应用超声电导仪局部给予地塞米松治疗急性痛风性关节炎的疗效观察

发布时间：2018-05-19 23:06

本文选题：痛风 + 超声电导仪　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨应用超声电导仪局部给予地塞米松治疗急性痛风性关节炎的疗效与安全性。方法:通过临床筛选2015年11月至2016年10月在青岛大学附属医院代谢性疾病科及痛风专病门诊诊治的痛风性关节炎患者(急性发作期)56例作为研究对象,使用随机数表将患者随机分组至试验组30例与对照组26例两组。对所有受试者进行为期14天的观察。对照组治疗方案为:安康信120mg qd应用3天,第4天起改为60mg qd再连续应用4天;秋水仙碱早晚各0.5mg,碳酸氢钠早中晚各1.0g,持续应用14天;试验组治疗方案:在对照组治疗方案的基础上第1~5天于发作关节局部应用超声电导仪局部给予地塞米松治疗。分别于第1~14天观察比较两组患者关节疼痛评分(VAS评分)、肿胀评分,分别于第1、3、5、7、14天留取静脉血检测及比较两组患者的实验室生化指标:血尿酸(UA)、C反应蛋白(CRP)、血沉(ESR)、白介素1β(IL-1β)、肿瘤坏死因子α(TNF-α),并观察评估两组患者试验前后胃肠道反应、血糖、血压及肝肾功能等变化情况。统计分析使用SPSS17.0软件进行数据处理,定量资料采用t检验和方差分析,定性资料用百分率表示并使用c2检验进行分析(因n30,统计时采用Fisher确切概率法)。统计结果以P0.05作为差异有统计学意义。结果:共有56例患者纳入试验,其中4例患者因为失访而被剔除,最终试验组28例、对照组24例完成随访,纳入统计对象。试验组与对照组关节疼痛评分(VAS评分)比较,第3、4、5、6、7、8、9、10、11、12、13、14天试验组均低于对照组,差异有统计学意义(F=3.98~9.31,P0.05,0.01);试验组与对照组关节肿胀评分比较,第3、4、5、6、7、8、9、10、11、12、13、14天试验组均低于对照组,差异有统计学意义(F=3.98~9.73,P0.05,0.01);试验组与对照组实验室生化指标比较,IL1-β第3、5、7天试验组均低于对照组,差异有统计学意义(F=4.12、4.02,P0.05),TNF-α第5、7天试验组均低于对照组,差异有统计学意义(F=4.02、4.02,P0.05),ESR第3、5、7天试验组均低于对照组,差异有统计学意义(F=4.02、4.12,P0.05),CRP第3、5、7天试验组均低于对照组,差异有统计学意义(F=4.02、4.50,P0.05);试验组与对照组药物副作用发生率比较,胃肠道反应(轻度恶心、胃部不适)发生率无统计学差异(c2=0.59,P0.05),血压波动(SBP升高20mm Hg)发生率无统计学差异(c2=0.21,P0.05),且两组均未出现血糖明显升高及肝肾功异常的病例。结论:应用超声电导仪局部给予地塞米松治疗急性痛风性关节炎可以提高消炎镇痛疗效,且安全性好
[Abstract]:Objective: to investigate the efficacy and safety of local administration of dexamethasone with ultrasonic conductometer in the treatment of acute gouty arthritis. Methods: from November 2015 to October 2016, 56 patients with gouty arthritis were selected from metabolic diseases department and outpatient clinic of Qingdao University affiliated Hospital. Patients were randomly divided into trial group (n = 30) and control group (n = 26). All subjects were observed for 14 days. In the control group, 120mg QD was used for 3 days and changed to 60mg QD for 4 days, colchicine 0.5 mg in the morning and evening, sodium bicarbonate at 1.0 g in the morning and evening for 14 days. The experimental group was treated with dexamethasone on the 5th day after the local application of ultrasonic conductance instrument on the basis of the control group. The joint pain scores, VAS scores and swelling scores were observed and compared between the two groups on the 1st day of 14 days. Venous blood samples were collected at 714 days after the first trimester, and the biochemical indexes of the two groups were compared: CRPU, ESR, IL-1 尾, TNF- 伪, TNF- 伪, and observed and evaluated the gastrointestinal reaction and blood glucose in the two groups before and after the trial, and compared the two groups of patients before and after the trial, and compared the biochemical indexes of the two groups, such as CRPU, ESR, IL-1 尾, TNF- 伪, TNF- 伪, et, TNF- 伪, TNF- 伪, TNF- 伪, TNF- 伪. Changes in blood pressure and liver and kidney function. Statistical analysis uses SPSS17.0 software to process data, quantitative data is analyzed by t test and variance analysis, qualitative data is expressed by percentage and analyzed by c2 test (because of n30, Fisher exact probability method is used in statistics). Statistical results with P0.05 as the difference was statistically significant. Results: a total of 56 patients were included in the trial, among which 4 patients were excluded because of missing visit. 28 cases in the trial group and 24 cases in the control group were followed up and included in the statistics. Compared with the control group, the joint pain scores of the trial group and the control group were significantly lower than that of the control group on the 3rd day (P < 0.05), and the joint swelling scores of the test group and the control group were lower than those of the control group on the day 344.98 ~ 9.31g / P 0.05 / 0.01g / d, respectively, and that of the control group was lower than that of the control group on the day of 34D, and the score of joint pain in the experimental group was significantly lower than that in the control group on day 1314, and the difference was statistically significant (P < 0.05), and the score of joint swelling in the trial group was lower than that in the control group on day 1314. The difference was statistically significant (P < 0.01), the biochemical indexes of the experimental group were lower than that of the control group on the 7th day, and the difference was statistically significant (P < 0.05). The experimental group was lower than the control group on the 57th day of TNF- 伪. The difference was statistically significant (P < 0.05). The ESR group was lower than the control group on the 3rd day of ESR, and the difference was statistically significant (P < 0.05). The difference was statistically significant in the experimental group (P < 0.05) and the control group (P < 0.05). The incidence of side effects in the experimental group was significantly lower than that in the control group (P < 0.05), and the incidence of side effects in the experimental group was significantly lower than that in the control group. There was no significant difference in the incidence of gastrointestinal reaction (mild nausea, stomach discomfort) between the two groups. There was no significant difference in the incidence of gastrointestinal reaction (mild nausea, stomach discomfort). There was no significant difference between the two groups in the incidence of elevated blood glucose and abnormal liver and kidney function. Conclusion: local administration of dexamethasone with ultrasonic conductometer can improve the anti-inflammatory and analgesic effect, and the safety is good.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589.7

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