表里分消法治疗心源性水肿的临床疗效研究

发布时间：2018-04-11 00:41

本文选题：心力衰竭 + 表里分消　；参考：《黑龙江中医药大学》2017年硕士论文

【摘要】：目的通过运用表里分消法治疗心源性水肿的临床观察,探讨对于心源性水肿的最佳治疗方案。方法:选取2014年12月～2015年12月就诊于我院,且诊断心力衰竭患者存在心源性水肿患者60例,患者随机分为治疗组及对照组。对照组按照传统强心,利尿,扩血管治疗;治疗组以表里分消为主,配合小剂量洋地黄类及扩血管药物,疗程为14天,观察两组患者治疗前后中医证候积分、水肿消退情况,心功能改善情况,尿量的增加有无以及血钾的变化。结果:比较两组患者在治疗前性别、年龄、中医证候积分、体重、原发病、6min步行试验情况,血钾均P0.05无统计学意义,提示二组患者具有可比性。1.两组患者中医证候改善比较,治疗组总有效率90%,对照组总有效率70%,治疗组效果优于对照组,计算以及比较后得出P=0.018故P0.05,具有统计学意义;在改善水肿方面,二组患者治疗前后水肿消退情况中,治疗组总有效率90%,对照组总有效率76.6.治疗组显著高于对照组。心功能改善情况中治疗组心功能改善情况总有效率为93%,对照组在改善心功能情况总有效率80%,治疗组显著高于对照组。2.比较两组患者6min步行试验中治疗后,治疗组中与对照组为477.33±77.18、349.00±62.38两组进行比较P0.05,差异具有统计学意义。3.两组患者治疗后尿量呈增加趋势,治疗组治疗前769.00±120.03ml,治疗7天后尿量为1141.00±150.82ml,治疗14天后,其尿量为1158.33±142.90ml进行组内比较,P值均小于0.05治疗有意义,对照组治疗前尿量为759.33±87.41ml,治疗7天后为991.33±81.56ml治疗14天后尿量为976.00±83.93ml,在治疗7天前有效(P0.05),7天之后,治疗无意义(P=0.57)。4.两组患者治疗期间血钾情况,治疗组治疗前以及3天、7天、12天、14天相对比,P值依次为0.48、0.319、0.717、0.209,各组之间无统计学差异对照组治疗前以及3天、7天、12天、14天相对比,P值依次为0.197、0.00、0.03、0.139,说明对照组在治疗第七天时,血钾情况明显降低,但仍在正常范围之内,随尿量的减少,其血钾在第12天又有所回升,直至到14天无明显变化。5.两组患者治疗后证候积分相比较治疗组与对照组的证候积分分别治疗前后证候积分为19.33±5.99、22.83±7.51,二者进行比较,P=0.017故P0.05,具有统计学意义;两组患者治疗前和治疗7天以及治疗14天后,中医症状积分主证的患者数量变化情况,均提示两组患者中医证候呈递减趋势,具有临床效果,但治疗组递减迅速,效果较对照组更显著。结论:对于心源性水肿患者应用表里分消法并配合西药治疗效果优于常规西医治疗方法,本方法对于改善中医证候,延长6分钟步行试验路程,改善心功能且对于钾离子影响较小有深刻意义,故发扬传统医学优势,具有一定临床研究意义。
[Abstract]:Objective to explore the best treatment for cardiogenic edema by clinical observation.Methods: from December 2014 to December 2015, 60 patients with cardiac edema were randomly divided into treatment group and control group.The control group was treated with traditional cardioversion, diuresis and vasodilatation, while the treatment group was treated with small doses of digitalis and vasodilators. The course of treatment was 14 days. The TCM syndromes and edema were observed before and after treatment in the two groups.The improvement of cardiac function, the increase of urine volume and the change of blood potassium.Results: there was no significant difference in sex, age, TCM syndrome score, body weight, 6-minute walking test of primary disease, blood potassium (P0.05) between the two groups, suggesting that the two groups have comparability. 1.The total effective rate of the treatment group was 90%, and the total effective rate of the control group was 70%. The effect of the treatment group was better than that of the control group. The calculation and comparison showed that P0. 018 and P0. 05 were statistically significant.Before and after treatment, the total effective rate of treatment group was 90 and that of control group was 76. 6%.The treatment group was significantly higher than the control group.The total effective rate of heart function improvement was 933 in the treatment group, 80 in the control group, and significantly higher in the treatment group than in the control group.After 6min walking test, the difference between the treatment group and the control group was 477.33 卤77.18349.00 卤62.38, the difference was statistically significant (P 0.05).The urine volume of the two groups showed an increasing trend after treatment. The urine volume of the treatment group was 769.00 卤120.03ml before treatment and 1141.00 卤150.82ml after 7 days treatment. After 14 days of treatment, the urine volume was 1158.33 卤142.90ml.The urine volume of the control group was 759.33 卤87.41 ml before treatment and 976.00 卤83.93 ml after 14 days of treatment with 991.33 卤81.56ml after 7 days of treatment.The status of serum potassium during the treatment of the two groups,Before treatment and 3 days after treatment, the P value of the treatment group was 0.488 卤0.3190.170.170.209, respectively. There was no significant difference between the control group and the control group before the treatment and the control group had the value of 0.197 / 0.000.0030.030.139before the treatment and the control group was on the 7th day after treatment, and the P value was 0.1970.0.0030.030.139in the control group, and the P value was 0.1970.0.0030.030.139in the control group at the 7th day after treatment.The serum potassium level was significantly decreased, but still within normal range. With the decrease of urine volume, the serum potassium increased on the 12th day, until the 14th day there was no obvious change. 5.The syndromes integral of the treatment group and the control group were 19.33 卤5.9ng 22.83 卤7.51 before and after treatment, which were statistically significant before and after treatment, and were compared between the two groups before and after treatment, and the difference was significant between the two groups before treatment, 7 days after treatment and 14 days after treatment.The changes in the number of patients with main syndromes of TCM symptoms indicated that the TCM syndromes of the two groups showed a decreasing trend with clinical effect, but the treatment group decreased rapidly and the effect was more significant than that of the control group.Conclusion: for patients with cardiogenic edema, the curative effect of epidermis and western medicine combined with western medicine is better than that of routine western medicine. This method can improve the syndrome of traditional Chinese medicine and prolong the walking distance of 6 minutes.The improvement of cardiac function has profound significance for potassium ion, so it is of clinical significance to carry forward the advantages of traditional medicine.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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