四畔疗法对臁疮创面愈合的影响

发布时间：2018-04-19 17:48

本文选题：臁疮 + 静脉性溃疡　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的:1.从脉络湿瘀病因病机着手,研究臁疮发病的主要病机,区别临床中以热盛肉腐作为主要病机特点的传统认识,区分静脉性溃疡和动脉性溃疡的不同之处;2.将淤积性皮炎洗剂联合压迫缠缚疗法运用于治疗臁疮患者,观察用药前后溃疡面变化情况,研究该疗法治疗臁疮的有效性和安全性,探索中医外治治疗臁疮的关键技术;3.初步探索臁疮四畔疗法局部熏洗及压迫缠缚疗法的疗效和操作规范。研究方法:本研究采用随机对照的研究方法,纳入50例患者,随机分为2组,每组各25例,治疗组给予四畔熏洗药物"淤积性皮炎洗剂"(桃仁、杏仁、郁李仁、薏苡仁、大黄、黄柏、黄芩、黄连、桑白皮、茯苓皮、白鲜皮、大腹皮)熏洗患处,然后以臁疮创面为中心,湿敷洗剂纱布后,用8cm宽低弹力绷带加压包扎,每日一次;对照组给予常规清洁换药,每日一次,总疗程为8周。不足8周疮面愈合者随即结束治疗。试验期间定期观察并记录创面面积,创面色泽、新生肉芽组织、创面渗液量、疼痛程度变化等情况,并记录治疗前后小腿交通支静脉反流程度变化情况。研究结果:1.治疗组与对照组创面愈合率比较:治疗组愈合9例,显效6例,有效8例,无效2例,总有效率为92%;对照组愈合3例,显效5例,有效14,无效6例,总有效率为76%,应用SPASS20.0统计学软件,经检验P0.05,有统计学意义,淤积性皮炎洗剂联合压迫缠缚疗法治疗臁疮组临床疗效优于常规换药对照组。2.不同时间疮面积分情况:治疗前、第2周、第4周、第8周治疗组创面积分分别为:18.84±3.64,14.00±5.62,9.40±6.57,6.24±6.35;对照组积分分别为:20.04±3.90,17.04±5.09,13.24±5.71,11.12±5.29。经检验治疗前及治疗后第 2周创面积分无显著差异,无统计学意义(P0.05),治疗第4周,治疗组与对照组创面积分均减小,但治疗组优于对照组,经检验有统计学意义(P0.05);治疗第8周,两组创面积分继续减小,但对照组变化较小,治疗组积分继续减小,仍优于对照组,经检验有统计学意义(P0.05)。3.不同时间段疼痛计分:经检验两组患者在治疗前、第2周、第4周疼痛计分差异不明显,经检验无统计学意义(P0.05);治疗第8周两组患者疼痛积分明显缩小,但治疗组优于对照组,经检验有统计学意义(P0.05)。4.治疗前后小腿交通静脉反流情况:治疗前治疗组患肢交通静脉反流值为2.28士0.458,对照组为2.24±0.453,两组差异较小,经检验无统计学意义(P0.05);治疗8周后治疗组患肢交通静脉反流值2.12±0.665,较治疗前有所下降,但是不明显。对照组治疗前后交通支静脉反流值无变化,说明常规换药对交通支静脉壁反流无改善作用。但两组数据通过非参数经验,无统计学意义(P0.05)。
[Abstract]:Objective: 1.Based on the etiology and pathogenesis of choroid dampness and stasis, the main pathogenesis of ecthyma was studied. The traditional understanding of heat and meat rot as the main pathogenesis of ecthyma and the difference between venous ulcer and arterial ulcer were distinguished. 2.The combined treatment of accretion dermatitis lotion and compression and binding therapy was applied to the treatment of ecthyma patients. The changes of ulcer surface before and after treatment were observed, the efficacy and safety of the treatment were studied, and the key technique of ecthyma treatment was explored.To explore the curative effect and operation standard of ecthyma four-side therapy for local fumigation and compression and binding therapy.Methods: in this study, 50 patients were randomly divided into two groups (25 cases in each group). The treatment group was treated with "silting dermatitis lotion" (peach kernel, almond, tulip kernel, Coix seed, rhubarb), the treatment group was treated with "silting dermatitis lotion" (peach kernel, almond, Yu Li ren, Coix seed, rhubarb).Radix Phellodendri, Radix Scutellariae, Coptis chinensis, Cortex Mori, Poria cocos skin, White fresh skin, large abdominal skin) fumigation and washing the affected area, then take the wound of ecthyma as the center, wet apply the gauze of lotion agent, use 8cm wide and low elastic bandage to press the bandage, once a day;The control group was given routine cleaning and dressing change once a day, the total course of treatment was 8 weeks.Less than 8 weeks after the healing of the sores, treatment ended immediately.The changes of wound area, wound color, new granulation tissue, wound effusion and pain degree were observed and recorded regularly during the experiment. The changes of the degree of reflux of the shank communicating branch vein before and after treatment were recorded.The result of the study was: 1.There were 9 cases of healing, 6 cases of remarkable effect, 8 cases of effective and 2 cases of ineffective in the treatment group, and the total effective rate was 922% in the treatment group, 3 cases in the control group, 5 cases in the marked effect, 14 cases in the treatment group, 6 cases in the failure.The total effective rate was 76g. The clinical curative effect of ecthyma group was better than that of routine dressing change control group (P 0.05) by using SPASS20.0 statistical software and test (P0.05), and there was statistical significance in the treatment of ecthyma in the treatment of ecthyma ulcer treated with silt dermatitis lotion combined with compression and binding therapy.Before treatment, at the 2nd week, the 4th week, the 8th week, the wound score of the treatment group was respectively: 1 18.84 卤3.64g 14.00 卤5.62U 9.40 卤6.57N 6.24 卤6.35, and the control group the score of the control group was 20.04 卤3.90g 17.04 卤5.0913.24 卤5.71U 11.12 卤5.29 respectively.There was no significant difference in wound score between the treatment group and the control group before and after treatment. There was no significant difference (P 0.05). At the 4th week of treatment, the wound score of the treatment group and the control group decreased, but that of the treatment group was better than that of the control group.At the 8th week of treatment, the wound score of the two groups continued to decrease, but the change of the control group was smaller, and the score of the treatment group was still lower than that of the control group, which was significantly better than that of the control group.Pain score in different time period: there was no significant difference in pain score between the two groups before treatment, at the 2nd week and the 4th week, but there was no significant difference in pain score between the two groups after the test, and the pain score of the two groups decreased significantly at the 8th week of treatment, but the treatment group was superior to the control group.The results showed that there was statistical significance (P 0.05). 4.Before and after treatment, the reflux of the shank communicating vein was 2.28 卤0.458 in the treatment group and 2.24 卤0.453 in the control group.After 8 weeks of treatment, the reflux value of communicating vein of the affected limb in the treatment group was 2.12 卤0.665, which was lower than that before treatment, but it was not obvious.There was no change in the reflux value of the communicating branch vein before and after treatment in the control group, indicating that routine dressing change had no effect on the reflux of the communicating branch vein wall.However, there was no significant difference between the two groups by non-parametric experience (P 0. 05).
【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】：R269

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