顾锡镇教授膏方治疗重症肌无力临床用药经验

发布时间：2018-02-27 08:16

  本文关键词： 重症肌无力 肌力 膏方 用药经验　出处：《南京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：本课题旨在通过收集重症肌无力患者的临床资料,观察顾锡镇教授膏方治疗重症肌无力的临床疗效,总结临床用药经验,为中医临床治疗提供参考依据。研究方法：纳入2013年10月至2015年12月江苏省中医院顾锡镇教授膏方门诊MG患者共34例,符合中医痿证诊断,服用膏方,疗程8周,在治疗前、治疗4周及8周时分别进行肌力评分。用SPSS软件进行统计分析,对治疗前后评分进行对比以评估疗效。对膏方所用中药进行频数分析,结合中医组方理论及辨证论治,总结顾锡镇教授膏方用药经验。研究结果：1.治疗4周、治疗8周与治疗前绝对评分分别相比,差异均具有统计学意义(P0.05),同时,治疗8周与治疗4周绝对评分相比,差异同样具有统计学意义(P0.05),因此,治疗4周、治疗8周后肌力均可改善,且治疗8周后肌力改善更明显。2.治疗4周与治疗8周相对评分总体均数均超过25%,说明两个阶段的治疗总体上均可达到好转及以上水平,以相对评分计算总有效率,治疗4周为76.47%,治疗8周为91.18%,治疗8周时有效率更高。3.眼睑、眼球活动、四肢、面部肌群的肌力绝对评分在治疗4周、治疗8周时均有明显下降,与治疗前绝对评分对比P0.05,表明两个治疗阶段后肌力均有所改善,治疗8周绝对评分与治疗4周绝对评分相比,差异有统计学意义(P0.05),说明8周后肌力改善更明显；咀嚼吞咽肌群在治疗4周后与治疗前相比,差别有统计学意义(P0.05),但治疗8周后较治疗4周后肌力评分无变化;呼吸肌治疗4周与治疗前相比,评分无变化,肌力无改善,但治疗8周后与治疗4周相比,差异有统计学意义(P0.05),表明呼吸困难需要较长疗程治疗后才能得到改善。4.顾锡镇教授膏方治疗MG疗效无明显性别、分型差别,不同性别、不同分型(Ⅰ、 ⅡA、ⅡB型)患者均能取得可靠疗效。5.顾锡镇教授膏方治疗MG常用补益药、安神药、消食药,注重升提引经药物,同时重视预防外感,随证加减。6.顾锡镇教授膏方治疗MG用药特点可归纳为：补益脾肾,兼顾五脏；紧扣主证,兼顾他证；升清降浊,调理气机；运脾和中,和胃安神；扶正祛邪,化湿解毒。研究结论：顾锡镇教授膏方治疗Ⅰ、Ⅱ型重症肌无力疗效确切,除咀嚼吞咽、呼吸肌以外的肌群肌力均可明显持续改善,疗效不受性别、分型的影响。顾锡镇教授膏方治疗MG用药常用补益药、安神药、消食药,注重升提引经药物,同时重视预防外感,随证加减;用药特点可归纳为：补益脾肾,兼顾五脏；紧扣主证,兼顾他证；升清降浊,调理气机；运脾和中,和胃安神;扶正祛邪,化湿解毒。
[Abstract]:Objective: through collecting the clinical data of myasthenia gravis patients, the purpose of this study was to observe the clinical effect of professor Gu Xizhen plaster on myasthenia gravis, and to summarize the experience of clinical medication. Methods: from October 2013 to December 2015, 34 patients with MG were included in the outpatient clinic of Professor Gu Xizhen of Jiangsu Provincial Hospital of traditional Chinese Medicine. The patients were diagnosed with TCM impotence syndrome and were treated with ointment for 8 weeks. After 4 weeks and 8 weeks of treatment, muscle strength scores were scored respectively. SPSS software was used for statistical analysis, and the scores before and after treatment were compared in order to evaluate the curative effect. The frequency of traditional Chinese medicine for ointment was analyzed, combined with the theory of traditional Chinese medicine prescription and differentiation of symptoms and signs. The results showed that there were significant differences in absolute scores for 4 weeks, 8 weeks after treatment and before treatment, respectively. At the same time, the absolute scores of 8 weeks of treatment and 4 weeks of treatment were significantly higher than those of 4 weeks of treatment. The difference was also statistically significant (P 0.05). Therefore, muscle strength could be improved after 4 weeks of treatment and 8 weeks of treatment. After 8 weeks of treatment, the improvement of muscle strength was more obvious. 2. The total mean of relative scores of 4 weeks and 8 weeks of treatment exceeded 25, which indicated that the two stages of treatment could reach the level of improvement and above, and the total effective rate was calculated by relative score. The effective rate was higher at 8 weeks. The absolute score of muscle strength of eyelid, eyeball movement, limbs and facial muscles decreased significantly at 4 weeks of treatment and 8 weeks of treatment. Compared with the absolute score before treatment, P0.05 showed that the muscle strength was improved after the two stages of treatment. The difference between the absolute score of 8 weeks and the absolute score of 4 weeks was statistically significant (P 0.05), which indicated that the improvement of muscle strength was more obvious after 8 weeks. The difference of masticatory swallowing muscle group after 4 weeks treatment was statistically significant compared with that before treatment, but there was no change in muscle strength score after 8 weeks treatment compared with that after 4 weeks treatment, but there was no change in muscle strength score and muscle strength in respiratory muscle group after 4 weeks treatment compared with that before treatment. But after 8 weeks of treatment and 4 weeks of treatment, the difference was statistically significant (P 0.05), which indicated that dyspnea needed a long course of treatment before it could be improved. Different types of patients (鈪，

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