揿针辅助中药治疗口腔扁平苔藓（脾虚湿蕴证）的短期临床疗效观察

发布时间：2018-07-23 10:16

【摘要】：目的：通过观察揿针辅助中药汤剂治疗口腔扁平苔藓(脾虚湿蕴证)的短期临床疗效,初步探索揿针在口腔扁平苔藓的治疗中的增效作用,以期拓展揿针的适用病症范围,延伸应用中医药方法治疗口腔扁平苔藓的思路。方怯：将四川省中医院口腔科口腔黏膜专病门诊所收治的60例合格口腔扁平苔藓患者随机分为A组治疗组(揿针加中药治疗)和B组对照组(中药治疗),每组各30例,要求入组患者必须符合口腔扁平苔藓的诊断标准和脾虚湿蕴证的辨证标准。对照组接受以健脾化湿方为主的中药治疗,治疗组在此基础上加用揿针埋针治疗,两组疗程均为30天。一个疗程结束后,分别比较两组治疗后第7天(D7)、第14天(D14)、第30天(D30)的口腔黏膜病损局部的体征及症状改善情况,以体征记分为客观观察指标,以疼痛直观类比标尺法(VAS)评分、口内局部症状改善情况(包括口干口黏,口腔黏膜麻木感、粗糙感)为主观观察指标,评价两组治疗的总有效率和疗效差异。所有数据采用SPSS 19.0统计软件进行处理分析。结果：1、总有效率：治疗结束后,A组总有效率93.33%,B组总有效率83.33%,差异无统计学意义(P0.05)。2、体征记分：治疗结束后,两组病损情况均有改善。A组在D7,D14,D30的体征记分值并未低于B组,差异无统计学意义(P0.05)；A组在D7,D14,D30的体征记分改善度均优于B组,体征记分总体下降幅度A组大于B组,差异无统计学意义(P0.05),同时A组体征记分下降者比例也高于B组。3、VAS评分：治疗结束后,两组疼痛程度均有减轻。A组在D7,D14,D30的VAS评分值并未低于B组,差异无统计学意义(P0.05)；A组在D7时疼痛减轻程度略优于B组,而B组在D14和D30时疼痛值下降程度都优于A组,VAS评分总体下降幅度A组不优于B组,差异无统计学意义(P0.05)；但是A组在D7,D14,D30时VAS评分下降者比例高于B组。4、局部症状：治疗结束后,部分患者口干口黏、麻木感、粗糙感症状有好转。A组中粗糙感好转比例高于B组；总体中粗糙感好转比例高于口干口黏或麻木感的好转比例。结论：1、中药健脾化湿方在口腔扁平苔藓脾虚湿蕴证的治疗中展示出了肯定的治疗效果,从局部上看能改善黏膜病损处充血水肿情况,减轻口内疼痛或其他不适感,缓解口干,口中黏腻,黏膜麻木感,粗糙感等症状,从整体上看可芳化湿浊,健运脾气,达到了祛邪扶正,标本同治的效果。2、揿针在本研究中并未表现出明显的增效作用,其原因可能与OLP的针灸疗法尚处于初步探索阶段,缺乏相关方法论研究和疗效评价标准作参考和指导,针灸治疗方案暂不成熟有关。因此,下一步可着眼于建立系统性的研究方法及标准评价体系,为今后的相关研究提供参考资料。
[Abstract]:Objective: to observe the short-term clinical effect of the treatment of oral lichen planus (spleen deficiency and dampness accumulation syndrome) by using Chinese medicine decoction supplemented by press acupuncture, and to explore the synergistic effect of press needle in the treatment of oral lichen planus, in order to expand the scope of disease of press needle. Extension of the treatment of oral lichen planus with traditional Chinese medicine. Fang Qi: 60 cases of qualified oral lichen planus patients treated in stomatology department of Sichuan traditional Chinese medicine hospital were randomly divided into group A (press acupuncture plus Chinese medicine treatment) and group B (control group) with 30 cases in each group. The patients in the group must meet the diagnostic criteria of oral lichen planus and the syndrome differentiation of spleen deficiency and dampness accumulation. The control group was treated with traditional Chinese medicine mainly for invigorating spleen and removing dampness, and the treatment group was treated with pressure-needle embedding acupuncture on this basis. The course of treatment in both groups was 30 days. After a course of treatment, the local signs and symptoms of oral mucosal lesions were compared between the two groups on day 7 (D7), day 14 (D 14) and day 30 (D 30). The improvement of intraoral local symptoms (including dry mouth viscosity, numbness of oral mucosa and rough feeling) was used as a subjective index to evaluate the total effective rate and curative effect of the two groups. All the data were analyzed by SPSS 19.0 statistical software. Results: at the end of treatment, the total effective rate of group A was 93.33 and the total effective rate of group B was 83.33, the difference was not statistically significant (P0.05) .2.The score of physical signs: after the treatment, there was improvement in both groups. The scores of physical signs in group A were not lower than those in group B, and the scores of signs in group A were not lower than those in group B. There was no significant difference (P0.05) the improvement degree of physical sign score in group A was better than that in group B (P 0.05), and the overall decrease of physical sign score in group A was greater than that in group B, and the improvement of the score of physical signs in group A was higher than that in group B. There was no significant difference (P0.05), at the same time, the proportion of patients with decreased score of physical signs in group A was also higher than that in group B: after treatment, the pain degree of group A was alleviated. The VAS score of group A was not lower than that of group B in D7 D14 D30, the difference was not statistically significant (P0.05). The degree of pain relief in group A was slightly better than that in group B at D7, while the degree of decrease of pain value in group B at D14 and D30 was better than that in group A (P < 0.05), but the overall decrease of VAS score in group A was not better than that in group B (P0.05). However, the proportion of patients in group A who had decreased VAS score at D7 / D14 / D30 was higher than that in group B. Local symptoms: after treatment, some patients had dry mouth stickiness, numbness, rough feeling symptoms improved. The proportion of rough feeling improvement in group A was higher than that in group B; In general, the improvement rate of rough feeling was higher than that of dry mouth viscidity or numbness. Conclusion 1. The traditional Chinese medicine Jianpi Huazheng Fang has shown positive therapeutic effect in the treatment of the syndrome of deficiency of spleen dampness in oral lichen planus. Locally, it can improve the hyperemia and edema in the lesion of mucous membrane, relieve the pain or other discomfort in the mouth, and relieve the dry mouth. The symptoms such as sticky mouth, numbness of mucous membrane, rough feeling and so on, can be aromatised and wet and turbid as a whole, and can move the temper healthily, thus achieving the effect of dispelling evil and nourishing the right, treating the specimen with the same treatment. 2. The press needle has no obvious synergistic effect in this study. The reason may be that the acupuncture and moxibustion therapy of OLP is still in the initial stage of exploration, lacking of relevant methodological research and evaluation criteria of curative effect, and that the treatment scheme of acupuncture is not mature yet. Therefore, the next step is to establish a systematic research method and standard evaluation system to provide reference for future research.
【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】：R276.8

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