关节镜微创术结合清热凉血方治疗湿热蕴结型膝痛风性关节炎的临床研究

发布时间：2018-04-04 21:05

本文选题：痛风性关节炎　切入点：湿热蕴结　出处：《广州中医药大学》2017年硕士论文

【摘要】：背景:随着大众饮食结构及生活习惯的改变,痛风的患病率呈逐年升高的趋势。痛风一病严重影响着患者的生活质量,西医对本病尚无根治方法,且多伴有明显的毒副作用。随着祖国医学对痛风一病的进一步了解,目前中医及中西医联合治疗痛风已取得较好疗效。目的:通过观察关节镜微创手术结合清热凉血方治疗湿热蕴结型膝痛风性关节炎的临床疗效及研究分析其作用机理,为临床治疗膝痛风性关节炎提供一种更加有效、安全的治疗方法。方法:本次研究对象选取符合纳入标准的自2016年2月份至2017年2月份在广州中药大学第三附属医院住院的59例膝痛风性关节炎患者,中医辨证均为湿热蕴结证型。然后按入院顺序依次编号,通过采用随机数字表法,分为治疗组(30例)和对照组(29例)。两组患者入院后均完善术前常规检查及手术评估,无手术绝对禁忌症后,行膝关节镜微创清理术及术后相同的常规处理。并且从术后第2天起,给予口服苯溴马隆片(昆山龙灯瑞迪制药有限公司国药准字J20130141),50mg/次,1次/d,早餐后服用,连续治疗4周。在治疗期间所有患者须定期复查肝肾功能,若提示肝肾功能严重异常者,须终止治疗。治疗组在上述治疗下,术后第二天起同时予清热凉血方水煎口服,1剂/天,以4周为一疗程。通过观察治疗1周、4周时的临床疗效,疼痛、关节功能积分,试验室指标(血尿酸、血沉、C-反应蛋白)水平变化。然后进行统计分析(SPSS19.0统计软件)。结果:1.治疗1周时,治疗组总有效率为90.0%,对照组总有效率为82.7%,治疗组的临床疗效虽优于对照组,但两组间差异无统计学意义(P0.05)。而在治疗4周,治疗组总有效率为100%,对照组总有效率为93.1%,治疗组的临床疗效较对照组明显改善,差异有统计学意义(P0.05)。2.治疗前,两组患者的疼痛积分、关节功能积分、BUA、ESR、CRP指标比较,差异无统计学意义(P0.05)。3.治疗1周及4周时,两组的疼痛、关节功能积分均低于治疗前(P0.05),且治疗组在降低疼痛、关节功能积分方面效果优于对照组,差异有统计学意义(P0.05)。4.在治疗1周时,两组复测的BUA、ESR、CRP水平均较治疗前下降,同时治疗组ESR、CRP水平低于对照组,差异有统计学意义(P0.05),而治疗组BUA水平虽低于对照组,但两组间差异无统计学意义(P0.05)。在治疗4周时,复测的BUA、ESR、CRP水平,治疗组均明显低于对照组,两组间差异均有统计学意义(P0.05);并且治疗4周与治疗1周时相比较,BUA、ESR、CRP水平进一步降低。结论:本次临床研究表明,关节镜微创手术结合清热凉血方治疗湿热蕴结型膝痛风性关节炎的疗效确切,可有效缓解临床症状,减轻疼痛,改善关节活动,降低血尿酸及炎性指标水平,是治疗膝关节痛风性关节炎的一种有效、微创、安全的治疗方法,值得在临床上推广。
[Abstract]:Background: with the changes of dietary structure and lifestyle, the prevalence of gout is increasing year by year.Gout disease seriously affects the quality of life of patients, Western medicine has no cure for the disease, and often with obvious side effects.With the further understanding of gout disease in traditional Chinese medicine, the treatment of gout with TCM and western medicine has achieved good curative effect.Objective: to observe the clinical effect and mechanism of arthroscopic minimally invasive operation combined with Qingreliangxue recipe in the treatment of knee gouty arthritis of damp-heat accumulation type, so as to provide a more effective method for the treatment of knee gouty arthritis.A safe treatment.Methods: 59 patients with knee gouty arthritis who were admitted to the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine from February 2016 to February 2017 were selected.The patients were divided into treatment group (n = 30) and control group (n = 29).The preoperative routine examination and surgical evaluation were improved in both groups after admission, and the knee arthroscopic minimally invasive debridement and the same routine management were performed after operation without absolute contraindication.And from the second day after operation, oral benzbromarone tablets were given (Kunshan Longlanliangruidi Pharmaceutical Co., Ltd.) J20130141C 50mg / once a day, taken after breakfast and treated continuously for 4 weeks.During treatment, all patients should regularly review their liver and kidney function, and if severe abnormal liver and kidney function are indicated, the treatment should be terminated.The treatment group was treated with Qingre Liangxue decoction for 4 weeks as a course of treatment.The changes of clinical efficacy, pain, joint function score and laboratory indexes (hematuria, erythrocyte sedimentation rate, C-reactive protein) were observed at 1 week and 4 weeks after treatment.Then statistical analysis was carried out by SPSS 19.0 software.The result is 1: 1.After one week of treatment, the total effective rate of the treatment group was 90.0 and the total effective rate of the control group was 82.7. The clinical effect of the treatment group was better than that of the control group, but there was no significant difference between the two groups.The total effective rate in the treatment group was 100 and the total effective rate in the control group was 93.1.The clinical efficacy of the treatment group was significantly improved than that of the control group, and the difference was statistically significant (P 0.05).Before treatment, there was no significant difference in pain score, joint function score and ESR-CRP between the two groups.After 1 and 4 weeks of treatment, the scores of pain and joint function in both groups were lower than those before treatment (P 0.05), and the effect of the treatment group in reducing pain and joint function score was better than that in the control group, the difference was statistically significant (P 0.05).At 1 week after treatment, the levels of BUAS CRP in the two groups were lower than those before treatment, and the level of BUA in the treatment group was lower than that in the control group (P 0.05). Although the level of BUA in the treatment group was lower than that in the control group, there was no significant difference between the two groups (P 0.05).At the 4th week of treatment, the level of BUAESR-CRP in the treatment group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P 0.05), and the level of BUAESR-CRP decreased further after 4 weeks of treatment and 1 week of treatment.Conclusion: this clinical study shows that arthroscopic minimally invasive surgery combined with Qingreliangxue prescription in the treatment of knee gouty arthritis with dampness and heat accumulation can effectively relieve clinical symptoms, relieve pain and improve joint activity.Reducing the level of serum uric acid and inflammatory index is an effective, minimally invasive and safe method for treating knee joint gouty arthritis, which is worth popularizing in clinic.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

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