温肾健脾方治疗肝硬化腹水的临床研究

发布时间：2018-05-12 20:15

本文选题：温肾健脾方 + 肝硬化　；参考：《湖北中医药大学》2016年硕士论文

【摘要】：目的:研究应用常规西医综合疗法联用温肾健脾中药方治疗肝硬化腹水的临床疗效及评价其安全性。方法:本实验遵从研究中制订的纳入及排除标准,选取满足条件的78例肝硬化腹水病人,进行随机数字分组,分为对照组和治疗组,各为39例。对照组单纯予以常规西医综合疗法:(1)一般治疗:休息及饮食疗法等;(2)病因治疗:如抗肝纤维化、降低门脉压、针对原发病等;(3)药物治疗:护肝降酶退黄、利尿、输血浆及人血白蛋白等对症支持疗法。治疗组在对照组治疗基础上联用温肾健脾类中药汤剂。疗程均为6周。观察并记录病人在疗程前后主要症状及其积分、体征、肝功能及凝血功能指标、24h尿量及腹水消退情况及实验结束后2个月内腹水复发情况等,用统计学进行临床功效归纳分析,并同时观察记录病人T、P、HR、BP,血液分析、肾功能、二便常规、心电图及药物不良反应等,评价药物的安全性。结果:⑴临床疗效比较:用药6周后治疗组显效15例、有效21例,总有效率为92.3%;对照组显效8例、有效20例,总有效率为71.8%;治疗组总有效率优于对照组,P(27)0.05,有统计学差异;⑵中医症状疗效比较:治疗组总有效率与显效率分别为94.9%、56.4%,对照组总有效率与显效率分别为74.4%、33.3%,两组相比较P0.05,具有统计学差异;⑶中医症状总积分比较:(1)同一组别在治疗前后的组内比较:6周疗程后中医症状总积分较治疗前明显下降,P0.05,有显著性差异,治疗后优于治疗前;(2)治疗组与对照组在治疗后比较:6周疗程结束后治疗组中医症状总积分较对照组下降更明显,P0.05,有著性性差异,治疗组优于对照组;⑷中医各主要症状积分比较:(1)同一组别在药物治疗前后各主要症状积分的组内比较:腹胀、水肿、倦怠乏力、食欲不振、恶心呕吐、便溏、胁肋疼痛、口干口苦、黄疸等症状积分均较治疗前下降,P0.05,有统计学差别,治疗后优于治疗前;(2)治疗组与对照组在6周疗程结束后各主要症状积分比较:腹胀、水肿、倦怠乏力、食欲不振、黄疸症状积分治疗组较对照组下降更明显,P0.05,证实统计学有显著差别,治疗组优于对照前,但6周疗程结束后治疗组与对照组恶心呕吐、便溏、胁肋疼痛及口干口苦症状积分无明显差异,P0.05,无统计学意义。⑸肝功能主要指标的比较:(1)同一组别在治疗前后的组内比较:治疗后ALT、AST、ALB、TBIL、CHE、TBA均较治疗前明显好转,P0.05,有统计学意义,治疗后优于治疗前;(2)6周疗程后治疗组与对照组比较:治疗组ALT、AST、TBIL、CHE、TBA均较对照组明显好转,P0.05,具有统计学意义,但两组在ALB改善方面无明显差别,P0.05,无统计学意义;⑹凝血功能的比较:(1)同一组别在治疗前后的组内比较:治疗后凝血功能较治疗前明显好转,P0.05,具有统计学差异;(2)6周疗程结束后治疗组与对照组的组间比较:治疗组凝血功能较对照组改善更明显,P0.05,具有显著性差异;⑺腹围及24h尿量的比较:(1)同一组别在治疗前后的组内比较:P0.05,具有统计学意义,治疗后优于治疗前;(2)疗程结束后治疗组与对照组的组间比较;P0.05,有统计学意义,提示治疗组在改善患者腹围及增加24h尿量方面优于对照组;⑻试验结束后2月内腹水复发情况比较:在疗程结束后2月内,治疗组有3例患者腹水复发,对照组有11例患者腹水复发,治疗组在2月内腹水复发率低于对照组,P0.05,有统计学意义。结论:常规西医综合疗法基础上联用温肾健脾中药方治疗肝硬化腹水,可显著改善病人的临床症状、体征、相关实验室指标及复发率,有利于腹水消退,临床效果显著,且在实验过程中未出现明显的毒副作用,药物使用安全,值得进一步临床实验研究及推广应用。
[Abstract]:Objective: To study the clinical efficacy and safety of traditional Chinese medicine combined with traditional western medicine combined with warm kidney and spleen invigorating traditional Chinese medicine in the treatment of cirrhotic ascites. Methods: the inclusion and exclusion criteria formulated in this study were made in this experiment, and 78 patients with cirrhosis ascites were selected and divided into control group and treatment group, each was 39. The control group only received conventional western medicine comprehensive therapy: (1) general treatment: rest and dietetic therapy, and (2) etiological treatment, such as anti liver fibrosis, lower portal pressure, primary disease and so on; (3) drug treatment: liver protection, depressing yellowing, diuresis, transfusion of plasma and Human Albumin, and other symptomatic support therapy. The treatment group was treated in the control group on the basis of treatment based on the temperature. The treatment of kidney invigorating Chinese herbs decoction was 6 weeks. The main symptoms, signs, signs, liver function and coagulation function, 24h urine volume and ascites regression and the recurrence of ascites within 2 months after the experiment were observed and recorded. The clinical efficacy was analyzed by statistics, and the patients' T, P, HR, B were observed at the same time. P, blood analysis, renal function, two stool routine, electrocardiogram and drug adverse reactions, and so on to evaluate the safety of drugs. Results: (1) comparison of clinical efficacy: after 6 weeks of medication, 15 cases were markedly effective in the treatment group, 21 cases were effective, the total effective rate was 92.3%, 8 cases in the control group, 20 effective, and the total effective rate was 71.8%; the total effective rate of the treatment group was better than the control group, and the total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group. The total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate of the treatment group was Comparison of Chinese traditional Chinese medicine symptoms: (2) comparison of the curative effect of traditional Chinese medicine: the total efficiency and effective efficiency of the treatment group were 94.9%, 56.4% respectively, the total effective rate and the significant efficiency of the control group were 74.4%, 33.3%, and the two groups were compared P0.05, with statistical difference; (1) the comparison of the same group in the group before and after the treatment: after 6 weeks of treatment, the symptoms of traditional Chinese medicine were total Scores were significantly lower than before treatment, P0.05, significant difference, after treatment before treatment; (2) compared with the control group after treatment: after 6 weeks of treatment, the total score of TCM symptoms in the treatment group decreased more significantly than the control group, P0.05, there were significant differences, the treatment group was better than the control group; (1) the same of the main symptoms of traditional Chinese medicine: (1) the same one Group comparison of the main symptom scores before and after the treatment: abdominal distention, edema, burnout, anorexia, nausea and vomiting, loose stool pain, dry mouth pain, jaundice, and jaundice symptom scores were lower than before treatment, P0.05, after treatment better than before treatment; (2) treatment group and control group after 6 weeks of treatment after the end of the main course. Symptom scores were compared: abdominal distention, edema, tired lassitude, anorexia, and jaundice symptom integral treatment group decreased more obviously than the control group, P0.05, confirmed statistically significant difference, the treatment group was better than the control group, but after 6 weeks of treatment, the treatment group and the control group had no significant difference in nausea and vomiting, stool pain and stomatostomy symptoms, P0.05 The comparison of main liver function indexes: (1) the comparison of the same group before and after treatment: after treatment, ALT, AST, ALB, TBIL, CHE, TBA were obviously better than before treatment, P0.05, statistically significant, better than before treatment; (2) the treatment group after 6 weeks treatment was compared with the control group: the treatment group was ALT, AST, TBIL, CHE, TBA were compared with the control group Obviously improved, P0.05, with statistical significance, but there was no significant difference between the two groups in the improvement of ALB, P0.05, no statistical significance. (1) compared with the same group before and after treatment: after treatment, coagulation function was significantly better than before treatment, P0.05, with statistical difference; (2) the treatment group and the control group after the end of 6 weeks of treatment. Compared with the control group, the coagulation function in the treatment group was more obvious than the control group, with a significant difference in P0.05. The comparison of abdominal circumference and 24h urine volume: (1) the comparison of the same group in the group before and after treatment: P0.05, with statistical significance, better than before the treatment; (2) the comparison between the treatment group and the control group after the end of the treatment; P0.05, with statistical meaning The treatment group was better than the control group in improving the patient's abdominal circumference and increasing the 24h urine volume. After the end of the trial, the recurrence of ascites in the treatment group after the end of February was compared: in the treatment group, there were 3 cases of ascites recurrence in the treatment group and 11 cases of ascites recurrence in the control group. The recurrence rate of ascites in the treatment group was lower in the treatment group than the control group in February, P0.05, with statistical meaning. Conclusion: the treatment of cirrhotic ascites with traditional Chinese medicine on the basis of conventional western medicine combined with traditional Chinese medicine can significantly improve the clinical symptoms, signs, related laboratory indexes and recurrence rate, which is beneficial to the elimination of ascites, the clinical effect is significant, and there is no obvious toxic and side effects in the process of experiment, and the safety of drug use is worthy of further study. Clinical experimental research and application.

【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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