桑芪首乌膏方对老年高血压患者中医体质干预的临床研究

发布时间：2018-09-07 16:33

【摘要】：目的:通过研究老年高血压(肝肾不足,心脾失养证)患者的中医体质分布情况;观察名老中医陆家龙教授经验方“桑芪首乌膏方”对老年高血压(肝肾不足,心脾失养证)患者的中医证候及体质状态的干预作用;进一步探讨辨病、辨证、辨体相结合防治老年高血压诊疗模式的意义,为中医体质学研究中“体质可调论”奠定理论基础。方法:将符合纳入标准的200例老年高血压患者进行信息采集,填写《中医体质分类与判定表》,按《中医体质分类与判定》标准进行体质判定,采用随机、对照研究方法,分为治疗组100例和对照组100例,对照组采用常规口服降压药治疗,并嘱低盐饮食、戒烟、限酒等改变不良生活方式;治疗组在对照组治疗的基础上加用桑芪首乌膏方,疗程均为28天;治疗后再次填写《中医体质分类与判定表》。整理前后两次数据,建立数据库,对两组患者治疗前后的中医证候总积分、中医体质转化分的变化、血压值、安全性指标进行对比分析。结果:1.最终病例187例,其中治疗组95例,对照组92例。两组患者在性别、年龄、病程、体质类型分布及治疗前的血压、中医证候总积分、中医体质转化分等方面差异无统计学意义;2.中医体质分布情况显示:187例老年高血压(肝肾不足,心脾失养证)患者的中医体质分布为:气虚质32.1%、平和质19.3%、阳虚质16.0%、阴虚质12.3%、痰湿质9.6%、湿热质3.7%、气郁质3.2%、血瘀质2.1%、特禀质1.6%。3.“桑芪首乌膏方”治疗老年高血压临床中医证候总积分、治疗总有效率对比研究:3.1中医证候总积分比较治疗组和对照组治疗前后中医证候总积分自身对照比较,差异均有统计学意义(P0.01);两组治疗28天后中医证候总积分组间比较,治疗组明显优于对照组(P0.01);3.2治疗总有效率比较治疗组总有效率为89.5%,对照组总有效率为41.3%,提示治疗组的疗效明显优于对照组(P0.01);4.中医体质转化分比较治疗组治疗前后平和质、气虚质、阳虚质、阴虚质、痰湿质、气郁质的体质转化分自身对照比较,差异均有统计学意义(P0.05),湿热质的体质转化分差异无统计学意义(P0.05);对照组治疗前后平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、气郁质的体质转化分自身对照比较,差异均无统计学意义(P0.05);两组患者治疗后组间比较,气虚质的体质转化分差异有统计学意义(P0.05),平和质、阳虚质、阴虚质、痰湿质、湿热质、气郁质的体质转化分差异无统计学意义(P0.05)。5.血压值比较两组治疗前后收缩压、舒张压组内比较均无统计差异(P0.05);两组治疗后收缩压、舒张压组间比较无统计差异(P0.05);6.安全性指标比较两组患者治疗前后血常规、尿常规、大便常规+潜血、肝功能、肾功能、心电图比较,差异无统计学意义。结论:老年高血压(肝肾不足,心脾失养证)患者的体质分布以气虚质、阳虚质、阴虚质多见,符合“以虚为主”的体质特点;桑芪首乌膏方能有效改善老年高血压患者的临床症状,起到改善老年高血压患者中医体质状态的作用,在治疗中未出现明显不良反应及毒副作用,临床安全有效,值得进一步推广和应用。
[Abstract]:Objective: To study the distribution of constitution of traditional Chinese medicine (TCM) in elderly patients with hypertension (liver and kidney insufficiency, heart and spleen dystrophy syndrome), observe the intervention effect of Sangqi Shouwu paste, a famous and old TCM professor Lu Jialong's empirical prescription, on the TCM syndrome and constitution of elderly patients with hypertension (liver and kidney insufficiency, heart and spleen dystrophy syndrome). Methods: 200 elderly hypertensive patients who met the inclusion criteria were collected information, filled in the "Classification and Judgment Form of Traditional Chinese Medicine Constitution" and judged according to the "Classification and Judgment of Traditional Chinese Medicine Constitution" criteria. The treatment group was given Sangqi Shouwu ointment on the basis of the treatment of the control group, and the treatment course was 28 days. The total score of TCM syndromes, changes of TCM constitution transformation, blood pressure and safety index were compared and analyzed before and after treatment. Results: 1. 187 cases were final, 95 cases in treatment group and 92 cases in control group. There was no significant difference in blood pressure, total score of TCM syndromes and constitution transformation score of TCM before treatment. 2. The distribution of TCM constitution in 187 elderly patients with hypertension (deficiency of liver and kidney, heart and spleen dystrophy syndrome) was 32.1%, 19.3%, 16.0%, 12.3%, 9.6% of phlegm and dampness, 3.7% of dampness and heat. Qi stagnation 3.2%, blood stasis 2.1%, special temperament 1.6%. 3. "Sangqi Shouwu Plaster" in the treatment of senile hypertension clinical TCM syndrome total score, treatment of total effective rate comparative study: 3.1 TCM syndrome total score compared with the treatment group and control group before and after treatment TCM syndrome total score self-control comparison, the difference was statistically significant (P 0.01); After 8 days, the total score of TCM syndromes in the treatment group was significantly better than that in the control group (P 0.01); the total effective rate was 89.5% in the treatment group and 41.3% in the control group, suggesting that the curative effect of the treatment group was significantly better than that of the control group (P 0.01); 4. The Constitutional Transformation scores of Yin-deficiency, phlegm-dampness and Qi-depression had statistical significance (P There was no significant difference between the two groups (P 0.05). There was no significant difference in blood pressure between the two groups before and after treatment. There was no significant difference in systolic blood pressure and diastolic blood pressure between the two groups. There was no significant difference in systolic blood pressure and diastolic blood pressure between the two groups (P 0.05). 6. Safety indexes were compared between the two groups before and after treatment, including blood routine, urine routine, stool routine + Occult blood, liver function, renal function, electrocardiogram. Conclusion: There was no significant difference in elderly patients with hypertension (liver and kidney insufficiency, heart and spleen dystrophy syndrome). Sangqi Shouwu ointment can effectively improve the clinical symptoms of senile hypertension patients and improve the constitutional state of senile hypertension patients. There are no obvious adverse reactions and toxic side effects in the treatment. It should be further promoted and applied.
【学位授予单位】：云南中医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R259

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