芍甘定颤汤治疗帕金森病的临床研究

发布时间：2018-07-15 14:15

【摘要】：目的本课题采用随机对照的设计方案,通过对帕金森病(PD)患者治疗前后症状、体征改善情况的临床观察,比较西药的使用情况,客观评价芍甘定颤汤辅助治疗帕金森病的疗效,为治疗帕金森寻找一条中西医结合的有效途径。方法收集符合PD诊断、纳入及排除标准的患者72名,随机分为观察组和对照组。对照组只给予西药普拉克索治疗,初始剂量为每次0.125 mg,每日3次；病情进展者,联合口服多巴丝肼片,初始剂量每次62.5mg,每日2次；观察组在上述西药治疗的基础上加用芍甘定颤汤。两组疗程均为3个月。分别在治疗前和治疗3个月后对两组PD患者进行各项UPDRS量表、中医症候量化分级表评分,并记录两组PD患者西药应用的种类和剂量。结果1.中西医结合治疗PD对UPDRS的影响治疗前观察组和对照组的UPDRS各部分及总分评分比较均无显著差异(P0.05),说明两组具有可比性；观察组与对照组治疗前后UPDRS总分比较差异明显(P0.05),且两组治疗后UPDRS总分的比较,观察组18.4706±6.3065分和对照组20.8286±5.4691分,比较有统计学差异(P0.05),说明两组在治疗后的UPDRS总分均明显改善,且对照组的改善更加明显：在UPDRS各部分积分的比较中,观察组治疗后UPDRS中的第Ⅱ、Ⅲ部分与对照组相比有统计学差异(P0.05),而在第Ⅰ、Ⅳ部分的比较中,差异不明显(P0.05),说明观察组在日常生活活动、运动功能部分评分的疗效更明显；由治疗前后UPDRS积分的变化计算其有效率,观察组有效率(85.29%)明显高于对照组(77.14%)。2.中西医结合治疗PD对中医症候量表的影响治疗前两组患者中医症候量表评分无统计学差异(P0.05),说明两组治疗前在中医症候方面均衡可比；两组治疗前后中医症候量表的总分均有明显差异(P0.05),说明两组在改善中医症候量表积分方面均有明显疗效；两组中医症候量表积分疗效差异有统计学意义(P0.05),且观察组总有效率(88.24%)高于对照组(74.29%),表明观察组疗效优于对照组。治疗后两组在手部动作迟缓、步态、颤振、面容、言语、生活自理力方面与治疗前相比均降低,且有统计学差异(P0.05),而观察组在肢体拘痉方面的疗效同样明显改善(P0.05),说明观察组在缓解PD患者肢体拘痉方面的效果好于对照组。3.中西医结合治疗PD对西药使用情况的影响两组患者经治疗3月后,普拉克索维持量比较,观察组的剂量明显小于对照组的剂量(P0.05),说明普拉克索与芍甘定颤汤联合应用治疗PD,只需较小维持剂量就能获得满意疗效。两组因病情进展加用多巴丝肼的情况比较,对照组加用多巴丝肼者的比例为15:35,,观察组加用多巴丝肼者的比例为4:34,两组比例比较具有统计学意义(P0.05),且多巴丝肼的使用剂量比较,观察组的用量明显较少(P0.05),说明联合应用芍甘定颤汤治疗PD,更能有效延迟PD病情的进展,降低加用多巴丝肼的几率,减少多巴丝肼的增加量。结论1.芍甘定颤汤联合西药治疗PD能有效改善患者的UPDRS评分、中医症候量化分级表评分。2.在西药治疗基础上加用芍甘定颤汤治疗早期PD的临床效果优于单用西药治疗的效果。3.西药与芍甘定颤汤联合应用治疗PD,只需较小维持剂量就能获得满意疗效；且能延迟PD病情的进展,降低多种西药联合应用的几率。
[Abstract]:Objective to adopt a randomized controlled design, through the clinical observation of the symptoms and signs of Parkinson's disease (PD) patients before and after treatment, compare the use of Western medicine, objectively evaluate the efficacy of Paeonia Gump Decoction in the treatment of Parkinson's disease, and to find an effective way to find a combination of Chinese and Western medicine for the treatment of Parkinson. A total of 72 patients were divided into the observation group and the control group. The control group was treated with western medicine pramexso, the initial dose was 0.125 mg each time, 3 times a day; the patients with the disease progressed, combined with the oral dose of 62.5mg, and 2 times a day for each time; the observation group was added to the western medicine on the basis of the treatment. The two groups were treated for 3 months. Before and after 3 months of treatment, two groups of PD patients were given various UPDRS scales, TCM syndrome grading scale scores, and the types and doses of Western medicine in two groups of PD patients were recorded. Results 1. the effect of combination of traditional Chinese and Western Medicine on UPDRS in the observation group and the control group of UPDRS before treatment. There was no significant difference in the score and total score (P0.05), indicating the comparability of the two groups. The total scores of UPDRS in the observation group and the control group were significantly different (P0.05), and the comparison of the total scores of the two groups after treatment was 18.4706 + 6.3065 and 20.8286 + 5.4691 in the control group (P0.05), indicating that the two groups were in the two groups. The total score of UPDRS after treatment was obviously improved, and the improvement of the control group was more obvious: in the comparison of the integral parts of the UPDRS, the second and third part of UPDRS in the observation group had a statistically significant difference compared with the control group (P0.05), while in the comparison of the first and fourth parts, the difference was not obvious (P0.05), indicating that the observation group was in daily life activities. The effect of the functional part score was more obvious; the efficiency of the UPDRS integral before and after the treatment was calculated, the effective rate of the observation group (85.29%) was significantly higher than that of the control group (77.14%). The effect of the combination of Chinese and Western Medicine on the TCM Syndrome Scale was not statistically significant (P0.05) in the two groups of patients before the treatment (P0.05), indicating that the two groups were before the treatment. The total score of TCM syndrome was significantly different in the two groups before and after treatment (P0.05), indicating that the two groups had obvious curative effect in improving the score of TCM Syndrome Scale, and the difference of the integral effect of the two groups of TCM syndrome scales was statistically significant (P0.05), and the total effective rate of the observation group (88.24%) was higher than that of the control group (74.2 9%), the observation group was better than the control group. After treatment, the two groups were lower in hand movement, gait, flutter, facial expression, speech, and self-care ability compared with before treatment, and there were statistical differences (P0.05), but the effect of the observation group in the limb spasmodic was also significantly improved (P0.05), indicating that the observation group was relieving the spasmodic side of the limbs of PD patients. The effect is better than the effect of the combination of.3. and Western Medicine on the use of Western medicine in the treatment of PD. Two groups of patients were compared with the maintenance of pramc after March. The dose of the observation group was significantly smaller than that of the control group (P0.05). Two groups were compared with dododozide in the two groups. The proportion of the control group added with dodozide was 15:35, and the proportion of dodozide in the observation group was 4:34 and the proportion of the two groups was statistically significant (P0.05), and the dosage of dodozide was compared, and the dosage of the observed group was significantly less (P0.05), indicating the combination of Paeonia Paeonia. The treatment of PD can effectively delay the progression of PD, reduce the probability of adding the use of the use of the use of the PD, and reduce the increase in the dose of the hydrazine. Conclusion 1. Paeonia Gan Ding tremor soup combined with western medicine can effectively improve the patient's UPDRS score, and the TCM Syndrome Quantification Scale score.2. is added to the early PD on the basis of the western medicine treatment. The effect of clinical effect is better than that of Western medicine alone..3. western medicine combined with peony Gump tremor soup is combined with the treatment of PD. Only a small amount of maintenance dose can be used to obtain satisfactory curative effect, and it can delay the progress of PD and reduce the probability of combination of various western medicine.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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