虎黄通腑泄浊除痹方治疗痛风湿热蕴结证临床疗效观察

发布时间：2018-04-17 22:28

本文选题：痛风 + 湿热蕴结证　；参考：《中国中医科学院》2016年硕士论文

【摘要】：研究目的分析比较痛风湿热蕴结证治疗前后症状体征、疼痛缓解时间、实验室指标(血尿酸、血沉、C-反应蛋白)的改善情况,对虎黄通腑泄浊除痹方的有效性和安全性作出评价,为进一步临床推广应用提供临床依据,也为缓解患者病痛提供新的方法。研究内容及方法：共收集66例,采用随机对照研究方法随机分为两组,试验组和对照组,试验过程中两组因为患者依从性差而各脱落1例,脱落后总病例数为64例,两组各32例。对照组服用双氯芬酸钠缓片治疗；试验组给予双氯芬酸钠缓释片加虎黄通腑泄浊除痹方治疗；两组均严格戒酒、低嘌呤饮食、足量饮水、避免劳累、受寒,治疗7天后,用统计软件综合分析比较各项观察指标,最后评定临床效果。研究结果1两组基线比较试验组32例,男30例,女2例,平均年龄47.56±13.75岁,平均病程343.44±597.7天；症状体征证候总分21.93±4.49分；对照组32例,男31例,女1例,平均年龄46.28±12.97岁,平均病程362.97±513.2天；症状体征证候总分21.28±4.18分；上诉各项指标、症状体征证候各项指标及实验室各项指标(UA、ESR、CRP)经过分析比较,结果均无统计学差异(P0.05),证明两组具有可比性。2两组总体疗效比较试验组总体有效率为93.75%,其中达到临床控制15例,显效11例,有效4例,无效2例；对照组有效率为78.13%,其中达到临床控制8例,显效10例,有效7例,无效7例；经统计软件分析差异有统计学意义(P0.05),说明试验组较对照组总体疗效更好,总有效率更高。3两组组内及组间比较组内疗效比较：研究结果显示治疗后试验组和对照组组内各项指标比较差异均有统计学意义(P0.05),两组治疗后在关节疼痛、关节肿胀、压痛、活动受限、发热、口渴、心烦不安、小便短黄及实验室指标(UA、ESR、CRP)方面均有改善。组间疗效比较：(1)症状体征证候治疗前后差值组间疗效比较,结果表明两组在改善患者疼痛、发热、口渴、心烦不安、小便短黄及总分方面,差异有统计学意义(P0.05),试验组在改善上诉方面疗效优于对照组；两组在压痛、肿胀、活动受限方面的差异无统计学意义(P0.05),不能证明试验组在改善患者压痛、肿胀、活动受限方面疗效优于对照组。 (2)两组疼痛缓解时间组间比较差异有统计学意义(P0.05),试验组与对照组比较,疼痛缓解更为迅速。(3)实验室指标治疗前后差值组间比较,结果表明两组在改善血沉上差异无统计学意义(P0.05)；在改善C-反应蛋白、血尿酸上的差异有统计学意义(P0.05),说明在降低患者C-反应蛋白、血尿酸方面,试验组较对照效果更佳,但是在降低血沉方面,尚不能证明试验组优于对照组。4两组治疗后安全性比较两组患者治疗后血常规、便潜血、肝肾功均正常；对照组发生1例胃肠不适,3个小时后自行缓解,未予特殊处理,判断应属于药物不良反应。研究结论虎黄通腑泄浊除痹方联合双氯芬酸钠缓释片与单用双氯芬酸钠缓释片治疗痛风湿热蕴结证在改善患者关节疼痛、关节肿胀、压痛、活动受限、发热、口渴、心烦不安、小便短黄及实验室指标方面均有效果,但是前者较后者总体疗效更好,总有效率更高,改善中医证候方面效果更突出,疼痛缓解更迅速。可见,虎黄通腑泄浊除痹方联合双氯芬酸钠缓释片治疗痛风湿热蕴结证具有较好的临床疗效及安全性,值得进一步临床推广应用,治疗过程中尚需要注意双氯芬酸的不良反应。
[Abstract]:Study objective: to analyze and compare the pain before and after treatment of symptoms and signs of stagnation of rheumatic fever, pain relief time, laboratory indexes (serum uric acid, ESR, C- reactive protein) to improve the situation, to evaluate the effectiveness and safety of tiger yellow Tongfu Xiezhuo ChuBi decoction, to provide clinical basis for further clinical application, but also provide a new method to alleviate the pain of patients. The research contents and methods: 66 cases were collected, using randomized study were randomly divided into two groups, experimental group and control group, two groups in the experimental process because of poor compliance of patients and the loss in 1 cases, total cases after falling number for 64 cases, two groups of 32 cases. The control group taking diclofenac sodium tablets in the treatment of slow; the experimental group was given the Diclofenac Sodium Sustained Release Tablets tiger yellow Tongfu Xiezhuo ChuBi decoction treatment; two groups were strictly abstinence, low purine diet, drinking enough water, avoid fatigue and cold, 7 days after treatment, with statistical software A comprehensive analysis and comparison of the observed indicators, finally, to assess the clinical effect of two groups. The results of 1 baseline test group 32 cases, male 30 cases, female 2 cases, mean age 47.56 + 13.75 years old, the average duration of 343.44 + 597.7 days; symptom syndrome score 21.93 + 4.49; control group 32 cases, male 31 cases, female 1 cases, mean age 46.28 + 12.97 years old, the average duration of 362.97 + 513.2 days; symptom syndrome score 21.28 + 4.18; the indicators of appeal, indexes and laboratory indexes of symptoms and signs of TCM syndrome (UA, ESR, CRP) after analysis and comparison, the results were not statistically significant (P0.05), that the two groups were comparable in two groups of.2 overall efficacy comparison test group total effective rate was 93.75%, which reached 15 cases of clinical control, 11 cases markedly effective 4 cases, invalid 2 cases; the control group was 78.13%, which reached 8 cases of clinical control, 10 cases markedly effective in 7 cases. The 7 cases are invalid; Statistical analysis software, the difference was statistically significant (P0.05), the experimental group compared with the control group, the overall effect is better, the total efficiency of higher.3 in the two groups and between groups within the group effect: the results showed that after treatment in experimental group and control group in the indexes of the differences were statistically significant (P0.05). The two groups after treatment in joint pain, joint swelling, tenderness, activity limitation, fever, thirst, restlessness, short yellow urine and laboratory indexes (UA, ESR, CRP) were improved. The curative effect were compared between: (1) signs of syndrome symptoms for comparing the difference between two groups before and after treatment the curative effect, results show that the two groups in the improvement of pain, fever, thirst, restlessness, short yellow urine and total score, the difference was statistically significant (P0.05), the experimental group to improve the appeal has better effect than the control group; the two group in tenderness, swelling, limitation of activity difference aspects of no statistical significance Yi (P0.05), can not prove that the experimental group in improving patients with tenderness, swelling, limitation of activity has better effect than the control group (2). Two groups of pain relief time were statistically significant difference (P0.05), the test group and control group, pain relief was more rapid. (3) laboratory indicators of the difference between before and after treatment comparison between groups, the results showed that the two groups in the improvement of erythrocyte sedimentation rate had no significant difference (P0.05); in the improvement of C- reactive protein, there was significant difference on serum uric acid (P0.05), in patients with lower C- reactive protein, blood uric acid, the experimental group than the control effect is better, but in reducing ESR, still can not prove that the experimental group than the control treatment safety of the two groups of.4 after treatment in the two groups after the blood routine, fecal occult blood, liver and kidney function were normal; the control group occurred in 1 cases of gastrointestinal discomfort, after 3 hours of self relief, no special treatment, the judgment should be In adverse drug reactions. Conclusion Huhuang Tongfu xiezhuochubi decoction combined with Diclofenac Sodium Sustained Release Tablets Diclofenac Sodium Sustained Release Tablets for the treatment of gout rdhs improvement in patients with joint pain, joint swelling, tenderness, activity limitation, fever, thirst, restlessness, short yellow urine and laboratory indexes were both effective, but the former than the latter in general better curative effect, the total efficiency is higher, improve the effect of TCM syndrome is more prominent, more rapid pain relief. Therefore, tiger yellow Tongfu Xiezhuo ChuBi decoction combined with Diclofenac Sodium Sustained Release Tablets pain rheumatic fever therapy has good clinical efficacy and safety of stagnation, and is worthy of further clinical application in the treatment process, still need to pay attention to the bad the reaction of diclofenac.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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