穴位埋线治疗绝经后女性复发性泌尿系感染临床疗效观察

发布时间：2018-03-07 00:13

本文选题：绝经后女性　切入点：复发性尿路感染　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究穴位埋线结合抗菌药治疗绝经后女性复发性泌尿系感染的临床疗效。方法:所有病例均为2015年10月至2016年10月,来自北京中医药大学第三附属医院泌尿科门诊中,符合调查病例标准的患者。根据本研究的纳入标准和排除标准进行严格筛选,将最终纳入的60例绝经后复发性泌尿系感染患者随机等分为治疗组和对照组。对照组根据药敏试验结果选择相对应的敏感抗菌药,若尿中段培养阴性者,予盐酸左氧氟沙星胶囊治疗,治疗组在抗菌药的基础上加用穴位埋线疗法,疗程均为6周,治疗结束后随访6个月观察复发率。分别收集治疗组和对照组在干预前后的中医症状积分,中段尿培养及尿白细胞检查,并监测不良反应,分析并统计两组临床疗效和安全性。结果:1.疗效结果:治疗组30例患者,痊愈为12例,基本痊愈为10例,有效为5例,无效为2例,脱落一例,治愈率为75.9%,总有效率为93.1%;对照组30例患者,痊愈为8例,基本痊愈为9例,有效为7例,无效为5例,脱落一例,治愈率为58.6%,总有效率82.8%,治疗组综合疗效优于对照组,两组比较差异有统计学意义(P0.05)。2.临床症状评定:治疗组和对照组在治疗后临床常见症状评分,及症状总积分与治疗前相比,均有所降低,两组比较差异有统计学意义(P0.05)。治疗后,患者反馈,治疗组症状缓解较对照组明显,但临床常见症状积分的比较无统计学差异(P=0.229,0.05);3.客观指标评定:两组患者的尿常规检测中,治疗后尿白细胞数均较治疗前明显减少,差异有统计学意义(P0.01);分别对比两组治疗前后尿白细胞计数变化,差异无统计学意义(P=0.957,0.05);分别对比两组治疗前后尿白细胞分级变化,有显著性差异,治疗均有效,P均0.01,但是治疗后组间比较,两组疗效差异不显著。4.比较治疗组及对照组患者尿培养结果,分析其细菌种类分布得出结论:治疗组患者感染大肠埃希菌为72.4%,粪肠球菌10.3%,肺炎克雷伯菌6.9%,其他10.3%;对照组患者感染大肠埃希菌为65.5%,粪肠球菌13.8%,肺炎克雷伯菌6.9%,其他13.8%。可见复发性尿路感染中,大肠埃希菌仍占主要部分。5.复发率比较:对参与本研究的患者在疗程结束后,进行6个月随访,试验组6个月内复发率为10.3%,明显低于对照组的24.1%,两组比较差异有统计学意义(P0.01)。结论:穴位埋线联合抗菌药治疗绝经后女性复发性泌尿系感染在改善症状上优于单独使用抗菌药,能有效控制本病远期复发,而且操作简便,疗程较合理,费用低廉,经济效益明显,临床上值得推广。
[Abstract]:Objective: to study the clinical efficacy of acupoint catgut embedding combined with antimicrobial agents in the treatment of recurrent urinary tract infection in postmenopausal women. Methods: from October 2015 to October 2016, all the patients were from the outpatient department of urology, the third affiliated Hospital of Beijing University of traditional Chinese Medicine. According to the inclusion criteria and exclusion criteria of this study, Sixty patients with recurrent urinary tract infection after menopause were randomly divided into treatment group and control group. The control group selected the corresponding sensitive antibiotics according to the results of drug sensitivity test. Levofloxacin hydrochloride capsule was given. The treatment group was treated with acupoint catgut embedding therapy on the basis of antimicrobial agents. The course of treatment was 6 weeks. After 6 months of follow-up, the recurrence rate was observed. The scores of TCM symptoms, urine culture and urine leukocyte examination were collected before and after intervention in the treatment group and the control group, and the adverse reactions were monitored. Results: in the treatment group, 12 cases were cured, 10 cases were basically cured, 5 cases were effective, 2 cases were ineffective, and 1 case was shed. The cure rate was 75.9 and the total effective rate was 93.1. In the control group, 8 cases were cured, 9 cases were basically cured, 7 cases were effective, 5 cases were ineffective, 1 case was lost, the cure rate was 58.6%, and the total effective rate was 82.8%. The comprehensive curative effect of the treatment group was better than that of the control group. Clinical symptom evaluation: the scores of common symptoms and the total score of symptoms in the treatment group and the control group were decreased after treatment compared with those before treatment, and the difference between the two groups was statistically significant (P 0.05). The symptom relief in the treatment group was more obvious than that in the control group, but there was no statistical difference in the scores of common symptoms in the treatment group. Objective index evaluation: in the routine urine examination of the two groups, the number of urinary white blood cells after treatment was significantly reduced compared with that before treatment. The difference was statistically significant (P 0.01), the change of urinary white blood cell count was not statistically significant before and after treatment, and there was significant difference between the two groups before and after treatment. There was no significant difference between the two groups after treatment. 4. The results of urine culture in the treatment group and the control group were compared. It is concluded that in the treatment group, the infection rate of Escherichia coli was 72.4, Enterococcus faecalis 10.3am, Klebsiella pneumoniae 6.9. and other 10.3.The control group was infected with Escherichia coli, Enterococcus faecalis 13.8am, Klebsiella pneumoniae 6.9b. He was 13.8. in the case of recurrent urinary tract infections, Escherichia coli still accounted for the main part of .5.Compared with the recurrence rate, the patients who participated in this study were followed up for 6 months after the end of the course of treatment. The relapse rate in the test group was 10.3 months, which was significantly lower than that in the control group (24.1%). The difference between the two groups was statistically significant (P 0.01). Conclusion: the treatment of recurrent urinary tract infection in postmenopausal women with acupoint catgut implantation combined with antimicrobial agents is better than using antibacterial drugs alone in improving the symptoms of recurrent urinary tract infection in postmenopausal women. It can effectively control the long term recurrence of the disease, and it is easy to operate, reasonable course of treatment, low cost, obvious economic benefit, and is worth popularizing clinically.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.9

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