壮医药线点灸治疗痛风性关节炎的临床研究

发布时间：2018-05-14 22:23

本文选题：急性痛风性关节炎 + 湿热蕴结　；参考：《广西中医药大学》2016年硕士论文

【摘要】：目的:本研究主要观察壮医药线点灸治疗壮医辩证分型中湿热蕴结型和瘀热阻滞型两种证型的急性痛风性关节炎患者的临床疗效和安全性,通过各组临床疗效、关节肿痛评分以及血尿酸情况行对比研究,评价壮医药线点灸治疗急性痛风性关节炎的临床疗效,以提高壮医药治疗水平,为建立一个有效的壮医疗法临床疗效评价体系,使壮医药临床标准化、疗效评价标准化提供新的内容及思路。方法:本研究参照2004版中国壮医内科学的诊断标准及美国风湿病协会诊断标准,选取2014年3月至2015年10月本院针灸科、肾内科、内分泌等门诊及住院部符合诊断标准的急性痛风性关节炎患者90例,按照就诊顺序采用随机表法将患者随机分为3组,治疗组A(湿热蕴结型)和治疗组B组(瘀热阻滞型)两组在口服西药的基础上,根据壮医理论“寒手热背肿在梅”的取穴原则采用壮医药线点灸疗法在“梅花穴”及肾俞、足三里进行点灸,且治疗A组配以一些清热祛湿理气通络的穴位(大椎、曲池、外关、合谷、太冲、阳陵泉、丰隆穴、阴陵泉穴,均取双侧),治疗组B组配以一些清热活血祛瘀通络的穴位(大椎、曲池、外关、合谷、太冲、血海、膈俞、三阴交,均取双侧)。两组治疗每穴1壮,每日3次,每次间隔10分钟,2周为1疗程;对照组服用秋水仙碱(西双版纳药业有限责任公司生产)与别嘌醇片(广东彼迪药业有限公司生产)治疗。记录3组患者治疗前、治疗后关节肿痛积分与血尿酸变化以及不良反应等情况,通过统计学分析对3组治疗前后做组内对比与组间对比,评价各组疗效与安全性。结果:经两个疗程治疗后,90例患者无脱落病例,均纳入研究。(1)临床疗效数据显示,两组治疗组与对照组比较P0.05,治疗A组与治疗B组比较P0.05;(2)三组治疗前后关节肿痛积分与血尿酸数据显示,同组治疗前后比较,P0.01;治疗后各组比较,治疗A、B两组与对照组比较,P0.01;治疗A组与治疗B组比较,P0.05。(3)对照组30例中,出现上述不良反应者10例,占33.3%;治疗A组30例中,12例出现局部皮疹皮肤瘙痒和(或)胃肠道反应症状的不良反应,占40.0%,治疗B组出现12例局部皮疹水泡皮肤瘙痒和(或)胃肠道反应,占40.0%,两组治疗组不良反应发生率与对照组相当(P0.05),而两组不同壮医证型的治疗组之间相比较,不良反应发生率也无明显差异(P0.05)。结论:(1)两个西药基础上的壮医药线点灸治疗组和西药对照组治疗急性痛风性关节炎均取得优异疗效,但壮医疗法效果要好于单纯西药,而不同证型壮医药线点灸治疗的两组疗效相比无明显差异;(2)三组疗法均能降低血尿酸,减轻关节肿痛症状的效果,但壮医疗法降低血尿酸水平和改善关节肿痛症状效果要好于单纯西药,而基于西药基础上的壮医药线点灸治疗的两组疗效相比无明显差异;(3)安全性评价结论方面,治疗组与单纯西药治疗安全性相当,而壮医药线点灸的主要不良反应是局部皮疹水泡皮肤瘙痒,其安全可能比西药高。
[Abstract]:Objective: To observe the clinical efficacy and safety of two syndrome types of acute gouty arthritis in the dialectical typing of Zhuang medicine in the dialectical typing of Zhuang medicine, and to evaluate the clinical efficacy of each group, the score of joint swelling and pain and the condition of blood uric acid, and evaluate the treatment of acute pain with Moxibustion of Zhuang medicine line point. The clinical curative effect of wind arthritis in order to improve the treatment level of Zhuang medicine, to establish an effective evaluation system of clinical curative effect of Zhuang medicine therapy, to make the clinical standardization of Zhuang medicine, and to standardize the evaluation of curative effect. Method: This study refers to the 2004 edition of Chinese Zhuang Medical diagnosis standard and the diagnosis standard of the American Rheumatism Association. 90 cases of acute gouty arthritis in the Department of acupuncture and moxibustion, Nephrology, endocrinology, endocrinology, endocrinology and inpatient department were selected from March 2014 to October 2015. The patients were randomly divided into 3 groups according to the order of medical treatment, the treatment group A (damp heat accumulation) and the group B of the treatment group (blood stasis heat block type) in the group of two groups in the oral Western Medicine On the basis of the theory, according to the theory of Zhuang medicine, the principle of "cold hand heat back swelling in plum" is adopted by Zhuang medicine line point moxibustion therapy in "Mei Hua point" and Shenshu and Zusanli point moxibustion, and the treatment group A with some acupoints (dzhui, Quchi, Wai Guan, Hegu, Tai Chong, Yang Mausoleum, Feng long point, Yin Ling spring point, both sides), and treatment group B The two groups were treated with 1 Zhuang each of the two groups, 3 times a day, 10 minutes each time, 2 weeks as 1 courses, and the control group took the colchicine (Xishuangbanna Pharmaceutical Co., Ltd.) and Allopurinol Tablets (Guangdong medicine industry) Treatment. Records of 3 groups of patients before treatment, after the treatment of joint swelling and pain score and blood uric acid changes and adverse reactions, through statistical analysis of the 3 groups before and after the comparison and comparison between groups to evaluate the efficacy and safety of each group. Results: after two courses of treatment, 90 patients without shedding cases, all included in the research (1) the clinical curative effect data showed that the two groups were compared with the control group P0.05, the treatment group A and the B group were compared P0.05; (2) the joint swelling pain score and the blood uric acid data before and after treatment were compared, P0.01; the treatment groups were compared, the treatment A, B two groups were compared with the control group, P0.01; the treatment A group compared with the B group, P0.05., P0.05.. (3) of the 30 cases in the control group, 10 cases of these adverse reactions were found, accounting for 33.3%. Of the 30 cases in the A group, 12 cases had local rash skin pruritus and / or gastrointestinal reaction symptoms, accounting for 40%. In the treatment group, 12 cases of local rash blister skin pruritus and / or gastrointestinal reaction were 40%. The incidence of adverse reactions in the two groups was 40%. The incidence of adverse reactions in the two group and the two groups was associated with the incidence of adverse reactions. The group was equivalent to (P0.05), but there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion: (1) the treatment group of Zhuang medicine line point moxibustion and the western medicine control group were better than the western medicine, but the effect of Zhuang medicine therapy was better than that of the western medicine, but the effect of Zhuang medicine therapy was better than that of the pure western medicine, but the effect of Zhuang medicine therapy was better than that of the pure western medicine. There is no significant difference in the curative effect between the two groups of different syndromes of Zhuang medicine line point moxibustion treatment. (2) the three groups can reduce the blood uric acid and reduce the effect of joint swelling and pain symptoms, but the effect of Zhuang Medical method to reduce the level of blood uric acid and improve the symptoms of joint swelling and pain is better than the pure western medicine, and the two groups based on Western Medicine on Zhuang medicine line point moxibustion treatment. There was no obvious difference in effect. (3) the safety evaluation conclusion, the treatment group and the pure western medicine treatment safety is equivalent, and the main adverse reaction of the Zhuang medicine line moxibustion is the local rash blister skin itching, its safety may be higher than the western medicine.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R29

【参考文献】