金黄活血散外敷治疗急性痛风性关节炎的临床观察

发布时间：2018-04-01 20:14

本文选题：急性痛风性关节炎　切入点：金黄活血散　出处：《山西省中医药研究院》2017年硕士论文

【摘要】：目的:本研究通过观察金黄活血散外敷治疗湿热蕴结型急性痛风性关节炎的临床疗效,初步探讨该药针对患病关节的镇痛消肿作用以及降低血尿酸和相关炎症指标的效果,并对其安全性进行评价,为该药的进一步推广应用提供依据。方法:本研究设计遵循平行对照、随机化原则,选取2015年1月~2016年12月期间就诊于山西省中医院疼痛科和风湿科住院部的患者,纳入患者均符合西医诊断标准和中医病证诊断标准,共纳入患者96例,随机分为治疗组(48例)和对照组(48例)。治疗组外敷金黄活血散,对照组外敷扶他林(双氯芬酸二乙胺乳胶剂),两组患者每日敷药2次,治疗10天。观察金黄活血散在改善关节疼痛、肿胀以及恢复关节功能等方面的作用,同时观察其降低血尿酸和相关炎症指标的作用。分别观察并记录两组患者治疗前后中医证候评分、疼痛VAS评分,以及实验室指标:血尿酸(UA)、血清C反应蛋白(CRP)、红细胞沉降率(ESR)的变化,同时注意监测可能出现的不良反应。采用SPSS23.0统计软件对全部数据进行分析处理。结果:1.两组临床总疗效比较:经过为期10天的治疗,治疗组总有效率为87.23%,对照组总有效率为76.60%,通过比较两组之间差异有统计学意义(P0.05),治疗组临床总疗效优于对照组。2.两组中医证候评分比较:治疗后两组患者中医证候评分较治疗前均有大幅度的降低,通过比较两组之间差异有统计学意义(P0.01),治疗组缓解各项关节主症及次症效果优于对照组。3.两组疼痛VAS评分比较:治疗后两组患者疼痛评分较治疗前均有明显的下降,通过比较两组之间差异有统计学意义(P0.01),治疗组缓解关节疼痛情况优于对照组。4.两组实验室指标比较:治疗后两组UA、CRP、ESR均较治疗前有明显的降低,治疗后组间比较,UA差别无统计学意义(P0.05),CRP、ESR差别有统计学意义(P0.05),CRP、ESR治疗后组间比较无临床意义,两种治疗方案均能有效降低血尿酸和改善炎症反应。5.两组安全性指标比较:两组患者治疗前后进行三大常规、心电图及肝肾功能比较,均无明显异常变化,不良反应发生率比较差别无统计学意义(P0.05)。结论:通过临床观察,外敷金黄活血散可有效缓解患者关节疼痛、红肿、功能障碍等主要症状,且能有效抑制患病关节的炎症反应,同时无明显不良反应,在降低血尿酸方面,与扶他林无明显差异。因此,运用金黄活血散外敷治疗急性痛风性关节炎,临床疗效良好,值得进一步推广应用。
[Abstract]:Objective: to observe the clinical efficacy of Jinhuang Huoxue Powder in treating acute gouty arthritis with damp-heat accumulation, and to explore the effect of this medicine on relieving pain and swelling and reducing serum uric acid and related inflammatory indexes.The safety of the drug was evaluated to provide the basis for the further application of the drug.Methods: according to the principle of parallel control and randomization, the patients who were admitted to the Department of pain and Rheumatology of Shanxi traditional Chinese Medicine Hospital from January 2015 to December 2016 were selected.All the patients were in accordance with the diagnostic criteria of western medicine and traditional Chinese medicine. 96 patients were randomly divided into treatment group (n = 48) and control group (n = 48).The treatment group was treated with Jinhuang Huoxue Powder and the control group with Fentalin (diclofenac diethylamine emulsion) twice a day for 10 days.To observe the effect of Jinhuang Huoxue Powder on improving joint pain, swelling and restoring joint function, and to observe the effect of Jinhuang Huoxue Powder on reducing blood uric acid and related inflammatory indexes.To observe and record the changes of TCM syndrome score, pain VAS score and laboratory indexes before and after treatment in two groups: serum uric acid, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ERR), and to monitor the possible adverse reactions.All the data are analyzed and processed by SPSS23.0 software.The result is 1: 1.After 10 days of treatment, the total effective rate of the treatment group was 87.23 and the total effective rate of the control group was 76.60. The difference between the two groups was statistically significant (P 0.05). The total clinical efficacy of the treatment group was better than that of the control group.Comparison of TCM syndromes between the two groups: after treatment, the scores of TCM syndromes in the two groups were significantly decreased compared with those before treatment, and the difference between the two groups was statistically significant (P 0.01). The effect of relieving the main symptoms and secondary symptoms of joints in the treatment group was better than that in the control group (3. 3).Comparison of pain VAS score between the two groups: after treatment, the pain scores of the two groups were significantly lower than those before treatment, the difference between the two groups was statistically significant (P 0.01), the relief of joint pain in the treatment group was better than that in the control group (.4).Comparison of laboratory indexes between the two groups: after treatment, the ESR of UAP was significantly lower than that of before treatment, and there was no significant difference in ESR between the two groups after treatment. There was no significant difference in ESR between the two groups after treatment, and there was no clinical significance between the two groups after treatment.Both can effectively reduce serum uric acid and improve inflammatory response.Comparison of safety indexes between the two groups: before and after treatment, there were no obvious abnormal changes in electrocardiogram and liver and kidney function, and there was no significant difference in the incidence of adverse reactions between the two groups before and after treatment (P 0.05).Conclusion: through clinical observation, application of Jinhuang Huoxue Powder can effectively relieve the main symptoms of joint pain, redness and swelling, dysfunction and so on, and can effectively inhibit the inflammatory reaction of the diseased joint, without obvious adverse reaction, so it can reduce blood uric acid.There was no significant difference between the two groups.Therefore, the application of Jinhuang Huoxue Powder in the treatment of acute gouty arthritis has a good clinical effect and is worth further popularizing.
【学位授予单位】：山西省中医药研究院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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