加味四妙丸基础上应用“青敷”治疗CKD痛风急性发作湿热痹络证的疗效观察

发布时间：2018-01-03 21:39

本文关键词：加味四妙丸基础上应用“青敷”治疗CKD痛风急性发作湿热痹络证的疗效观察　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:在西医及加味四妙丸基础上,观察"青敷"治疗CKD痛风急性发作湿热痹络证的疗效,探讨外治法在CKD痛风急性发作中的治疗作用,为内科临床应用中医特色治疗提供依据。方法:收集2015年01月至2016年12月江苏省中医院住院患者共53例,符合CKD及急性痛风性关节炎湿热痹络证的诊断标准,治疗组32例,对照组21例。在低嘌呤饮食、碱化尿液、延缓肾功能进展等西医基础治疗上,治疗组予内服加味四妙丸联合外敷青敷方,对照组予内服加味四妙丸方。以1周期为1个观察周期,观察3～4个周期,比较两组治疗前后关节疼痛及功能评分(VAS视觉疼痛评分、关节肿痛指数、关节功能评分)、炎症指标(hsCRP、WBC、N)及肾功能(BUN、Scr、UA)等指标的变化及不良反应。结果:①治疗组总有效率为96.86%,对照组总有效率为90.48%,差异无统计学意义(P0.05)。②治疗组病情完全缓解最长16天,最短4天,平均(7.81 ±3.27)天;对照组病情完全缓解最长27天,最短3天,平均(11.33±6.04)天,治疗组所需疗程短于对照组差异有统计学意义(P0.05),提示治疗组可缩短疗程。③两组在改善VAS视觉疼痛评分、关节肿痛指数、关节功能评分、肿痛关节周径、肿痛关节皮温方面,组内比较差异有显著统计学意义(P0.01);组间治疗前后差值比较,治疗组优于对照组差异有统计学意义(P0.05),提示治疗组可较好地缓解CKD痛风红肿热痛的临床症状。④两组在改善炎症指标(hsCRP、WBC、N)、肾功能(BUN、Scr、UA)方面,组内比较hsCRP、WBC、N、BUN差异有统计学意义(P0.05);组间治疗前后差值比较无统计学意义(P0.05),提示两组在改善炎症反应及延缓肾功能进展方面疗效相当。⑤两组治疗期间均未见不良反应发生,两组肝功能指标较治疗前无变化差异无统计学意义(P0.05);两组血小板较治疗前升高,组内比较差异有统计学意义(P0.05)。结论:在西医及加味四妙丸基础上应用"青敷"能有较好地缓解CKD痛风急性发作湿热痹络证的临床症状、缩短疗程,并且无不良反应。
[Abstract]:Objective: on the basis of western medicine and modified Simiao pills, to observe the curative effect of "Qingfu" in treating acute attack of CKD gout with damp-heat arthralgia syndrome, and to explore the therapeutic effect of external treatment method in acute attack of CKD gout. Methods: from January 2015 to December 2016, 53 inpatients in Jiangsu traditional Chinese Medicine Hospital were collected. According to the diagnostic criteria of CKD and acute gouty arthritis, 32 cases in treatment group and 21 cases in control group were treated with western medicine on low purine diet, alkalized urine and delayed progression of renal function. The treatment group was treated with modified Simiao Pill combined with external application of Qingfu recipe, while the control group was treated with Jiawei Simiao Pill recipe. The observation period was 1 cycle, and the observation period was 3 ~ 4 cycles. The scores of joint pain and function before and after treatment were compared. VAS visual pain score, joint swelling and pain index, joint function score, inflammation index and renal function bun were compared between the two groups before and after treatment. Results the total effective rate of the treatment group was 96.86 and the total effective rate of the control group was 90.48%. There was no significant difference in the treatment group (P0.052.The longest 16 days, the shortest 4 days, mean 7.81 卤3.27) days; In the control group, the longest 27 days, the shortest 3 days, the average of 11.33 卤6.04 days, the treatment group required a shorter course of treatment than the control group (P 0.05). It was suggested that the treatment group could shorten the course of treatment in improving VAS visual pain score, joint swelling and pain index, joint function score, peripheral diameter of swelling and pain joint, skin temperature of swelling and pain joint. The difference between the two groups was statistically significant (P 0.01). The difference between groups before and after treatment, the treatment group is better than the control group, the difference is statistically significant (P 0.05). It is suggested that the treatment group can relieve the clinical symptoms of CKD gout redness and swelling and heat pain. 4 both groups can improve the inflammation index of hsCRPG-WBCU and renal function. The difference of hsCRP- WBCnbun was statistically significant (P0. 05). There was no significant difference between the two groups before and after treatment, suggesting that the two groups in improving inflammatory reaction and delaying the progress of renal function, there was no adverse reaction occurred in both groups during the treatment period. 5. There was no significant difference in liver function between the two groups before treatment (P 0.05). Platelet levels in both groups were higher than those before treatment. Conclusion: on the basis of western medicine and modified Simiao pills, the application of "Qingfu" can relieve the clinical symptoms of acute attack of CKD gout with dampness-heat Bi collaterals. The course of treatment was shortened without adverse reaction.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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