推拿干预小儿脾虚质的临床评价研究

发布时间：2018-04-17 19:52

本文选题：推拿 + 小儿脾虚质　；参考：《南京中医药大学》2017年硕士论文

【摘要】：目的:小儿脾虚质是小儿体质中常见的一种体质类型,推拿对干预小儿脾虚质具有一定的疗效。本课题依据《中医治未病实践指南·推拿干预小儿脾虚质》(评价稿)的内容,运用临床观察及医学统计等方法,对推拿干预小儿脾虚质临床一致性和临床疗效进行探讨分析,为进一步制订符合临床实际需要的儿科治未病指南提供临床支持。方法:本研究分两部分进行。第一部分,采用病例调查分析方法,在《中医治未病实践指南·推拿干预小儿脾虚质》专家指导组指导下,选取了不同地域11个医疗机构作为评价单位,病例选取时间范围为近1年内,且不少于200例。从诊断、辨证、治疗等方面与指南进行比较,填写《中医诊疗指南一致性测试表(病例调查表)》,提交项目课题组。通过临床一致性评价分析结果来探讨《中医治未病实践指南·推拿干预小儿脾虚质》的临床实用性。第二部分,将符合脾虚质诊断的70例患儿,随机分成推拿组和药物组各35例,推拿组:采用《中医治未病实践指南·推拿干预小儿脾虚质》(评价稿)中推拿穴位处方。药物组:小儿壮儿饮口服液(江苏省中医院制剂,规格250ml/瓶,苏药制药批号:Z04000520),用法:0～3岁儿童每次10ml,每日3次,3～6岁儿童每次15ml,每日3次,6～12岁儿童每次20ml,每日3次。疗程:5日为1个疗程,共四个疗程。观察小儿脾虚质治疗前后各项症状积分,比较临床效果差异。结果第一部分1.对11个评价单位的213例小儿脾虚质一致性测试表汇总统计后可以看出:四个方面一致率均为100%。选穴及与操作相关因素的一致率因存在个体体质差异和地区地域的不同,其一致率虽为100%,但是比较一致率在其中所占比例较大。2.213例脾虚质病例中脾气虚和脾虚肝旺所占比例稍高,分别为43%、30%。11个医院评价单位在临床诊治脾虚质时采用的辨证分型与项目工作组提供的脾虚质治未病指南评价稿基本一致.3.穴位共使用27个共计1570频次,使用指南推荐穴位16个共1461频次,所占比例93%,说明推拿干预小儿脾虚质指南评价稿中选穴临床评价一致性较高。第二部分1.治疗前组间比较:推拿组和药物组在患儿性别、年龄及症状积分无统计学差异(P0.05)2.治疗后比较(1)两组组内比较:治疗中和治疗前对比,P0.05两者具有统计学差异,治疗末与治疗前比较,P0.05,两组也有统计学差异,(2)两组比较:推拿组治疗中、治疗末平均总积分均高于药物组,P值均小于0.05,两者均有统计学差异。结论:1.《中医治未病实践指南·推拿干预小儿脾虚质》(评价稿)临床一致性评价中体质判断、体质分型、判断依据及推拿操作、调护预防临床一致率均达到了 100%。2.推拿对干预小儿脾虚质的总体疗效要优于小儿壮儿饮口服药。3.《中医治未病实践指南·推拿干预小儿脾虚质》与中医儿科或推拿科干预小儿脾虚质的诊断、治疗等方面一致,且具有显著的临床效果。
[Abstract]:Objective: spleen deficiency in children is a common type of constitution in children, massage has a certain effect on intervention of spleen deficiency in children.According to the contents of massage intervention on spleen deficiency in children (evaluation draft), the clinical consistency and clinical effect of massage intervention on spleen deficiency in children were analyzed by clinical observation and medical statistics.To provide clinical support for the further development of guidelines for the treatment of pediatric diseases that meet the actual clinical needs.Methods: the study was divided into two parts.In the first part, using the method of case investigation and analysis, under the guidance of the expert guidance group, 11 medical institutions in different regions were selected as evaluation units under the guidance of the "practice Guide of Chinese Medicine for preventing Diseases" and Massage intervention in Children with spleen deficiency.The time range of case selection was within one year, and not less than 200 cases.Compare the diagnosis, syndrome differentiation and treatment with the guidelines, fill out the conformance test form of TCM diagnosis and treatment guidelines (case questionnaire) and submit it to the project group.The clinical practicability of massage intervention on spleen deficiency in children was discussed through the results of clinical consistency evaluation.In the second part, 70 children with spleen deficiency were randomly divided into massage group (35 cases) and drug group (35 cases).Drug group: children Zhuangeryin oral liquid (Jiangsu Provincial Hospital of traditional Chinese Medicine, standard 250ml/ bottle, Soviet pharmacy batch number: 10 ml / time, 15 ml / day, 3 times / day, 6 years old, 20 ml / day, 3 times a day, 3 times a day).Course of treatment: 5 days as a course of treatment, a total of four courses.To observe the symptom scores before and after treatment of spleen deficiency in children and to compare the clinical effect.Results the first part 1.According to the statistics of 213 children's spleen deficiency conformance test table in 11 evaluation units, it can be seen that the consistent rate of four aspects is 100.The consistency rate of acupoint selection and operation related factors was different in individual physique and region.Although the consistency rate was 100, the relatively consistent rate accounted for a large proportion of the cases with spleen deficiency. The proportion of spleen Qi deficiency and spleen deficiency liver prosperity was a little higher in 2.213 cases of spleen deficiency.The syndrome differentiation and classification used in clinical diagnosis and treatment of spleen deficiency were basically consistent with the evaluation draft provided by the project working group for the treatment of spleen deficiency.A total of 27 points were used for 1570 times and 16 points were recommended for 1461 frequencies, accounting for 93% of the total, indicating that the clinical evaluation consistency of acupoints selection was high in the evaluation draft of massage intervention guide for spleen deficiency in children.Part 1.Comparison before treatment: there was no significant difference in gender, age and symptom score between massage group and drug group (P 0.05).Comparison after treatment: comparison between two groups: there was a statistical difference between the two groups (P0.05) in treatment and before treatment, P0.05 at the end of treatment and before treatment, and there was also a statistical difference between two groups (P < 0.05): in the treatment of massage group, there was also a statistical difference between the two groups: in the treatment of massage group, there was a significant difference between the two groups.The mean total score at the end of treatment was higher than that in the drug group (P < 0.05), and there was statistical difference between the two groups.Conclusion 1. In the clinical consistency evaluation, constitution judgment, constitution classification, judgment basis and massage operation, the consistent rate of regulating nursing and preventing clinical were 100. 2.The overall curative effect of massage on children's spleen deficiency is better than that of children's Zhuangeryin oral medicine .3.The practice guide of traditional Chinese medicine for preventing disease intervention is consistent with that of Chinese pediatrics or massage department in the diagnosis and treatment of children's spleen deficiency, and in the intervention of Chinese pediatrics or massage department in the diagnosis and treatment of children's spleen deficiency.And has the remarkable clinical effect.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R244.1

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