Owing to insufficient understanding of the extraesophageal manifestations of gastroesophageal reflux disease among the general public,they often visit the respiratory department or other departments,and are restricted by the conventional inertial thinking and equipment conditions of basic hospitals.The high rate of clinical misdiagnosis results in the aggravation of patients' economic and mental burden.According to the remarkable effect of acupuncture on gastroesophageal reflux disease in the early stage of the research group,this study evaluates the treatment of gastroesophageal reflux cough by needling the T3-T12 spinous process in the dorsal part of Du Meridian,guided by the theory of meridian diagnosis and the principle of acupuncture and moxibustion treatment based on pain.Effectiveness and the relationship between cough and gastric lesions were analyzed by the degree of tenderness and tenderness threshold.In this study,the patients were randomly divided into two groups:acupuncture group and Western medicine group.The patients in the acupuncture group were treated with acupuncture under the spinous process of T3-T12,while the patients in the western medicine group were treated with oral omeprazole enteric-coated capsule.To compare the therapeutic effect of these two methods on gastroesophageal reflux cough patients,observe the difference of RDQ questionnaire,cough symptom score table and Leicester Cough Questionnaire before and after treatment under T3-T12 spinous process,and analyze the frequency of tenderness and the change rule of tenderness degree and tenderness threshold before and after treatment,so as to objectively evaluate the effect of acupuncture at the dorsal segment of Dumai on gastroesophageal reflux cough.To explore the response point of GERC in the dorsal segment of Du Meridian,to verily the law of back tenderness of GERC patients in the early stage of the research group,and to analyze the relationship between cough and gastric diseases.METHODS:60 GERC patients were randomly selected from the Department of Acupuncture and Moxibustion,Guangji Hospital of Traditional Chinese Medicine,Beijing from January 2016 to July 29,2017.All patients met the inclusion criteria.After obtaining the informed consent of the patients,the patients were divided into acupuncture group and Western medicine group by random number table method,30 cases in each group.In general,11 males and 19 females were in the acupuncture group.The youngest age distribution was 23 years old and the oldest was 70 years old.The average age was 53.9 years old.The shortest duration of GERC was 2 months,the longest was 30 years and the average duration was 9.4 years.In general,there were 7 males and 23 females in the western medicine group.The youngest age was 31 years old,the oldest age was 78 years old,the average age was 51.1 years old.In the course distribution,the shortest duration was 3 months,the longest was 40 years,and the average course was 4.5 years.There was no significant difference in gender,age and course between the two groups(P>0.05).Reflux disease diagnostic questionnaire(RDQ),cough symptom score,Leicester Cough Quality of Life Questionnaire(LCQ),T3-T12 subspinous tenderness and tenderness threshold were measured before treatment in both groups.In the acupuncture group,T3-T12 subspinous process of the dorsal segment of the Du Meridian was selected as the needle point,which was treated once a day,once every other day and three times a week.Patients in western medicine group were given omeprazole enteric-coated capsules orally,twice a day,20 mg once.After 8 weeks of treatment,the Reflux Disease Diagnostic Questionnaire(RDQ)and Cough Symptom Scale,Leicester Cough Quality of Life Questionnaire(LCQ)score,T3-T12 subspinous tenderness and tenderness threshold were re-evaluated.The curative effect evaluation was calculated by nimodipine method:curative effect index=(pre-treatment integral-post-treatment integral)/pre-treatment integral X 100%.Refer to the consensus opinion of TCM diagnosis and treatment of gastroesophageal reflux disease,Spleen and Stomach Disease Branch,Chinese Society of Traditional Chinese Medicine,2017.Criteria for evaluating the efficacy of syndromes:1.Clinical recovery:symptoms disappeared,curative effect index(>95%).2.Significant effect:symptoms disappeared basically,although occasional symptoms disappeared quickly,70%less than curative effect index less than symptoms improvement percentage less than 95%.3.Effective:Symptoms did not disappear,but less than before treatment,efficacy index is greater than or equal to 30%,less than 70%.4 ineffective:symptoms did not disappear,the degree of illness was not less than untreated,even the degree of illness was aggravated,the curative effect index was less than 30%.The cure rate was calculated by the number of cured and effective cases.The results showed that:1.To compare the RDQ scale scores of two groups of GERC patients before and after treatment.The RDQ scale scores of two groups before treatment were compared between groups.The test results showed that there was no significant difference(P>0.05),and the two groups could be compared.By comparing the RDQ score of GERC patients in two groups,it was found that the RDQ score of each group after treatment was lower than that before treatment(P<0.05).After treatment,the RDQ score of acupuncture group was lower than that of Western medicine group,and the difference was statistically significant(P<0.05).2.The effective rate of RDQ scale score of patients in acupuncture group and Western medicine group before and after treatment was compared:6 cases were cured in acupuncture group,3 cases were cured in western medicine group,18 cases were markedly effective in acupuncture group,20 cases were markedly effective in western medicine group,6 cases were effective in acupuncture group,2 cases were effective in western medicine group,0 cases were ineffective in acupuncture group and 5 cases were ineffective in western medicine group.There was no deterioration and recovery in both groups.The dominant rates were 77%and 80%respectively.3.Compare the cough symptom score between the two groups before and after GERC treatment.There is no significant difference in cough symptom score between the two groups before and after treatment(P>0.05),and the two groups can be compared.Comparing the day score of cough symptom score scale between the two groups,it was found that the score of each group after treatment was lower than that before treatment(P<0.05).Comparing the day score of cough after treatment between the two groups,the day score of cough symptom score scale in the acupuncture group was lower than that in the western medicine group after treatment,and the difference was statistically significant(P<0.05).4.Comparing cough symptom score at night before and after GERC treatment between the two groups:There was no significant difference in cough symptom score before and after treatment between the two groups(P>0.05),and the two groups could be compared.Comparing the night score of cough symptom score scale between the two groups,it was found that the score of each group after treatment was lower than that before treatment(P<0.05).Compared with the night score after treatment,the night score of the acupuncture group was lower than that of the western medicine group(P<0.05).5.Comparing the effective rate of cough symptom integral before and after treatment in two groups:18 cases in the acupuncture group,13 cases in the western medicine group,11 cases in the acupuncture group,7 cases in the western medicine group,1 case in the acupuncture group,4 cases in the western medicine group,0 cases in the acupuncture group and 6 cases in the western medicine group,there was no deterioration in both groups,and the acupuncture group recovered.The marked rate was 97%,and the marked rate was 67%in the western medicine group.6.Comparing the scores of Leicester Cough Quality of Life Questionnaire between the two groups before and after treatment:before treatment,the physiological,psychological and social scoring of LCQ in the western medicine group and the acupuncture group were compared between the two groups,showing no significant difference(P>0.05),which could be compared between the two groups.After treatment,the scores of each area in each group were compared before and after treatment,and it was found that the scores of each area after treatment were higher than those before treatment(P<0.05).After treatment,the scores of the acupuncture group were significantly higher than those of the western medicine group(P<0.05).7.Comparing the frequencies of grade ? and ? tenderness under each spinous process of T3-T12 in 60 GERC patients:the frequencies of subspinous tenderness under each spinous process were 20%from high to low,19%under T8 spinous process,14%under T5 spinous process,13%under T6 spinous process,9%under T9 spinous process,7%under T10 spinous process,and 7%under T4 spinous process.The frequencies were 7%,4%under T11 spinous process and 3%under T3 spinous process.8.Comparing the degree of tenderness before and after treatment in GERC patients of the two groups:counting the tenderness levels under each spinous process of T3-T12 patients of the two groups,using the C2 test of grade data,comparing before and after treatment in the two groups,the degree of tenderness under the spinous process of T3-T12 patients in the acupuncture group was less than that before treatment(P<0.05),and the degree of tenderness under the spinous process of T3,T4,T5,T6,T7 and T10 patients in the western medicine group was more treated after treatment(P<0.05).The degree of tenderness in the acupuncture group was better than that in the western medicine group(P<0.05)in terms of T4,T5,T6 and T7 spinous processes.9.Comparisons of tenderness thresholds before and after treatment in two groups of GERC patients:There was no significant difference between the two groups of GERC patients before and after treatment(P>0.05),and there was comparability between the two groups.After treatment,the threshold of subspinous tenderness of T3-T12 in the acupuncture group was higher than that before treatment,and the difference was statistically significant(P<0.05).After treatment,the threshold of tenderness in western medicine group was higher than that before treatment under T3,T4,T5 and T7 spinous processes,the difference was statistically significant(P<0.05).After treatment,the threshold of tenderness in acupuncture group was higher than that in western medicine group under T5 and T7 spinous processes,and the difference was statistically significant(P<0.05).Conclusion:1.Acupuncture at the dorsal segment of Du Meridian T3-T12 subspinous process has a better effect on GERC than western medicine group PPI(omeprazole enteric-coated capsule).Acupuncture at the dorsal segment of Du Meridian T3-T12 has a stronger improvement in the overall impact of cough on the quality of life of patients than western medicine group PPI(omeprazole enteric-coated capsule).That is to say,the improvement of the physiological,psychological and social impact of acupuncture on cough is stronger than PPI(Omeprazole enteric-coated capsule).Meprazole enteric-coated capsules).2.After treatment,the degree of tenderness and threshold of tenderness under T5 and T7 spinous processes in the acupuncture group were better than those in the western medicine group.The tenderness of T5 and T7 Dumai can be used to judge the changes of GERC. |
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