基于临床证据的中药复方治疗病毒性心肌炎组方用药规律研究

发布时间：2018-05-16 19:00

本文选题：病毒性心肌炎 + 系统评价　；参考：《山东中医药大学》2016年硕士论文

【摘要】：目的:探讨中药复方治疗病毒性心肌炎的用药规律、关键配伍及核心治法,为该病的临床治疗方案提供理论参考依据。方法:(1)检索CNKI、VIP、Wanfang data等中文数据库中中药复方治疗病毒性心肌炎的临床研究文献,筛选符合要求的临床对照试验文献,并对纳入研究的有效性进行评价;(2)提取系统评价中筛选出的有效研究中的有效处方,运用中医传承辅助系统(v2.5)进行数据分析;(3)总结治疗病毒性心肌炎的用药组方规律与核心治法。结果:(1)筛选出符合纳入标准的临床研究343项,涉及治疗成人病毒性心肌炎中药复方285首,治疗小儿病毒性心肌炎中药复方74首;(2)Meta-分析显示:3项研究所选处方在临床有效率比较上无统计学意义,提示为无效治疗,其余340项研究中的359首方剂对病毒性心肌炎有效;(3)对有效处方中的药物进行数据分析,成人处方在(支持度50%,置信度0.85)时提取5味核心药组,小儿处方在(支持度35%,置信度0.8)时提取2味核心药组;(4)分别对纳入的治疗成人和小儿病毒性心肌炎的180味和104味药物进行功能分类和药性总结;(5)利用复杂系统熵聚类分析治疗成人和小儿病毒性心肌炎的复方分别得到8个和6个备选新方药组。结论:(1)中药复方治疗病毒性心肌炎疗效显著,具有毒副作用小、效果稳定性高的特点;(2)补气药、活血化瘀药、清热解毒药、补阴药、清热凉血药、清热燥湿药、收涩药、解表药、补血药等9类药物为治疗成人病毒性心肌炎的主要功能类别药物(82.14%);补气药、活血化瘀药、清热解毒药、补阴药、收涩药、清热燥湿药、补血药、清热凉血药等8类药物为治疗小儿病毒性心肌炎的主要功能类别药物(约80%);(3)黄芪-麦冬-丹参-五味子-炙甘草为关联度最高的治疗成人病毒性心肌炎常用核心药组,丹参、姜半夏、石菖蒲为关联度最高的备选新方的核心药物;丹参-五味子为关联度最高的治疗小儿病毒性心肌炎的常用核心药组,瓜蒌、桂枝为关联度最高的备选新方的核心药物;(4)临床以益气养阴、清热解毒、活血化瘀、宁心安神为其主要治法,根据兼证适当配伍养血、燥湿、收涩、解表、安神、渗湿、化痰、开窍等药物,即可组成扶正祛邪、标本兼治的有效临床复方。
[Abstract]:Objective: to explore the rule, key compatibility and core treatment of traditional Chinese medicine for viral myocarditis, and to provide theoretical basis for clinical treatment of the disease. Methods: to search the clinical research literature of traditional Chinese medicine compound for treating viral myocarditis in Chinese database, such as data and so on, and to screen the literature of clinical controlled trials that meet the requirements. The effectiveness of the study was evaluated and the effective prescriptions were extracted from the effective research selected in the evaluation system. To summarize the prescription and core treatment of viral myocarditis by means of traditional Chinese Medicine inheritance Assistance system (v2.5). Results (1) 343 clinical studies, involving 285 Chinese herbs for the treatment of viral myocarditis in adults, were selected. The analysis of 74 Chinese herbs for the treatment of viral myocarditis in children showed that there was no statistical significance in the clinical effective rate of the prescription selected in the three studies, indicating that the prescription was ineffective. 359 prescriptions of the other 340 studies were used to analyze the effective drugs in viral myocarditis. Five core drugs were extracted from adult prescriptions at the time of (support 50, confidence 0.85). Children's prescriptions at (support 35g, confidence 0.8) extraction of 2 core drugs group (4) to include in the treatment of viral myocarditis in adults and children 180 and 104 drugs for the functional classification and drug summarization) the use of complex system entropy Cluster analysis was used to treat viral myocarditis in adults and children. Conclusion the traditional Chinese medicine compound has remarkable curative effect in treating viral myocarditis. It has the characteristics of low toxicity and high stability. It has the characteristics of invigorating qi, activating blood circulation and removing stasis, clearing away heat and detoxification, reinforcing yin, clearing away heat and cooling blood, clearing heat and dampness, and collecting astringent drugs. Nine kinds of drugs, such as antipods, blood-tonifying drugs and so on, are the main functional drugs for the treatment of adult viral myocarditis. They are 82.14. They are tonifying qi, promoting blood circulation, clearing heat and removing blood stasis, clearing away heat and detoxification, supplementing yin, receiving astringent drugs, clearing away heat and dampness, and tonifying blood. Eight kinds of drugs, such as clearing heat and cooling blood, are the main functional categories of treating viral myocarditis in children. Astragalus membranaceus, Radix Ophiopogonis, Danshen, Schisandra Schisandra and Glycyrrhiza Glycyrrhiza are the most commonly used core drugs in the treatment of viral myocarditis in children, salvia miltiorrhiza, Salvia miltiorrhiza, Rhizoma Pinellia ternata and Acorus calamus are the core drugs of the new formula with the highest correlation; Danshen and Schisandra are the most commonly used core drugs for the treatment of viral myocarditis in children, Trichosanthes. Cinnamon branch is the core drug of alternative new prescription with the highest degree of correlation.) clinically, it is mainly treated by supplementing qi and nourishing yin, clearing away heat and detoxification, activating blood circulation and removing blood stasis, and calming heart and tranquilizing the mind. According to the appropriate combination of syndrome and syndrome, it nourishes blood, dries dampness, collects astringent, releases tables, calms the nerves, seeps dampness, dissipates phlegm, and reduces phlegm. Open orifices and other drugs, you can form an effective clinical compound for strengthening the spirit and dispelling evil and treating both symptoms and symptoms.
【学位授予单位】：山东中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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