毫火针刺络放血治疗下肢静脉曲张的临床观察

发布时间：2018-04-19 19:28

本文选题：毫火针刺络放血疗法 + 下肢静脉曲张　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:本研究通过观察毫火针刺络放血治疗下肢静脉曲张,明确该法的疗效,并对病变最常涉及的大小隐静脉瓣膜功能不全,交通静脉瓣膜功能不全和两者兼有的混合型瓣膜功能不全等三种不同类型的LEW治疗作用进行了比较分析,明确它们之间的的差别,从而在临床上能更好地、有针对性地发挥毫火针对下肢静脉曲张的治疗作用,同时,通过研究也为进一步阐明毫火针治疗下肢静脉曲张的机理研究提供思路和部分临床依据。方法:将符合纳入标准的55例下肢静脉曲张患者为研究对象,采用自身前后对照临床实验设计原则,首先,对所有研究对象进行详细问诊及专科检查,结合下肢动静脉多普勒B超及加压试验的结果,明确下肢静脉曲张的类型,采用静脉曲张临床表现严重程度评分(VCSS),静脉曲张功能损害程度评分(VDS)及静脉曲张患者生活质量调查表(CIVIQ)等三种临床调查问卷对患者进行整体的评价,然后,采用用毫火针刺络放血疗法对研究对象进行1-3次的治疗,每2-4周一次,具体治疗次数及间隔时间需视患者局部火针创伤修复情况及临床疗效评估而定,首次治疗结束后2-4周评估一次疗效,三次治疗或不足三次,但患者已经达显效标准的即为治疗疗程结束,其后一个月左右进行一次疗效评价,以此作为最终疗效及结局指标。通过观察VCSS,VDS,CIVIQ量表的积分变化情况,以及其他的相应检查项目,对临床疗效进行评定、分析。数据收集及统计分析采用SPSS 20.0统计软件包。结果:最终完成治疗及观察的病例43例,通过对数据的分析得出以下结论:①经过2-3次的毫火针治疗以及治疗前和治疗后一个月的观察,43例患者总体显效率与有效率分别为32.56%、74.42%,且VCSS与VDS及CIVIQ积分的前后比较,有统计学意义,说明毫火针对下肢静脉曲张症状有较好的治疗效果,且可以改善下肢静脉曲张患的者的生活质量。;②三种不同类型的下肢静脉曲张患者在毫火针治疗前,在年龄、性别、病程、症状积分及生活质量积分等,经比较分析,无统计学差异(P0.05),具有可比性。③三种不同类型的静脉曲张的临床疗效:大小隐静脉瓣膜功能不全及混合型的显效率和有效率分别为8.33%、0.00%;41.67%、70.00%,明显低于交通支瓣膜功能不全的患者61.91%、95.24%,且有统计学意义;而从三者的VCSS、VDS、CIVIQ积分在治疗后及前后差值的比较来看,除了 CIVIQ的前后差值比较没有统计学差异外,其余都有统计学差异。提示:毫火针对交通支瓣膜功能不全的临床表现严重程度、静脉功能损害程度的改善能力要明显好于大小隐静脉瓣膜功能不全与混合型的瓣膜功能不全。对下肢静脉曲张患者的生活质量的改善方面也是毫火针对交通支静脉瓣膜功能不全的最好。结论:毫火针刺络放血治疗下肢静脉曲张疗效肯定,且具有安全性,可有效改善床表现严重程度和静脉功能损害程度,提高了患者的生活质量。而对临床常见的三种不同类型的下肢静脉曲张中,对交通支瓣膜功能不全类型疗效最为显著。
[Abstract]:Objective: To investigate the curative effect of the treatment of varicose veins of the lower extremities by observing the acupuncture and collaterals of the milli fire on the varicose veins of the lower extremities, and the effect of the three different types of LEW treatment on the most common lesions of the small size saphenous venous valvular insufficiency, the insufficiency of the venous valve function and the mixed type of the mixed valve function were compared and analyzed. The difference between them can be better in clinical and the therapeutic effect of the milli fire on the varicose veins of the lower extremities, and the mechanism of the study of the mechanism of the healing of the varicose veins of the lower extremities is also provided through the study. Methods: 55 cases of varicose veins of lower extremity were conformed to the standard. The patient was the subject of the study, using the principle of clinical experiment design before and after self control. First, all the subjects were examined in detail and the special examination, combined with the results of Doppler B ultrasound and pressure test of the lower limbs, the types of varicose veins of the lower extremities were clearly defined, and the varicose function of varicosity (VCSS) and the function of varicose veins were used. Three kinds of clinical questionnaires, such as the degree of damage score (VDS) and the quality of life questionnaire (CIVIQ) of patients with varicose veins, were evaluated as a whole. Then, the patients were treated with 1-3 times of treatment by using the acupuncture collaterals and blood letting therapy. Every 2-4 weeks, the number of treatment and interval time should be treated with the repair of local fire injury. And the clinical efficacy evaluation was determined. 2-4 weeks after the first treatment, a curative effect was evaluated, three treatment or less than three times, but the patient had reached the standard of the treatment at the end of the treatment course. After a month or so, a therapeutic evaluation was carried out as a final outcome and outcome index. The changes in the VCSS, VDS, CIVIQ scale were observed. The clinical effects were evaluated and analyzed. Data collection and statistical analysis were carried out by SPSS 20 software package. Results: 43 cases were finished with the final treatment and observation. Through the analysis of the data, the following conclusions were drawn: (1) after 2-3 times of hot needle therapy, before treatment and one month after treatment. The overall efficiency and efficiency of the 43 patients were 32.56% and 74.42% respectively, and the comparison of the VCSS and VDS and CIVIQ scores was statistically significant, indicating that the milli fire was better for the symptoms of varicose veins of the lower extremities, and could improve the living quality of the patients with varicose veins of the lower limbs. (2) three different types of varicose veins of the lower limbs. The age, sex, course of disease, symptom score, and quality of life score were compared, and there was no statistical difference (P0.05). (3) the clinical efficacy of three different types of varicose veins: 8.33%, 0%, 41.67%, 70%, respectively, of small size saphenous venous valvular insufficiency and mixing type, respectively. There were statistically significant differences in the difference values of VCSS, VDS and CIVIQ after treatment and before and after the treatment of the three VCSS, VDS, and CIVIQ points. The degree of clinical manifestation, the improvement of the degree of venous dysfunction should be better than the insufficiency of the valvular insufficiency of the saphenous vein and the mixed type of valve insufficiency. The improvement of the quality of life of the patients with varicosity of the lower extremity is also the best for the insufficiency of the venous valve function. The lower extremity varicosity is effective and safe. It can effectively improve the severity of the bed and the damage of venous function, and improve the quality of life of the patients. In the three different types of lower extremity varicose veins, the most significant effect on the insufficiency type of the traffic branch valve is the most effective.

【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】：R246.1

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