基于病机的多发性硬化急性期督脉贴敷法的临床疗效评价

发布时间：2018-06-12 03:15

本文选题：病机 + 多发性硬化急性期　；参考：《北京中医药大学》2017年硕士论文

【摘要】：研究目的1.比较中医外治穴位贴敷疗法合基础治疗方案与单纯基础治疗方案对多发性硬化急性期的临床疗效,评价穴位贴敷法对多发性硬化急性期的疗效作用。2.创新性的提出基于多发性硬化急性期中医病机认识基础上的督脉穴位贴敷理论,探讨以控制病机发展的外治方法与分经论治方法的切合点。研究方法本研究是北京市中医药科技项目《基于病机的多发性硬化急性期督脉贴敷法的临床评价》的主要研究内容。以多发性硬化急性期患者为研究对象,按照随机数字表法随机纳入患者50例,其中治疗组25例,对照组25例。参照"痿证(多发性硬化)中医诊疗方案"的辨证论治方案作为基础治疗方案进行研究设计,治疗组采用基础治疗方案结合穴位贴敷的外治法,对照组采用基础治疗方案。依据多发性硬化肾虚为本,湿热为标的中医病机理论,穴位贴敷法分别采用清利湿浊和补肾温阳两种治法,方药分别采用《理瀹骈文》所载行水膏和扶阳益火膏加减。行水膏贴敷于大椎、陶道、身柱穴,扶阳益火膏贴敷于两侧肾俞、命门、腰阳关、两足底涌泉穴。每日贴敷1次,每次4～6小时,共贴敷28天。分别于穴位贴敷用药当天、第14天、第28天3个时点进行临床评估。采用NIHSS评分、EDSS评分及Barthel指数及临床常见症状评分对多发性硬化急性期患者的神经功能、生活质量的改善情况进行疗效评估。研究结果1.基本资料:本研究共纳入53例患者,脱落3例(因家住外地不能如期随访),最终纳入统计分析共50例,其中治疗组25例,对照组25例。治疗组平均年龄40.76± 10.787,女性19例,男性6例;对照组平均年龄38.56± 11.132,女性19例,男性9例。两组女性38例,男性12例,女:男=3.2:1。治疗组和对照组入组当天在性别、年龄、民族、文化程度及职业等人口学资料比较中均无统计学差异(P0.05)。治疗组和对照组的在发病前感染史、吸烟史、饮酒史、糖尿病、中风、高脂血症等病史资料及证型、体质等中医基本资料均无统计学差异(P0.05),具有可比性。2.NIHSS评分变化结果:治疗组入组当天评分4.0(3.0),入组第28天评分3.4(4.0),下降1.0(2.5),差异具有统计学意义(P0.01);对照组入组当天评分3.0(4.0),入组28天评分3.0(2.0),下降1.0(2.0),差异具有统计学意义(P0.05)。对治疗组与对照组入组14天、28天NIHSS总分比较无显著性差异。治疗组入组14天、入组28天与入组当天,对照组入组28天与入组当天进行两两比较,结果均存在显著性差异。3.EDSS评分变化结果:治疗组入组当天评分(11.08±4.564),入组28天评分(5.24±3.407),下降(5.840±3.793),差异具有统计学意义(P0.01);对照组入组当天评分(11.80±5.008),入组 28 天评分(6.76±3.407),下降(5.040±3.780),差异具有统计学意义(P0.01)。治疗组与对照组入组14天比较存在显著性差异,入组28天比较无显著性差异。治疗组入组28天、入组14天分别与入组当天,对照组入组28天与入组当天比较,差异均存在统计学意义。4.Barthel指数评分变化结果:治疗组入组当天评分80.0(25.0),入组第28天评分90.0(17.5),上升10(17.5),差异具有统计学意义(P0.01);对照组入组当天评分80.0(32.5),入组第28天评分85(27.5),上升5.0(15.0),差异具有统计学意义(P0.01)。治疗组与对照组入组第14天与入组当天Barthel指数评分差值比较具有统计学差异。治疗组入组14天、入组28天分别与入组当天、对照组入组28天与入组当天比较,差异均具有统计学意义。5.常见临床症状改善情况:治疗组肢体无力、视力障碍、二便障碍、感觉异常、语言不清、共济失调、肢体疼痛、头晕治疗前后均存在差异,差异具有统计学意义(P0.05)。对照组肢体无力、二便障碍、感觉异常、共济失调、头晕差异具有统计学意义(P0.05);视力障碍、语言不清、肢体疼痛治疗前后无显著性差异(P0.05)。治疗组与对照组入组第28天组间临床症状评分比较,肢体无力、视力障碍及感觉异常三组临床症状治疗前后疗效存在差异,差异具有统计学意义(P0.05)。6.临床疗效分析:治疗组25例,显效17例(68%),有效6例(24%),无效2例(8%),总有效率92%。对照组25例,显效9例(36%),有效12例(48%),无效4例(16%),总有效率84%。差异具有统计学意义(P0.05)。研究结论1.在多发性硬化急性期内科治疗基础上,结合基于病机的中医外治穴位贴敷法可明显改善患者急性期神经功能缺损程度,改善临床症状,提高生活质量,为多发性硬化急性期临床治疗提供了新的方法和思路。2.基于多发性硬化急性期中医病机理论,创新性的提出内科辨证论治与外科分经(督脉)论治结合,应用了中医元素,发挥了中医治疗难治病的特色。3.穴位贴敷法疗效确切,操作简单,降低多发性硬化治疗成本,患者依从性较高,有利于在基层临床推广应用。
[Abstract]:Objective 1. to compare the clinical effect of traditional Chinese medicine acupoint application therapy combined with basic therapy and simple basic therapy on acute stage of multiple sclerosis, and to evaluate the effect of Acupoint Application on acute phase of multiple sclerosis (.2.) and to bring forward the innovation of the meridian point based on the understanding of the acute phase of multiple sclerosis in the acute phase of multiple sclerosis. The research method is the main research content of the clinical evaluation of the acute phase of multiple sclerosis based on the pathogenesis of the disease machine based acute phase of multiple sclerosis in Beijing. The digital table method was randomly included in 50 patients, including 25 cases in the treatment group and 25 cases in the control group. Referring to the syndrome differentiation and treatment scheme of "multiple sclerosis" (multiple sclerosis), the treatment group was designed as the basic treatment scheme. The treatment group adopted the basic treatment scheme combined with the external treatment of acupoint application, and the control group adopted the basic treatment scheme. According to the multiple characteristics. To harden the kidney deficiency and damp heat as the traditional Chinese medicine theory, the acupoint application method of the acupoint application was used respectively in the two methods of clearing wet turbid and tonifying the kidney and warming Yang respectively. The prescription was applied to the Zhui, Tao, body column, and Fu Yang Yi Huo ointment on both sides of the Shenshu, the life gate, the waist Yang Guan and the two foot. Yongquan point was applied 1 times a day for 4~6 hours each time for 28 days. The clinical evaluation was performed on the day of acupoint application, fourteenth days and twenty-eighth days at 3 points. The NIHSS score, the EDSS score, the Barthel index and the clinical common symptom score were applied to the improvement of the nerve function and quality of life of the patients with multiple sclerosis. 1. basic data: a total of 53 patients were included in the study, and 3 cases were dropped out (due to home stay in the field), and 50 cases were finally included in the statistical analysis, including 25 cases in the treatment group and 25 in the control group. The average age of the treatment group was 40.76 + 10.787, the female 19 cases were 6 cases, the average age of the control group was 38.56 + 11.132, the female 19 cases, the male 9 cases. Two groups of women 38 cases, male 12 cases, female: male =3.2:1. treatment group and control group on the day of sex, age, nationality, education and occupation and other demographic data are not statistically significant (P0.05). The treatment group and the control group in the history of pre onset infection, smoking history, drinking history, diabetes, stroke, hyperlipidemia and other medical history data and syndrome type, The basic data of traditional Chinese medicine had no statistical difference (P0.05), and the results of comparable.2.NIHSS score were 4 (3), 3.4 (4) and 1 (2.5) in the twenty-eighth days of entry group, and the difference was statistically significant (P0.01); the score of the control group was 3 (4), and the group was scored 28 days, 3 (2), declined 1 (2), and the difference has a difference. There was statistical significance (P0.05). There was no significant difference between the treatment group and the control group for 14 days and 28 days, and there was no significant difference in the total score of the 28 days. The treatment group entered the group 14 days, the group entered the group 28 days and the day of entry, the control group entered the group 28 days and the day of entry of 22, the results were significantly different.3.EDSS score changes: the treatment group was scored (11.08 + 4.5) on the day of entry. 64), the score of 28 days in the group (5.24 + 3.407), decreased (5.840 + 3.793), and the difference was statistically significant (P0.01). The score of the control group was (11.80 + 5.008), and the score of the group was 28 days (6.76 + 3.407), and the difference was statistically significant (P0.01). The difference was significant between the treatment group and the control group. There was no significant difference. The treatment group entered the group for 28 days, 14 days in the group and the day of entry, the control group was compared with the group for 28 days, the difference was statistically significant.4.Barthel index score change results: the treatment group was 80 (25), twenty-eighth days score 90 (17.5), 10 (17.5), the difference was statistically significant (P0.01); The score of the control group was 80 (32.5), the score of the group was 85 (27.5) and 5 (15), and the difference was statistically significant (P0.01). The difference between the treatment group and the control group at fourteenth days and the day of entry was statistically significant. The treatment group entered the group for 14 days, and the group entered the group 28 days respectively, and the control group entered the group 28 days and the control group entered the group on the day 28 days. On the day of entry, the difference was statistically significant in the improvement of common clinical symptoms of.5.: there were differences in the treatment group, such as limb weakness, visual impairment, two stool disorder, abnormal sensation, malfunction, ataxia, limb pain, and dizziness. The difference was statistically significant (P0.05). The control group was weak in limbs, two stool disorder, and abnormal sensation. The difference of ataxia and dizziness was statistically significant (P0.05); there was no significant difference between the treatment group and the control group (P0.05). The clinical symptom scores of the twenty-eighth days between the treatment group and the control group were compared, and there were differences in the clinical symptoms before and after the treatment of the limb weakness, the visual impairment and the sensation abnormality. Statistical significance (P0.05).6. clinical efficacy analysis: 25 cases in the treatment group, effective 17 cases (68%), effective 6 cases (24%), invalid 2 cases (8%), total effective 92%. control group 25 cases, significant effect 9 cases (36%), effective 12 (48%), invalid 4 cases (16%), the total effective 84%. difference has statistical significance (P0.05). Conclusion of the study conclusion in the acute stage of multiple sclerosis medical treatment basis The combination of TCM External Treatment acupoint application based on disease machine can obviously improve the degree of nerve function defect in acute phase of patients, improve the clinical symptoms and improve the quality of life. It provides a new method and thought for the clinical treatment of acute stage of multiple sclerosis,.2. based on the theory of TCM Syndrome in acute stage of multiple sclerosis, and innovatively put forward the dialectical theory of internal medicine. The combination of treatment and surgical treatment (Du Meridian) has applied the elements of traditional Chinese medicine. The.3. acupoint application is effective, easy to operate, to reduce the cost of the treatment of multiple sclerosis, and the compliance of the patients is high, which is beneficial to the application of the clinic.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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