赖氏通元法艾灸治疗心源性水肿的临床研究

发布时间：2018-05-17 07:30

本文选题：心源性水肿 + 艾灸　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：本课题旨在通过随机对照试验,将符合各项标准的病例按随机分配的原则,分别纳入实验组(分为通元组、传统组)及对照组,观察并比较三组治疗第1、3、7天的体重下降幅度、中医症状积分下降幅度和24小时尿量,以及治疗结束后疗效评价。通过比较,评估通元法艾灸治疗心源性水肿的临床疗效,为防治心源性水肿提供有效可行的新方法、新思路。深入探索赖氏通元疗法的临床作用和理论内涵,凸显通元疗法的优越性,同时拓宽通元针法的表现形式。方法：所有病例均来源于广州中医药大学第一附属医院心内科,通过严格的纳入标准和排除标准,将符合要求的病例随机分配入对照组30例及实验组60例,实验组又分为通元组30例与传统组30例。三组均同时使用内科利尿、强心、扩血管等西医基础治疗,在此基础上,实验组则分别再予通元法取穴艾灸和传统法取穴艾灸治疗。观察并比较三组治疗第1、3、7天的体重下降幅度、中医症状积分下降幅度和24小时尿量,以及治疗结束后疗效评价。结果：一、一般资料方面：经比较,三组患者的性别、年龄、原始体重、症状积分及疾病诊断分布无明显差异(P0.05),不具有统计学意义,具有可比性。二、疗效分析：1.三组患者治疗后,体重较前明显下降,下降幅度呈不断递增趋势。第1、3、7天对照组体重下降幅度分别为1.76±2.15,3.82±3.58,5.36±3.23,通元组下降幅度分别为2.83±2.09,6.97±3.88,9.82±4.08,传统组下降幅度分别为2.18±2.62,4.96±3.37,7.38±4.24。三组组内比较,均有P0.05,差异有统计学意义。三组同期两两比较,第1天三组比较P0.05,提示差异无统计学意义；第3天通元组与其余两组之间比较P0.05,提示皆有差异有统计学意义,通元组大于传统组和对照组,而传统组与对照组比较P0.05,差异无统计学意义,提示二者差异不明显,第三天传统组与对照组的体重下降幅度基本相同;第7天三组比较P0.05,差异有统计学意义,提示该天体重下降幅度通元组大于传统组大于对照组。2.三组患者治疗后,症状较前明显改善,呈渐进式好转。第1、3、7天对照组症状积分下降幅度分别为5.80±6.27,8.90±5.55,10.73±5.07,通元组症状在积分下降幅度分别为9.10±5.07,15.03±6.08,19.20±6.08,传统组症状积分下降幅度分别为6.17±4.53,11.93±4.87,15.60±5.60。三组组内三天比较,均有P0.05,差异有统计学意义。三组同期两两比较,第1天通元组与其余两组之间比较P0.05,差异皆有统计学意义,提示当天症状积分下降幅度通元组大于传统组和对照组,而传统组与对照组比较P0.05,差异无统计学意义,提示二者差异不明显,说明通元组较传统组能更早地改善患者的症状;第3天和第7天三组两两比较,皆有P0.05,差异有统计学意义,提示这两天三组症状积分下降幅度通元组大于传统组大于对照组。3.三组患者治疗后,尿量增多,呈先增后减趋势。第1、3、7天对照组尿量分别为1980.67±503.53,2564.33±555.34,1646.67±489.20,通元组尿量分别为2064.33±456.33,3054.30±535.42,2273.67±389.38,传统组尿量分别为2022.33±477.94,2626.13±460.60,1893.33±494.65。三组组内三天比较,均有P0.05,差异有统计学意义,根据均值大小,对照组和传统组三天尿量比较第3天大于第1天大于第7天,而通元组三天尿量比较为第3天大于第7天大于第1天,说明通元组较传统组利水消肿的作用更加持久。三组同期两两比较,第1天三组比较P0.05,提示差异无统计学意义；第3天通元组与其余两组之间比较P0.05,提示皆有差异有统计学意义,通元组大于传统组和对照组,而传统组与对照组比较P0.05,差异无统计学意义,提示二者差异不明显,该天传统组与对照组的尿量基本相同；第7天三组比较P0.05,差异有统计学意义,提示该天尿量通元组大于传统组大于对照组。4.三组患者治疗后,疗效不同,对照组有效率为70%,通元组有效率为100%,传统组有效率为83.33%,经秩和检验分析,对照组与通元组比较,Z=-2.99,P0.05；对照组与传统组比较,Z=-1.04,P0.05；通元组与传统组比较,Z=-2.13,P0.05,说明通元组的临床疗效优于对照组和传统组,而对照组与传统组的疗效相当。结论：整体说明,在内科利尿、强心、扩血管等西医基础治疗加用艾灸措施,能更好地治疗心源性水肿,快速缓解患者的临床症状,促进身体康复。而不同的取穴方法,其临床疗效亦不相同。依据赖氏通元针法理论取穴,其艾灸效果优于传统取穴法艾灸治疗,通元法作用更强,取效更快,是值得临床推广使之更好地服务于社会的治疗方法。
[Abstract]:Objective: the purpose of this study was to observe and compare the weight decline of the three groups in the experimental group (divided into the Tongyuan group, the traditional group) and the control group according to the principle of random distribution according to the principle of randomized controlled trial, which were divided into the experimental group (divided into the Tongyuan group, the traditional group) and the control group, and the three groups were treated with the decrease of symptom score and the amount of urine of 24 hours, and the treatment after the end of treatment. To evaluate the clinical efficacy of Moxibustion in the treatment of cardiogenic edema by comparison, to provide effective and feasible new methods for the prevention and treatment of cardiogenic edema, and to explore the clinical role and theoretical connotation of Ryan's Tongyuan therapy, highlight the superiority of the Tongyuan therapy and broaden the manifestations of the Tongyuan acupuncture method. All from the Department of Cardiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, through strict inclusion criteria and exclusion criteria, 30 cases of the control group and 60 cases of the experimental group were randomly assigned to the control group. The experimental group was divided into the Tongyuan group and the traditional group 30 cases. The three groups all used the basic treatment of Western medicine, such as the internal Cori urine, the heart and the blood vessels, and so on. On this basis, the experimental group was given the acupuncture point moxibustion and the traditional method of Acupoint Moxibustion treatment. The weight loss of the three groups on day 1,3,7, the decrease of TCM symptom score and the 24 hour urine volume, and the evaluation of the curative effect after the end of the treatment were compared. There was no significant difference in age, original weight, symptom score and diagnosis distribution of disease (P0.05). There was no statistical significance, and was comparable. Two, the curative effect analysis: after treatment in group 1., the weight decreased significantly and the decrease was increasing. The weight loss of group 1,3,7 was 1.76 + 2.15,3.82 + 3.58,5.36 + 3.23, respectively. The decline range of the Tongyuan group was 2.83 2.09,6.97 + 3.88,9.82 + 4.08 respectively, and the decrease of the traditional group was 2.18 + 2.62,4.96 + 3.37,7.38 + 4.24. three groups, respectively, and there were P0.05, the difference was statistically significant. The three groups were compared with 22, first days and three groups were compared to P0.05, suggesting that the difference was not statistically significant; third day tuple and the rest two groups. The difference between the two and the control group was larger than the traditional group and the control group, while the traditional group and the control group were compared with the control group. The difference was not statistically significant. The difference was not significant. The difference between the two groups was not obvious. The third day group was basically the same as the control group, and the seventh day three groups compared P0.05, the difference was statistically significant. The difference was statistically significant. The average weight loss in the general group was greater than that of the control group.2. three groups, and the symptoms were improved obviously after the treatment. The symptom score of the control group was 5.80 + 6.27,8.90 + 5.55,10.73 + 5.07 respectively in the 1,3,7 day control group, and the lower amplitude of the symptoms in the general group was 9.10 + 5.07,15.03 + 6.08,19.20 + 6., respectively. 08, the decrease of the symptom score in the traditional group was 6.17 4.53,11.93 + 4.87,15.60 + 5.60. three groups in three days, and the difference was statistically significant. The three group was compared with the 22 compared with the other two groups, the difference was statistically significant between the first day tuple and the other two groups, suggesting that the decline of the symptom integral of the day was greater than that of the transmission group. The combination group and the control group, while the traditional group and the control group were compared P0.05, the difference was not statistically significant, suggesting that the difference between the two is not obvious, indicating that the Tongyuan group can improve the patient's symptoms earlier than the traditional group, and the third and seventh day three groups, 22 comparison, all have P0.05, the difference is statistically significant, suggesting that the three groups of three groups of symptom scores decrease in the general group. After the treatment of the.3. three groups in the traditional group, the urine volume increased first and then decreased. The urine volume of the control group was 1980.67 + 503.532564.33 + 555.341646.67 + 489.20 in the 1,3,7 day control group, and the urine volume in the Tongyuan group was 2064.33 + 456.333054.30 + 535.422273.67 + 389.38 respectively. The urine volume in the traditional group was 2022.33 + 477.942626.13 + 460.60,1, respectively. In the 893.33 + 494.65. three groups, there were three days compared with P0.05, the difference was statistically significant. According to the mean value, the comparison group and the traditional group three days urine volume was greater than first days greater than seventh days, while the three day urine volume in the Tongyuan group was third days larger than seventh days greater than seventh days, indicating that the function of the Tongyuan group was more lasting than the traditional group. The three groups were compared with 22 in the same period, first days and three groups were compared with P0.05, suggesting that the difference was not statistically significant. The difference between the third day group and the other two groups was statistically significant. The Tongyuan group was larger than the traditional group and the control group. The difference between the traditional group and the control group was P0.05, and the difference was not statistically significant, suggesting that the two differences were not obvious, The urine volume between the traditional group and the control group was the same as that in the control group. The difference was statistically significant between the three groups on the seventh day and the difference was statistically significant. It suggested that the urine volume group was more effective than the traditional group.4. three of the control group. The effective rate of the control group was 70%, the effective rate of the Tongyuan group was 100%, the traditional group had an effective rate of 83.33%, and the rank sum test analysis was used. Compared with the Tongyuan group, Z=-2.99, P0.05; compared with the traditional group, the control group was compared with the traditional group, Z=-1.04, P0.05; the Tongyuan group was compared with the traditional group, Z=-2.13, P0.05. The clinical effect of the Tongyuan group was better than the control group and the traditional group, while the control group had the same effect as the traditional group. Conclusion: the whole body shows the basic treatment of Western medicine, such as internal medicine diuresis, strong heart, vasodilator and so on. The treatment with moxibustion can better treat the cardiogenic edema, quickly relieve the clinical symptoms of the patients and promote the recovery of the body. The different methods of taking acupoints are different in clinical curative effect. According to the theory of Lai's Tongyuan acupuncture, the effect of moxibustion is better than the traditional point method of moxibustion treatment. The effect of the Tongyuan method is stronger and the effect is faster. It is worthy of clinical practice. It is worth clinical Promotion of better service to the society.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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