火针治疗急性痛风性关节炎的疗效观察

发布时间：2018-03-29 23:00

本文选题：痛风性关节炎　切入点：急性发作　出处：《广州中医药大学》2016年硕士论文

【摘要】：目的：本研究通过对痛风性关节炎急性发作期患者火针点刺的治疗指标的观察,客观评价其疗效,为该病的临床治疗方案提供可靠的循证医学证据。方法：选择2015年6月至2016年2月在广州中医药大学第一附属医院针灸科、风湿科病房就诊且符合研究纳入标准的痛风性关节炎急性发作患者,共60例,按照1：1的比例,随机分配至试验组(基础调护+火针点刺+西药组)和对照组(基础调护+西药组),每组各30例。试验组在基础调护前提下,采用火针点刺结合西药治疗的方法。①基础调护；②火针常规选穴：阿是穴(3个)隐白、解溪、太溪；结合辨证取穴(风湿郁热证加足三里、阴陵泉、曲池、内庭)；局部选穴等,均患侧取穴；③常规西药治疗：对照组在基础调护上仅使用常规西药治疗(依托考昔片：120mg, qd；碳酸氢钠片：1g, tid)。两组西药治疗每日1次,连续使用8日；火针点刺隔日1次,5天为1疗程,连续治疗2个疗程,疗程间休息2日。治疗前、后分别对患者进行中医症状体征分级量化及VAS疼痛评定量表进行评分,采用SPSS20.0软件进行统计分析。结果：治疗前,对两组患者的性别、年龄、病程、病位等一般资料比较,差异无统计学意义(P＞0.05),组间具有可比性；对两组患者中医症状体征积分、VAS积分、血尿酸、血沉等实验室指标的基线比较,差异无统计学意义(P＞0.05),组间具有可比性。治疗2个疗程后,两组总体疗效方面,试验组总有效率为93.33%,对照组总有效率100%,差异无统计学意义(P＞0.05)；镇痛疗效方面,试验组和对照组总有效率均为100%,经秩和检验,组间比较差异具有统计学意义(P＜0.05)。两组中医症状体征总积分、关节VAS疼痛积分较治疗前均有改善(P0.05),在活动受限、次要症状两方面,两组总体改善效果没有明显差异(P＞0.05),其余中医症状的总体改善效果试验组均优于对照组(PO.05)。结论：1.在同样的基础调护前提下,火针点刺局部腧穴结合西药治疗与单纯西药治疗痛风性关节炎的急性发作均有效。2.两组方案在治疗结束时对患者关节活动受限、次要症状两方面的改善效果相当,其余中医症状(关节疼痛、触痛、肿胀)及总体改善效果,试验组均优于对照组。3.疗程结束后,试验组对局部疼痛的改善效果优于对照组。针对痛风性关节炎急性发作,火针疗法能有效改善关节疼痛、关节触痛、关节肿胀等症状,作为一种无明显副作用的治疗手段,值得临床广泛推广。
[Abstract]:Objective: to evaluate the curative effect of acute gouty arthritis by observing the therapeutic indexes of fire acupuncture in patients with gouty arthritis. To provide reliable evidence-based medical evidence for the clinical treatment of the disease. Methods: selected from June 2015 to February 2016, Department of Acupuncture and moxibustion, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, A total of 60 patients with acute attack of gouty arthritis in rheumatic wards who met the criteria included in the study, according to the 1:1 ratio, They were randomly assigned to the experimental group (the basic control group) and the control group (30 cases in each group). The method of fire acupuncture combined with western medicine treatment .1 basic adjustment and nursing 2 fire needle routine selection points: Ashi (3) hidden white, Jiexi, Taixi, combined with syndrome differentiation (rheumatism and stagnation heat plus Zusanli, Yin Ling Quan, qu Chi, Inner chamber, etc., local points selection, etc.). The patients in the control group were treated with routine western medicine only on the basis of adjusting nursing. The control group was treated with routine western medicine only (1: 1 g sodium bicarbonate, QD). The two groups were treated with western medicine once a day for 8 consecutive days. Fire needle needling every other day for 5 days was a course of treatment, with two consecutive courses of treatment. Before and after the treatment, the patients were graded and quantified by TCM symptom and physical signs and VAS pain rating scale. Results: before treatment, there was no significant difference in sex, age, course of disease and disease position between the two groups (P > 0.05). There was no significant difference in VAS score, blood uric acid, erythrocyte sedimentation rate and other laboratory indexes between the two groups (P > 0.05), and there was comparability between the two groups. After two courses of treatment, the overall curative effect of the two groups was not significant (P > 0.05). The total effective rate was 93.33 in the trial group and 100 in the control group, with no significant difference (P > 0.05). In terms of analgesic effect, the total effective rate of the trial group and the control group was 100, with rank sum test. The difference between the two groups was statistically significant (P < 0.05). The total score of symptoms and signs of traditional Chinese medicine and the pain score of joint VAS in both groups were improved compared with those before treatment (P < 0.05). There was no significant difference between the two groups in the overall improvement effect (P > 0.05). The overall improvement effect of other TCM symptoms in the experimental group was better than that in the control group (P < 0.05). Conclusion: 1. Under the same basic condition, the experimental group is better than the control group. The acute attack of gouty arthritis treated with fire acupuncture and local acupoints combined with western medicine was effective. 2. At the end of the treatment, the joint movement of the patients was restricted, and the improvement of secondary symptoms was similar in two aspects. The other TCM symptoms (joint pain, tenderness, swelling) and the overall improvement effect were better in the experimental group than in the control group. 3. After the treatment, the improvement effect of local pain in the experimental group was better than that in the control group, and the acute attack of gouty arthritis was better in the experimental group than in the control group. Fire acupuncture therapy can effectively improve joint pain, joint tenderness, joint swelling and other symptoms, as a treatment without obvious side effects, it is worthy of extensive clinical promotion.
【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】：2016
【分类号】：R246.1

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