加味清瘟败毒饮治疗病毒性脑炎（痰热壅盛型）的临床疗效观察

发布时间：2018-03-03 07:22

本文选题：病毒性脑炎　切入点：痰热壅盛型　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:通过实用性随机对照试验,评价在基于指南的规范治疗基础上加用加味清瘟败毒饮治疗病毒性脑炎(痰热壅盛型)的临床疗效,为进一步探讨病毒性脑炎的中医规范化治疗,提供可靠的临床证据。方法:(1)将符合纳入标准的70例病例,参照随机数表,以1:1的比例随机分为治疗组和对照组,每组各35例。治疗组予加味清瘟败毒饮+基于指南的规范化西医治疗,对照组予基于指南的规范化西医治疗,两组均观察14天。(2)分别于治疗前、治疗7天、治疗14天三个时点采集血液及脑脊液标本,通过比较血白细胞数、中性粒细胞比值、脑脊液压力、脑脊液蛋白定量及白细胞数的变化,观察评价加味清瘟败毒饮对患者理化常规指标的影响。(3)分别于治疗前、治疗7天、治疗14天统计临床症状、体征积分,通过积分变化,评价加味清瘟败毒饮对患者临床症状、体征的影响。(4)分别于治疗前、治疗14天两个时点统计脑电图及头颅MRI分级,评价加味清瘟败毒饮对患者脑电图波形及头颅影像学改变的影响。结果:(1)病毒性脑炎疗效评价:治疗组总有效率97.14%,对照组总有效率88.57%,两组疗效差异具有统计学意义(P0.05),说明加味清瘟败毒饮治疗痰热壅盛型病毒性脑炎的临床疗效显著。(2)治疗7天:治疗组与对照组组内比较:临床症状、体征积分,血常规(白细胞数、中性粒细胞比值)及脑脊液(压力、蛋白定量、白细胞数)均较治疗前下降(P0.05);组间比较:治疗组下降程度较对照组显著(P0.05)。(3)治疗14天:两组组内比较:临床症状、体征积分,血常规(白细胞数、中性粒细胞比值)及脑脊液(压力、蛋白定量、白细胞数)均较治疗7天时下降(P0.05),脑电图分级、头颅磁共振分级较治疗前改善(P0.05);组间比较:治疗组改善程度较对照组显著,差异具有统计学意义(P0.05)。结论:加味清瘟败毒饮能够明显改善痰热壅盛型病毒性脑炎患者的理化常规指标、临床症状、体征积分,降低脑电图、头颅MRI分级。尤其能够降低患者发热程度、缩短发热周期,促进昏迷患者苏醒,改善疾病预后。总之,加味清瘟败毒饮治疗病毒性脑炎(痰热壅盛型)临床疗效显著,无明显毒副作用,值得临床推广使用。
[Abstract]:Objective: to evaluate the clinical efficacy of Jiawei Qingwen Baidu decoction in the treatment of viral encephalitis (phlegm and heat obstruction type) on the basis of the standard treatment based on the guidelines through a practical randomized controlled trial. In order to further explore the standardized treatment of viral encephalitis in TCM and provide reliable clinical evidence, 70 cases that met the inclusion criteria were randomly divided into treatment group and control group with the proportion of 1: 1 according to the random number table. There were 35 cases in each group. The treatment group was treated with standardized western medicine with modified Qingwen Baidu Yin, and the control group with standardized western medicine treatment based on guidelines. The two groups were observed for 14 days and treated for 7 days, respectively. Blood and cerebrospinal fluid (CSF) samples were collected at three time points after treatment for 14 days. The changes of white blood cell count, neutrophil ratio, cerebrospinal fluid pressure, cerebrospinal fluid protein quantification and white blood cell count were compared. Observe and evaluate the effect of Jiawei Qingwen Baidu decoction on the physical and chemical routine indexes of patients. Before treatment, 7 days of treatment, 14 days of treatment, statistics of clinical symptoms and signs integral, through integral changes, evaluate the clinical symptoms of Jiawei Qingwen Baiduyin on patients' clinical symptoms. The effects of physical signs on EEG and MRI grade of the skull were recorded at two time points before treatment and 14 days after treatment, respectively. To evaluate the effect of Jiawei Qingwen Baidu decoction on EEG waveform and cranial imaging changes in patients. Results: the curative effect of viral encephalitis in the treatment group was 97.14. The total effective rate in the treatment group was 97.14. The total effective rate in the control group was 88.57. The difference between the two groups was statistically significant. The clinical curative effect of modified Qingwen Baidu decoction on phlegm and heat accumulation type viral encephalitis was remarkable for 7 days: comparison between the treatment group and the control group: clinical symptoms, Physical sign score, blood routine (leukocyte count, neutrophil ratio) and cerebrospinal fluid (pressure, protein quantification), The number of white blood cells in the treatment group was significantly lower than that in the control group for 14 days. The comparison between the two groups: clinical symptoms, signs score, blood routine examination (white blood cell count, white blood cell count, white blood cell count, WBC count, WBC count, WBC count, WBC count, WBC count, WBC count, WBC count, WBC count, WBC count). The ratio of neutrophil to neutrophil and cerebrospinal fluid (pressure, protein quantification, white blood cell count) decreased P0.05, EEG grade and cranial magnetic resonance grade improved P0.05 compared with that of control group after 7 days of treatment, and the improvement degree of treatment group was significantly higher than that of control group. Conclusion: Jiawei Qingwen Baidu decoction can significantly improve the physical and chemical indexes, clinical symptoms and signs of viral encephalitis patients with phlegm-heat blockage, and reduce EEG. Cranial MRI grade. In particular, it can reduce the degree of fever, shorten the period of fever, promote the recovery of coma patients, and improve the prognosis of disease. In short, the clinical effect of Jiawei Qingwen Baidu decoction on viral encephalitis (phlegm and heat accumulation type) is remarkable. There are no obvious side effects, so it is worth popularizing in clinic.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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