针刺配合西药治疗急性化脓性中耳炎临床观察及实验研究

发布时间：2018-03-04 13:05

本文选题：急性化脓性中耳炎　切入点：针刺　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：临床研究部分目的:通过随机对照的方法比较针刺结合西药为主的治疗组和以西药为主的对照组的疗效优劣及不良反应,对急性化脓性中耳炎中西医结合治疗方法的临床疗效进行客观评价。方法:将60例符合纳入标准的急性化脓性中耳炎患者随机分为治疗组和对照组各30例。治疗组采用针刺耳门、听会、翳风、足三里、丘墟,并采用0.3%氧氟沙星滴耳液滴耳治疗,对照组采用单纯西药治疗,针刺每日1次,连续5次,休息2天为1周,西药每日1次,共2周。治疗结束后比较两组患者临床改善总有效率及不良反应率,以评估针刺对本病疗效的影响。结果:治疗组与对照组患者临床改善总有效率分别为92.9%、82.8%,治疗组临床改善总有效率明显高于对照组,两组比较差异有统计学意义(K0.05)。而治疗组与对照组患者耳部刺痛发生率分别为3.57%、10.34%,耳部瘙痒发生率分别为7.14%、13.79%,治疗组患者耳部刺痛及耳部瘙痒发生率虽都低于对照组,两组比较差异无统计学意义(P0.05)。结论:相比于西药组,针刺联合西药治疗急性化脓性中耳炎具有缓解患者病情,减少不良反应,预后优势明显等优点,具有临床推广使用价值。实验研究部分目的:通过观察电针及氧氟沙星滴耳液分别对急性化脓性中耳炎模型的大鼠血清中致炎因子TNF-α、IL-6、耳蜗血流动力学指标及炎症状态等相关指标的改变,探讨电针对本病的作用机制。方法:挑选39只符合标准的雄性大鼠接受急性中耳炎模型造模,造模成功后(造模过程中死亡3只)随机分成3组,每组12只。造模3天后,①组给予0.2ml的0.9%氯化钠盐水滴耳,②组采用皮内针电针大鼠双侧耳部,治疗20min,③组给予氧氟沙星滴耳液0.2ml滴耳。各组均2次/天,共治疗7天。各组测定血清致炎因子TNF-a、IL-6在造模前、造模完成后、治疗3天、治疗7天后的水平;试验结束后再各自检测耳蜗微循环血液流动学指标,包括耳蜗血流量、平均动脉压;处死豚鼠后记录中耳炎症情况及细菌培养计数。结果:电针组和西药组的血清致炎因子TNF-a、IL-6低于对照组,差异有显著统计学意义(P0.05);电针组与西药组比较,差异无统计学意义(P0.05)。实施干预的两个组与对照组比较,平均动脉压、耳蜗血流量等血流动力学指标都有所上升,差异有统计学意义(P0.01,P0.05);实施干预的两组之间比较,差异无统计学意义(P0.05)。实施干预的两组与对照组比较,中耳炎症评分、细菌培养计数水平都有所下降,差异有显著统计学意义(P0.01);实施干预的两组之间比较,中耳炎症评分差异无统计学意义(P0.05),细菌培养计数差异有显著统计学意义(P0.05)。结论:电针或氧氟沙星滴耳液均能够降低血清致炎因子以及升高平均动脉压、耳蜗血流量,降低中耳炎症评分及减少细菌培养计数,具有加快耳蜗微循环血流及杀菌、消炎的优点,使其促进豚鼠中耳炎达到痊愈。在抗菌方面,电针较氧氟沙星西药组效果更佳,具有临床推广使用价值。
[Abstract]:Clinical study objective: the therapeutic effect and adverse reaction of treatment group by randomized controlled comparison of acupuncture combined with western medicine and the control group with western medicine based on the acute suppurative otitis media clinical curative effect of combined treatment of traditional Chinese and Western medicine method of objective evaluation. Methods: 60 cases of acute suppurative otitis media in accordance with the inclusion criteria patients were randomly divided into treatment group and control group with 30 cases in each group. The treatment group with acupuncture, Tinghui, Yifeng, Zusanli, Qiuxu, and the 0.3% Ofloxacin Ear Drops ear treatment, control group was treated with western medicine, acupuncture 1 times a day, 5 times, 2 days of rest for 1 weeks, Western Medicine 1 times a day, a total of 2 weeks after the end of treatment. Compared two groups of patients with clinical improvement of the total efficiency and adverse reaction rate, to evaluate the effect of acupuncture on the disease curative effect. Results: the treatment group and the control group clinical improvement rate were 92.9 %, 82.8%, treatment group total effective rate of clinical treatment was significantly higher than the control group, there was significant difference between two groups (K0.05). The treatment group and control group patients with ear tingling were 3.57% and 10.34%, ear pruritus occurred in 7.14%, 13.79%, treatment group patients with ear tingling and itching ear although the rate is lower than the control group, the two groups had no statistically significant difference (P0.05). Conclusion: compared with western medicine group, acupuncture combined with western medicine treatment can alleviate the disease in patients with acute suppurative otitis media, reduce the adverse reactions and prognosis have obvious advantages and other advantages, is worthy of clinical application. The experimental study objective: through the observation of acupuncture and Ofloxacin Ear Drops rat serum on acute suppurative otitis media model respectively in inflammatory factor TNF- alpha, IL-6, relevant indicators of cochlear blood flow index and inflammation change effect of Electroacupuncture on The mechanism of this disease. Methods: to select 39 only in accordance with the standards of the male rats received acute otitis media model, after the success of modeling (death modeling process = 3) were randomly divided into 3 groups, 12 rats in each group. After 3 days, the 0.2ml group was given 0.9% sodium chloride brine ear, 2 group adopted the treatment of 20min with intradermal needle electroacupuncture in rats with bilateral ear, the group received the Ofloxacin Ear Drops 0.2ml. Some groups were 2 times / day, 7 days of treatment. The determination of serum inflammatory factors in TNF-a groups, IL-6 before modeling, after modeling, for 3 days, 7 days after treatment the level of test results; after each test beam of cochlear microcirculation blood flow indexes, including cochlear blood flow, mean arterial pressure; middle ear inflammation records and bacterial culture counting. Results: Serum guinea pigs were sacrificed after electroacupuncture group and Western medicine group of inflammatory factor TNF-a, IL-6 lower than the control group, the difference was statistically significant (P0.05); Electro acupuncture group and Western medicine group, the difference was not statistically significant (P0.05). The two group compared with the control group intervention, mean arterial pressure, cochlear blood flow and other hemodynamic parameters were increased, the difference was statistically significant (P0.01, P0.05); the implementation of the intervention between the two groups, the difference was not statistically significant (P0.05). The two intervention group compared with the control group, the middle ear inflammation score, bacterial levels decreased, the difference was statistically significant (P0.01); the implementation of the intervention between the two groups, there was no significant difference of middle ear inflammation score (P0.05), the difference of bacterial culture counting was statistically significant (P0.05) conclusion: Electroacupuncture or Ofloxacin Ear Drops are able to reduce the serum inflammatory factors and increased mean arterial pressure, cochlear blood flow, reduce the middle ear inflammation score and reduce bacterial culture counting, has enhanced the cochlear microcirculation The advantages of blood flow, bactericidal and anti-inflammatory make it promote the healing of guinea pig's otitis media. In terms of antibacterial aspect, electroacupuncture is better than ofloxacin and Western medicine, and it has the value of clinical popularization and application.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R764.21

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