妇科如意散外治协同逍遥散加减治疗慢性盆腔痛的临床观察

发布时间：2018-04-21 10:59

本文选题：慢性盆腔痛 + 妇科如意散　；参考：《云南中医学院》2017年硕士论文

【摘要】：目的:本课题运用临床对照观察研究,观察全国名中医易修珍教授的经验方“妇科如意散”外治协同逍遥散加减治疗肝脾不调夹瘀型慢性盆腔痛(CPP)的临床疗效。通过对患者治疗前后其盆腔疼痛、伴随症候及体征、生活质量改善等情况进行疗效观察和统计分析,评价中药内外综合治疗疗效,探寻中医药治疗CPP更加有效的药物和方法。方法:将56例符合纳入标准的慢性盆腔痛(肝脾不调夹瘀型)患者随机分为观察组和对照组,33例为观察组(妇科如意散外用+逍遥散加减口服),23例为对照组(仅逍遥散加减口服)。经净后第一天开始用药,连续用药10天为一疗程,一个月经周期治疗一个疗程,连续治疗两个疗程。通过观察两组患者治疗前后中医临床症状(下腹疼痛、腰骶部疼痛、带下异常等)、局部体征、盆腔积液、疼痛评分的变化及健康状况调查问卷等方面的变化进行总结归纳,利用SPSS21.0统计软件,对临床收集的数据通过秩和检验、卡方及t检验等方法,进行统计分析。结果:1、两组综合疗效比较,观察组与对照组的总疗效分别为93.9%和78.2%,观察组临床疗效优于对照组(P=0.036㩳0.05)。2、各项指标相比,组内比较,两组治疗在慢性盆腔痛、带下异常及烦躁易怒方面疗效比较,差异均有统计学意义,其中观察组在减轻慢性盆腔痛、改善带下异常方面有显著性差异(P㩳0.01);组间比较,观察组患者在腹痛、腰骶部疼痛、带下异常等指标改善方面,观察组疗效优于对照组(P㩳0.05),尤其在带下异常、疼痛在劳累、性交后及经期前后加重方面明显优于对照组(P㩳0.01);局部体征方面,治疗后子宫活动度、附件区增粗压痛改善方面差异有统计学意义,观察组优于对照组(P㩳0.05);而在月经不调、烦躁易怒、失眠等方面,两组疗效相当,差异无统计学意义(P0.05)。3、理化检查方面,疗后组内比较,两组治疗对盆腔积液改善方面均有效果(P㩳0.05);组间比较,差异具有统计学意义,观察组优于对照组(P㩳0.05);观察组外周血红细胞压积(HCT)较治疗前降低(P㩳0.05),血常规白细胞总数及其中性分类(WBC、NEUT#)治疗前后变化无统计学差异(P㧐0.05);对照组外周血WBC、NEUT#、HCT治疗前后变化无统计学差异(P㧐0.05);且两组比较,外周血HCT指标改善方面观察组优于对照组(P㩳0.05)。4、两组患者治疗后疼痛程度评分水平均下降,两组疗后较疗前比较,疼痛数字分级法(NRS评分)、疼痛口述分级法(VRS评分)差异均有统计学意义(P㩳0.05);NRS评分、VRS评分组间比较差异亦有统计学意义(P㩳0.05),表明二组均能降低盆腔疼痛评分,且内外合治组对镇痛疗效优于口服中药组。5、对生存质量各维度积分值的影响:治疗后内外合治组八个维度积分与治疗前比较,差异均有显著性(P㩳0.01),均高于治疗前;口服中药组八个维度积分与治疗前比较虽均有提高,但仅一般健康状况、生理机能、生理职能、躯体疼痛四个维度治疗前后比较差异有统计学意义(P㩳0.05);治疗后内外合治组维度积分高于口服中药组,一般健康状况、情感职能、社会功能、躯体疼痛、精力、精神健康维度比较差异具有统计学意义(P㩳0.05)。结论:1、妇科如意散协同逍遥散加减口服治疗慢性盆腔痛疗效显著。妇科如意散外敷能有效治疗慢性盆腔痛。2、妇科如意散外治+逍遥散加减口服、逍遥散加减口服对于肝脾不调夹瘀型慢性盆腔痛患者的疼痛程度、中医症状及局部体征等方面均有改善,且妇科如意散外治协同逍遥散加减疗效优于单纯逍遥散加减,值得进一步研究和推广使用。3、妇科如意散外治协同逍遥散加减内外合治能够更好的提高慢性盆腔痛患者的生活质量。
[Abstract]:Objective: To observe the clinical effect of the experience of Professor Yi Xiuzhen, a Chinese traditional Chinese medicine, on the treatment of chronic pelvic pain (CPP) with stagnation of liver and spleen with stasis of stagnation and stasis in the treatment of liver spleen and spleen stasis syndrome, and the improvement of the quality of life, such as the symptoms and signs, and the improvement of the quality of life. To observe the curative effect and statistical analysis, evaluate the curative effect of traditional Chinese medicine and internal and external treatment, explore the more effective medicine and methods of Chinese medicine treatment of CPP. Methods: 56 cases of chronic pelvic pain (liver and spleen unadjusted and stasis type) were randomly divided into the observation group and the control group, and 33 cases were the observation group (gynecologist Ruyi powder external use + Xiaoyao Powder Plus and minus mouth) 23 cases as the control group (only Xiaoyao Powder plus or minus oral). After the first day after the net use of medication, continuous medication for 10 days as a course of treatment, a menstrual cycle for a course of treatment, a continuous treatment of two courses. Through the observation of the clinical symptoms of the two groups of patients before and after the treatment of traditional Chinese medicine (lower abdominal pain, lumbosacral pain, abnormality, etc.), local signs, pelvic effusion, The changes in pain score and health status questionnaire were summarized, and SPSS21.0 statistical software was used to analyze the clinical data through rank and test, chi square and t test. Results: 1, the total curative effect of the two groups was compared, the total curative effect of the observation group and the control group was 93.9% and 78.2% respectively, the observation group was 93.9% and the observation group respectively. The clinical effect was better than that of the control group (P=0.036? 0.05).2. Compared with each other, the curative effect of the two groups in the treatment of chronic pelvic pain, abnormality and irritability were statistically significant. There were significant differences between the observation group in alleviating chronic pelvic pain and improving the abnormality of the band (P? 0.01); the group was compared with the observation group. The observation group was better than the control group (P? 0.05) in abdominal pain, lumbosacral pain, and abnormality, especially in the subband, the pain was overworked, and the aggravation of after and before and after the menstrual period was obviously superior to the control group (P? 0.01); in the local sign, the difference of the uterine activity after treatment and the improvement of the adnexal thickening and tenderness in the appendix area was statistically significant Learning significance, the observation group was better than the control group (P? 0.05); while in the irregular menstruation, irritability, insomnia, and other aspects, the two groups had the equivalent effect, the difference was not statistically significant (P0.05).3, the physical and chemical examination, after the treatment group, the two groups were effective (P? 0.05) in the improvement of the pelvic effusion (P? 0.05); the difference between the groups was statistically significant, the observation group was better than the observation group. The control group (P? 0.05); the hematocrit (HCT) of peripheral blood cells in the observation group decreased (P? 0.05), the total number of blood routine white blood cells and its neutral classification (WBC, NEUT#) had no statistical difference before and after treatment (P? 0.05); the changes of WBC, NEUT#, and HCT in the control group were not statistically significant before and after treatment (P? 0.05); and the two groups were compared, and the HCT index of peripheral blood was improved. The observation group was superior to the control group (P? 0.05).4, and the level of pain degree in the two groups decreased after treatment. The two groups were compared with before the treatment, the pain digital classification (NRS score), and the pain oral classification (VRS score) difference were statistically significant (P? 0.05); the NRS score was also statistically significant (P? 0.05) in the VRS score group (P? 0.05). The two groups can all reduce pelvic pain score, and the effect of internal and external treatment group on analgesic effect is better than that of oral Chinese medicine group.5, the effect on the integral value of each dimension of quality of life: after treatment, the eight dimensions of internal and external treatment group and before treatment, the difference is significant (P? 0.01), all higher than before treatment; oral Chinese medicine group eight dimension integral and before treatment before treatment Although the four dimensions of general health, physiological function, physiological function and somatic pain were significantly different before and after treatment (P? 0.05); the dimension integral of the internal and external treatment group after treatment was higher than that of the oral Chinese medicine group, and the general health, emotional function, social function, somatic pain, energy and mental health were different. Statistical significance (P? 0.05). Conclusion: 1, gynecologic Ruyi powder combined with Xiaoyao Powder plus or minus oral treatment of chronic pelvic pain is effective. Gynecologic such as external application can effectively treat chronic pelvic pain,.2, gynecologic treatment plus Xiaoyao Powder plus or minus oral, Xiaoyao Powder plus or minus oral treatment of chronic pelvic pain patients with liver spleen and spleen stasis type chronic pelvic pain patients pain degree, The curative effect of medical symptoms and local signs is improved, and the curative effect of the Department of gynaecology is better than simple Xiaoyao Powder Plus subtract. It is worth further studying and popularizing the use of.3.

【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R271.9

【参考文献】