“易层”贴敷缓解中重度膝骨性关节炎患者疼痛的疗效研究

发布时间：2018-05-12 03:41

本文选题：膝骨性关节炎 + “易层”贴敷　；参考：《南京中医药大学》2016年硕士论文

【摘要】：背景：随着人口老龄化的进程,膝骨性关节炎(KOA)发病率逐年增加,严重困扰着中老年患者的正常生活。KOA患者以疼痛为主诉,故对疼痛的控制是治疗KOA的根本。目的：通过“易层”贴敷及扶他林软膏对比治疗具有膝关节置换指征的中重度KOA患者,对其临床疗效进行客观评估及统计分析。探索中重度KOA患者膝关节疼痛性质及“易层”贴敷疗法缓解局部疼痛的疗效。方法：选取满足本课题纳入标准的病例32例,随机分为治疗组(易层贴敷组)16例及对照组(扶他林组)16例。药物治疗3周。分别于就诊第1天、第7天、第14天、第21天、2月、3月六个节点,比较两组WOMAC评分、NPQ疼痛评分、关节功能分级改善情况,评估两种药物缓解中重度KOA疼痛的手术替代疗效。结果：(1)两组病例在性别上、年龄上、患膝的左右无明显差异性(P0.05)。(2)两组病例治疗前,在走平路、行走楼梯、晚问休息、坐着或平卧着、站立时疼痛评分、WOMAC疼痛总评分、WOMAC,总评分、NPQ评分无差异性(P0.05)。而治疗第21天与就诊第1天相比均有统计学意义(P0.05),说明两利药物对中重度KOA患者疼痛均有较好的控制作用。(3)两组病例第7天在平路上行走、上下楼梯、晚间睡觉、坐着或躺着、站立时疼痛评分、WOMAC疼痛总评分、WOMAC总分相比均有统计学意义,扶他林组评分低于易层贴敷组,说明扶他林对KOA的疼痛控制起效时间较易层贴敷短。(4)易层贴敷组第2月及第3月行走楼梯、站立时疼痛评分、WOMAC疼痛总评分、WOMAC总评分与第21天相比,均无差异性(P0.05),而扶他林组均有统计学差异(P0.05),说明在停药后,扶他林组病例关节疼痛复发率较高。(5)首次就诊时两组NPQ疼痛评分均0,可以认为两组病例疼痛性质为神经病理性疼痛,两组治疗第21天NPQ评分与治疗后2月、3月比较有统计学意义,但易层贴敷组评分持续下降,扶他林组评分持续上升。(6)首次就诊、就诊第21天、第2月时,两组关节功能分级比较均无统计学意义(P0.05)。第3月两组分级情况有统计学意义(P0.05)。(7)治疗后两组有效率均为100%,而易层贴敷组的显效率为50%,高于扶他林组的12.5%,有统计学意义(P0.05),说明“易层”贴敷疗法对中重度KOA疼痛的控制效果优于扶他林。结论：中重度KOA患者膝关节局部疼痛性质为神经病理性疼痛。“易层”贴敷及扶他林软膏在改善中重度膝骨性关节炎患者疼痛症状以及提高生活质量方面均有显著疗效,然而“易层”贴敷在长期控制关节疼痛、改善关节功能方面优势更加明显。
[Abstract]:Background: with the aging of the population, the incidence of knee osteoarthritis (KOA) is increasing year by year, which seriously puzzles the normal life of middle-aged and elderly patients. Koa patients mainly complain of pain, so the control of pain is the fundamental to treat KOA. Objective: to evaluate and analyze the clinical effect of moderate and severe KOA patients with knee replacement indication by using "change layer" and Futalin ointment. Objective: to explore the nature of knee joint pain in moderate and severe KOA patients and the curative effect of "easy layer" application to relieve local pain. Methods: Thirty-two patients who met the criteria were randomly divided into two groups: the treatment group (16 cases) and the control group (16 cases). Drug therapy for 3 weeks. At the first day, the 7th day, the 14th day, the 21st day, the second month and the third month, the WOMAC score and the joint function grade were compared between the two groups to evaluate the effect of the two drugs on the relief of moderate and severe KOA pain. Results (1) there was no significant difference between the two groups in terms of sex, age, left and right knee. (P0.05) before treatment, the two groups of patients were walking the level road, walking the stairs, asking late to rest, sitting or lying on their backs. There was no difference in total score of NPQ and total score of WOMAC (P 0.05). On the 21st day of treatment, there was significant difference between the first day and the first day of treatment, indicating that the two drugs had better control effect on pain in patients with moderate and severe KOA.) on the 7th day, the two groups of patients walked on the level road, went up and down stairs, slept at night, sat or lay down. There was significant difference in the total score of WOMAC and the total score of WOMAC in standing group, and the score of Futalin group was lower than that of the change layer application group. The results showed that the onset time of KOA pain control was shorter than that of the easy-layer application. 4) the treadmill group walked the stairs in the 2nd and 3rd months, and the total pain score of WOMAC when standing was compared with that on the 21st day. There was no difference between the two groups (P 0.05), but there was a statistical difference between the two groups (P 0.05), which indicated that the recurrence rate of joint pain was higher in the Fu Thalin group than in the control group. The NPQ pain scores of the two groups were all 0 at the first visit. The nature of the pain in the two groups could be considered as neuropathic pain. The NPQ score on the 21st day of treatment was significantly higher than that on the 2nd and 3rd month after treatment, but the score of the change layer application group continued to decrease, and the score of the Futalin group continued to rise. 6) the first visit was made on the 21st day and the 2nd month after the treatment. There was no significant difference in articular function grade between the two groups (P 0.05). After the treatment, the effective rate of the two groups was 100, while that of the other group was 50, which was higher than that of the Futalin group (12.5g, P 0.05), which indicated that the "change layer" patch therapy had pain in moderate and severe KOA. The control effect of pain is better than that of Fu Thalin. Conclusion: the local pain of knee joint in moderate and severe KOA patients is neuropathic pain. "Yi layer" and Futalin ointment have significant effects on improving pain symptoms and quality of life in patients with moderate and severe knee osteoarthritis, but "change layer" is used to control joint pain for a long time. The advantages of improving joint function are more obvious.
【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】：2016
【分类号】：R684.3

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