桂枝加葛根汤加味治疗风寒湿型神经根型颈椎病的临床观察

发布时间：2018-06-18 03:00

本文选题：神经根型颈椎病 + 风寒湿型　；参考：《成都中医药大学》2016年硕士论文

【摘要】：目的：通过桂枝加葛根汤加味结合颈椎牵引、中频脉冲与布洛芬缓释胶囊口服配合颈椎牵引、中频脉冲治疗风寒湿型神经根型颈椎病的疗效的对比研究,探讨桂枝加葛根汤加味治疗风寒湿型神经根型颈椎病的临床疗效及作用机制。方法：将2015年9月至2016年1月就诊于我院骨科的60例风寒湿型神经根型颈椎病的研究对象；运用信封随机分组法,将病患分为治疗组和对照组,各30例。治疗组予桂枝加葛根汤加味,一日一剂,配合每天颈椎牵引、中频脉冲一次,各20分钟；对照组予布洛芬,一日两次,配合每天颈椎牵引、中频脉冲一次,各20分钟；2周为一个疗程,共2个疗程。两组治疗前、后分别用目测类比评分(VAS)、田中靖久评分评估受试者的症状体征及随访3个月的田中靖久评分；并用SPSS19.0对数据统计处理。结果：(1)两组的总体疗效对比：P0.05,对比无统计学差异：表明两组的总体疗效无明显差别；但桂枝加葛根汤加味组的临床控制率(20%)和显效率(43.3%)均高于对照组的10.3%和34.5%。(2)两组治疗后VAS评分对比：P0.05,对比有统计学差异：说明桂枝加葛根汤加味组对缓解疼痛的效果要好于对照组。两组治疗后田中靖久症状体征功能评分对比：PO.05,对比无统计学差异；说明两组在治疗后田中靖久症状体征功能评分的改善差别不显著；但桂枝加葛根汤加味对改善症状体征功能还是要略微好于布洛芬。(3)两组1、2个月后复发例数对比：P0.05,对比无统计学差异；说明两组1、2个月后复发例数没有显著的差别。 3个月后复发例数对比：P0.05,对比有明显差异；说明布洛芬组3个月后复发例数比治疗组明显增加。由表可看出,对照组的复发例数随着时间的推移,增长幅度越大；说明布洛芬组的远期疗效比桂枝加葛根汤加味组差。结论：(1)桂枝加葛根汤加昧方可以治疗风寒湿型神经根型颈椎病,总体疗效与布洛芬缓释胶囊对照组没有明显差别；但远期疗效较好,且复发例数较少；说明中医辨证治疗更具优势。(2)本方的药理作用机制可能为：①缓解肌肉痉挛,改善微循环,消除炎症反应和神经根水肿；②镇痛消炎,保护神经细胞和调节骨代谢；③抑制免疫反应；针对“根性痛”三个主要病理。
[Abstract]:Objective: to compare the curative effect of Guizhi plus Gegen decoction combined with cervical traction, medium frequency pulse and ibuprofen sustained release capsule combined with cervical traction and middle frequency pulse in the treatment of rheumatic and wet nerve root cervical spondylosis. To explore the clinical efficacy and mechanism of Guizhi plus Gegen decoction in the treatment of cervical spondylosis of nerve root type of wind-cold and dampness type. Methods: from September 2015 to January 2016, 60 patients with rheumatic, cold and wet nerve root type cervical spondylosis were randomly divided into treatment group and control group with 30 cases each. The treatment group was treated with Guizhi plus Gegen decoction, one dose per day, combined with cervical traction every day, and the control group was given ibuprofen twice a day, once a day, 20 minutes each, and the control group was given ibuprofen once a day. 2 weeks as a course of treatment, a total of 2 courses of treatment. Before and after treatment, visual analogue scores were used to evaluate the symptoms and signs of the subjects and the follow-up data were analyzed by SPSS 19.0. Results there was no significant difference in the total curative effect between the two groups: (1) there was no significant difference in the total curative effect between the two groups. However, the clinical control rate of Guizhi plus Gegen decoction group (20) and the effective rate (43.3%) were higher than those of the control group (10.3% and 34.55.0%). The VAS score of the two groups after treatment was compared with that of the control group (P 0.05). The comparison showed that there was a significant difference between Guizhi group and Gegen decoction group in relieving pain. The effect was better than that in the control group. There was no significant difference in the scores of symptoms and signs between the two groups after treatment, indicating that there was no significant difference in the scores of symptoms and signs between the two groups after treatment. But Guizhi plus Gegen decoction could improve the function of symptoms and signs slightly better than that of ibuprofen group 1, and the number of recurrence cases 2 months later had no statistical difference, indicating that there was no significant difference in the number of recurrence cases between the two groups after 1 and 2 months. The number of recurrence cases in ibuprofen group after 3 months was significantly higher than that in treatment group. It can be seen from the table that the number of recurrence cases in the control group increases more with time, which indicates that the long-term effect of ibuprofen group is worse than that of Guizhi plus Gegen decoction group. Conclusion (1) Guizhi plus Gegen decoction can treat cervical spondylopathy of nerve root type of wind-cold and dampness type, the overall curative effect is not significantly different from that of ibuprofen sustained release capsule control group, but the long-term effect is better, and the number of recurrence cases is less. It is suggested that the pharmacological mechanism of traditional Chinese medicine (TCM) is to relieve muscle spasm, improve microcirculation, eliminate inflammatory reaction and nerve root edema, analgesia and anti-inflammation, protect nerve cells and regulate bone metabolism. 3 inhibition of immune response and three major pathologies of "root pain".
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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