超声介导复方黄柏液治疗粉刺性乳痈的临床研究

发布时间：2018-09-11 19:33

【摘要】：背景:粉刺性乳痈在西医学上称之为"浆细胞性乳腺炎",具有病程长、不易治疗、容易反复发作、预后不佳的特点,给患者的生活和工作带来了极大的不便,给患者的生理和心理造成了极大的创伤,就目前国内外的研究表明,该病并没有一种特效性的治疗方法。目的:本研究提出了运用超声介导复方黄柏液靶向递送技术治疗肿块期粉刺性乳痈,以进一步了解超声介导药物靶向递送技术治疗肿块期粉刺性乳痈的有效性和安全性,为医学界治疗肿块期粉刺性乳痈提供新方法和新思路,以提高临床疗效。方法:将40例粉刺性乳痈患者随机均分成两组,分别为超声组(即治疗组)和西药组(即对照组)。超声组(20例):①将2个空白的耦合剂贴片挤干,分别加入2.5ml的复方黄柏液,将贴片置于两个电极上,再固定在治疗仪的2个治疗头上待用;②触摸乳房肿块,确定可扪及肿块的最长径的两端,做好标记;③清洁病人乳房,待皮肤干燥后,将治疗头用绷带或胶带固定在皮肤上;④接通电源后,按病人所能耐受的参数进行调整(一般不需要调整),时间为30min,按开始键进行治疗;⑤30min后取下治疗头,贴片仍需贴于原处保留3-4小时,促使药物充分被吸收。该治疗每日2次,3周为一疗程。西药组(20例):20例采用西药保守治疗,在本次实验中使用抗生素+地塞米松的组合,第一周:0.4%替硝唑200ml+注射用头孢拉定1g+生理盐水250ml+地塞米松磷酸钠,头孢拉定使用前行该药的皮试,显示阴性反应后使用;地塞米松磷酸钠前三天使用量为10mg/天,后四天5mg/天。所有药物进行静脉滴注,每天一次,连续滴注1周。第二周:头孢拉定胶囊口服,持续服用一周,每天3次,每次0.5g;地塞米松片口服,持续服用一周,每天1次,每次1.5mg。第三周:头孢拉定胶囊口服,持续服用一周,每天3次,每次0.5g。3周为一疗程。观察记录超声组患者的乳房疼痛程度分级、乳房肿块大小分级、症状体征积分在治疗前、治疗3周后的数据;与此同时,观察记录西药组乳房疼痛程度分级、乳房肿块大小分级、症状体征积分在治疗前、治疗3周后的数据。利用SPSS21.0软件将两组数据分别进行组内及组间的数据比较。结果:1、乳房疼痛程度分级、肿块大小分级、症状体征积分的比较:治疗3周后,超声组的疼痛程度分级、肿块大小分级、症状体征积分较治疗前明显降低,均有p0.01,说明超声组治疗前后在统计学上有明显差异;西药组治疗3周后,乳疼痛程度分级、肿块大小分级、症状体征积分较治疗前降低显著,均有p0.01,说明西药组治疗前后在统计学上有明显差异。超声组和西药组的乳房疼痛程度分级、乳房肿块大小分级、症状体征积分这三个方面,在经过3周治疗后相比较,均有p0.05,差异有统计学的意义。2、临床疗效的比较:经过3周的治疗后,超声组共20例,治愈6例,占30%;显效10例,占50%;有效3例,占15%;总有效率19例,占95%;西药组共20例,治愈2例,占10%;显效6例,占30%;有效9例,占45%);总有效17例,占85%。对超声组和西药组两组治疗3周后的疗效数据采取秩和检验进行分析统计,p0.05,说明两组的有效率差异具有明显的统计学意义。结论:超声介导复方黄柏液靶向递送技术治疗肿块期粉刺性乳痈能有效减轻此病的临床症状和体征,有助于提高临床治愈率,获得良好的治疗效果,十分值得进行推行使用。
[Abstract]:BACKGROUND: Acne mammary carbuncle is called "plasma cell mastitis" in Western medicine. It has the characteristics of long course, difficult treatment, easy recurrence and poor prognosis. It brings great inconvenience to the life and work of patients, and causes great trauma to the physiology and psychology of patients. Objective: To investigate the efficacy and safety of ultrasound-mediated drug delivery in the treatment of acne mastitis and to provide a new method for the treatment of acne mastitis. Methods: 40 cases of acne mammary carbuncle were randomly divided into two groups: the ultrasonic group (treatment group) and the western medicine group (control group). The ultrasonic group (20 cases): 1. Two blank coupling patches were extruded and dried, and 2.5ml compound Phellodendron solution was added, and the patches were placed on two electrodes, and then fixed on the therapeutic apparatus. 2 treatment head to be used; 2 touch the breast mass to determine the longest diameter of the two ends of the mass, marking; 3 clean the patient's breast, after the skin is dry, the treatment head with bandage or adhesive tape fixed on the skin; 4 switch on the power supply, according to the patient can tolerate the parameters (generally do not need to adjust), time is 30 minutes, press _30 minutes later, remove the treatment head, the patch still need to stick on the original place to retain 3-4 hours, to promote the full absorption of the drug. The treatment twice a day, three weeks for a course of treatment. Western medicine group (20 cases): 20 cases were treated conservatively with Western medicine, in this experiment using antibiotics + dexamethasone combination, the first week: 0.4% tinidazole 200 ml + injection head. Sporadine 1 G + normal saline 250ml + dexamethasone sodium phosphate, Cefradine before the use of the drug skin test, showed negative reaction after use; dexamethasone sodium phosphate dosage of 10 mg / day before the first three days, 5 mg / day after four days. All drugs intravenous drip once a day, continuous drip for 1 week. Second week: Cefradine capsule oral, continued to take one day 3 weeks, 3 times a day, 0.5 g each time; oral dexamethasone tablets, continued to take one week, once a day, 1.5 mg each time. 3 weeks: oral cefradine capsules, continued to take one week, three times a day, each time 0.5 G. At the same time, observe and record the data of breast pain degree classification, breast mass size classification, symptoms and signs integral before treatment and after 3 weeks of treatment in western medicine group. Sign score comparison: 3 weeks after treatment, the ultrasonic group pain degree classification, tumor size classification, symptoms and signs scores were significantly lower than before treatment, all p0.01, indicating that the ultrasonic group before and after treatment in a statistically significant difference; Western medicine group after 3 weeks of treatment, breast pain degree classification, tumor size classification, symptoms and signs scores were significantly lower than before treatment. There were significant differences in the degree of breast pain, the size of breast mass and the score of symptoms and signs between the ultrasound group and the western medicine group. After treatment, there were 20 cases in ultrasound group, 6 cases were cured, accounting for 30%; 10 cases were markedly effective, accounting for 50%; 3 cases were effective, accounting for 15%; 19 cases were effective, accounting for 95%; 20 cases in western medicine group, 2 cases were cured, accounting for 10%; 6 cases were markedly effective, accounting for 30%; 9 cases were effective, accounting for 45%; 17 cases were effective, accounting for 85%. Rank sum test was used to analyze the curative effect data of ultrasound group and Western medicine group after 3 weeks treatment, p0.05. Conclusion: Ultrasound-guided targeted delivery of compound Phellodendron Cortex Phellodendri solution can effectively alleviate the clinical symptoms and signs of acne mammary carbuncle in mass stage, help to improve the clinical cure rate and obtain good therapeutic effect, which is worth promoting.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R269

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