隔姜灸联合温阳逐水膏穴位贴敷治疗肝硬化腹水的临床疗效评价

发布时间：2018-11-10 20:51

【摘要】：目的:客观地评价隔姜灸联合温阳逐水膏穴位贴敷疗法治疗肝硬化腹水的临床疗效及安全性,明确其治疗优势,并初步探讨其作用机理,为该疗法的临床应用提供有效依据,且为进一步探索新的安全有效的中医外治法提供有益参考。方法:选择符合本研究纳入标准及排除标准的60例肝硬化腹水患者作为研究对象,按照患者入组的先后顺序及随机数字表原则,以相等的比例将入选患者随机分为两组,即治疗组和对照组各30例。两组患者分别给予不同的治疗措施,对照组采用肝硬化腹水的西医基础治疗联合中药参附仙桂颗粒口服;治疗组在对照组治疗方案基础上加用隔姜灸联合温阳逐水膏穴位贴敷,两组均治疗2个疗程,10日为1个疗程,随访3个月。观察两组治疗前后中医证候、腹围、体重、24h尿量、B超探测下腹水深度、肝功能(TBIL、ALT、AST、ALB)、肾功能(血尿素氮BUN、血肌酐Cr)、电解质(血清钾K~+、钠Na~+)等指标的变化及不良反应的发生情况,并观察两组的总体临床疗效及中医证候疗效,比较两组有无统计学差异。在研究过程中,治疗组脱落1例,对照组脱落2例,故实际入组人数为治疗组29例,对照组28例。结果:1.治疗组和对照组的总有效率分别为93.10%和71.43%。两组总有效率比较差异具有统计学意义(P0.05),表明治疗组疗效明显优于对照组。2.两组患者治疗后症状积分较治疗前均有明显下降,且治疗组较对照组下降更为显著,两组患者治疗前后症状积分变化比较差异具有统计学意义(P0.05);另外,两组患者中医证候疗效比较差异具有统计学意义(P0.05)。3.两组患者治疗后腹围、体重较治疗前均有明显下降,24h尿量较治疗前均有明显增加,且治疗组较对照组变化幅度更高,两组患者治疗前后腹围、体重、24h尿量差值分别进行比较,差异均具有统计学意义(P0.05)。4.两组患者治疗后肝功能主要指标较治疗前均有改善,且治疗组较对照组改善更为明显,经统计分析,差异具有统计学意义(P0.05)。5.两组患者治疗后B超探测下腹水暗区最大深度较治疗前均有明显减小,且治疗组较对照组减小更为明显,两组患者治疗前后腹水深度变化比较差异具有统计学意义(P0.05);两组患者治疗后腹水分级较治疗前均有改善,且治疗组较对照组改善程度更大,经比较具有显著性差异(P0.05)。结论:本研究结果显示两组在治疗肝硬化腹水方面均有效,但合用隔姜灸联合温阳逐水膏穴位贴敷治疗组的疗效较常规中西药治疗的对照组更显著,能较大程度地改善患者的症状、体征,并能明显减小腹围、减轻体重、增加24h尿量、减少腹水量、改善腹水等级,有效地促进腹水消退,且在治疗过程中及治疗后未发生明显的不良反应,安全性较高。说明隔姜灸联合温阳逐水膏穴位贴敷治疗脾肾阳虚型肝硬化腹水的疗效肯定,值得临床推广应用。
[Abstract]:Objective: to evaluate objectively the clinical efficacy and safety of ginger-separated moxibustion combined with Wenyangzhushui ointment acupoint application in the treatment of ascites due to liver cirrhosis, to clarify its therapeutic advantages, and to explore its mechanism of action so as to provide an effective basis for the clinical application of the therapy. And to further explore new safe and effective external treatment of Chinese medicine to provide a useful reference. Methods: sixty cirrhotic ascites patients who met the criteria of inclusion and exclusion of the study were randomly divided into two groups according to the order of admission and the principle of random number table. There were 30 cases in the treatment group and 30 cases in the control group. Two groups of patients were given different treatment measures, the control group with liver cirrhosis ascites treated with western medicine combined with Chinese medicine Shenfu Xiangui granule oral; The treatment group was treated with ginger-separated moxibustion combined with Wenyang Zhushui ointment on the basis of the control group. The two groups were treated for 2 courses, 10 days as a course of treatment, followed up for 3 months. The TCM syndromes, abdominal circumference, body weight, 24h urine volume, depth of lower ascites, liver function (TBIL,ALT,AST,ALB), renal function (blood urea nitrogen, BUN, serum creatinine Cr), electrolyte) were observed before and after treatment in both groups. The changes of sodium Na~ and the occurrence of adverse reactions were observed. The overall clinical efficacy and TCM syndromes of the two groups were observed and there was no statistical difference between the two groups. In the course of the study, there were 1 case in the treatment group and 2 cases in the control group, so the actual number of the patients in the treatment group was 29 cases and that in the control group was 28 cases. The result is 1: 1. The total effective rates of treatment group and control group were 93.10% and 71.43%, respectively. The total effective rate of the two groups was significantly higher than that of the control group (P0.05), indicating that the curative effect of the treatment group was significantly better than that of the control group. 2. The symptom scores of the two groups after treatment were significantly lower than before treatment, and the treatment group was more significant than the control group, the difference between the two groups before and after treatment was statistically significant (P0.05). In addition, the two groups of patients with traditional Chinese medicine syndrome efficacy difference was statistically significant (P0.05). After treatment, the abdominal circumference, body weight and 24h urine volume of the two groups were significantly decreased, and the changes of the treatment group were higher than those of the control group, the abdominal circumference and body weight of the two groups were higher than those of the control group before and after treatment. 24 hours urine volume difference were compared, the differences were statistically significant (P0.05). The main indexes of liver function in the two groups were improved after treatment, and the improvement in the treatment group was more obvious than that in the control group. The difference was statistically significant (P0.05). After treatment, the maximum depth of the underlying ascites dark area detected by B-ultrasound in the two groups was significantly decreased compared with that before treatment, and the decrease in the treatment group was more obvious than that in the control group. There was significant difference in the changes of ascites depth between the two groups before and after treatment (P0.05). The ascites grade of the two groups were improved after treatment, and the degree of improvement in the treatment group was greater than that in the control group, the difference was significant (P0.05). Conclusion: the results of this study show that both groups are effective in the treatment of ascites due to cirrhosis, but the curative effect of the treatment group combined with ginger separated moxibustion combined with Wenyangzhushui ointment at acupoint is more significant than that of the control group treated with traditional Chinese and western medicine. It can improve the symptoms and signs of the patients, reduce the abdominal circumference, reduce the weight, increase the urine volume for 24 hours, reduce the quantity of ascites, improve the grade of ascites, and promote ascites to recede effectively. There was no obvious adverse reaction during and after treatment, and the safety was high. The results showed that the curative effect of ginger separated moxibustion combined with Wenyang Zhushui ointment on ascites of liver cirrhosis due to deficiency of spleen and kidney yang was definite and worth popularizing in clinic.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.1

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