【摘要】：目的：糖尿病足(Diabetic Foot,DF)是糖尿病的嚴(yán)重慢性并發(fā)癥之一,其具有很高的致殘性和治療費(fèi)用,嚴(yán)重降低了患者的生活質(zhì)量。本研究通過觀察加味黃芪桂枝五物湯治療0-1級(jí)DF的臨床療效,來探討治療前期DF的有效方法,極大減少其向后期DF發(fā)展的可能性,促進(jìn)DF患者傷口愈合。其意義在于：1.發(fā)揮中醫(yī)藥簡、便、廉、效等優(yōu)勢,在起到治療效果的同時(shí)極大地減輕患者經(jīng)濟(jì)負(fù)擔(dān)；2.體現(xiàn)中醫(yī)“治未病”的思想,未雨綢繆,在DF前期進(jìn)行有效的中藥干預(yù),及時(shí)截?cái)嗖〕?極大地改善患者生活質(zhì)量；3.本研究為經(jīng)方治療DF及DF的預(yù)防提供了客觀的研究材料,同時(shí)也為今后作進(jìn)一步的研究打下了基礎(chǔ)。本研究通過挖掘經(jīng)方并根據(jù)DF前期的特點(diǎn)進(jìn)行化裁,觀察加味黃芪桂枝五物湯治療氣虛血瘀兼肌膚脈絡(luò)痹阻證的DF療效,尋找治療DF合適的經(jīng)方。方法：于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院內(nèi)分泌科住院病人中選取51例符合入組標(biāo)準(zhǔn)的患者,隨機(jī)分成治療組和對(duì)照組,采取自愿原則,先填寫基本信息表,進(jìn)行諸如年齡、性別、病程等一般基礎(chǔ)資料的差異比較,提示了兩個(gè)研究組基線一致具有可比性后,在3個(gè)星期的研究時(shí)間內(nèi),治療組服用加味黃芪桂枝五物湯,對(duì)照組口服彌可保片及靜滴前列地爾注射液。對(duì)兩組病人的FBG、2hPBG、血液流變學(xué)、ESR、ABI等指標(biāo)的治療前后比較,以及參照全身癥狀量表及足部癥狀量表(見附錄3、4)進(jìn)行全身及足部癥狀治療前后評(píng)分,總體評(píng)價(jià)二者治療糖尿病足的臨床療效。所有資料分析使用軟件SPSS22在計(jì)算機(jī)中完成,統(tǒng)計(jì)方法計(jì)數(shù)資料用卡方檢驗(yàn)或者秩和檢驗(yàn),計(jì)量單位均以均值±標(biāo)準(zhǔn)差(x±s)表示,組間采有獨(dú)立樣本t檢驗(yàn),組內(nèi)采用配對(duì)樣本t檢驗(yàn),不符合正態(tài)分布者,組間、組內(nèi)采用非參數(shù)檢驗(yàn),P0.05有顯著性差異,P0.01有非常顯著性差異。結(jié)果：通過對(duì)治療組、對(duì)照組治療前后組內(nèi)組間的比較,可初步認(rèn)為本方對(duì)血糖的改善無明顯治療作用；本方對(duì)血液流變學(xué)里的多項(xiàng)指標(biāo)的改善程度較單純的西醫(yī)治療更明顯；對(duì)ABI的改善本方相較于西藥組的治療有明顯的優(yōu)勢；對(duì)中醫(yī)證侯的改善優(yōu)于西藥組�？傮w上,本方對(duì)治療0-1級(jí)DF的療效優(yōu)于對(duì)照組。結(jié)論：從臨床結(jié)果來看,本方對(duì)治療DF前期的療效優(yōu)于對(duì)照組,值得進(jìn)一步研究中藥聯(lián)合西藥的臨床療效。
[Abstract]:Aim: diabetic foot (Diabetic Foot,DF) is one of the serious chronic complications of diabetes mellitus. It has high disability and treatment cost, which seriously reduces the quality of life of the patients. The purpose of this study was to observe the clinical efficacy of modified Huangqi Guizhi Wuwu decoction in the treatment of 0 ~ 1 grade DF, to explore the effective methods for the treatment of early stage DF, to greatly reduce the possibility of its development to the later stage of DF, and to promote wound healing in patients with DF. Its meaning is: 1. Giving full play to the advantages of simplicity, convenience, cheapness, efficiency and other advantages of traditional Chinese medicine can greatly lighten the economic burden of patients at the same time as it plays a therapeutic effect; 2. Reflect the thought of "cure no disease" of traditional Chinese medicine, make a good plan in advance, carry on effective Chinese medicine intervention in the early stage of DF, cut off the course of disease in time, greatly improve the quality of life of the patients; 3. This study provides an objective research material for the prevention of DF and DF, and lays a foundation for further research in the future. In this study, the therapeutic effect of modified Huangqi Guizhi Wuwu decoction on qi deficiency, blood stasis and skin choroidal obstruction was observed by digging the meridian formula and making use of the characteristics of pre-DF, in order to find a suitable recipe for treatment of DF. Methods: 51 inpatients in the Department of Endocrinology of the first affiliated Hospital of Guangzhou University of traditional Chinese Medicine were randomly divided into two groups: treatment group and control group. The difference of general basic data, such as gender, course of disease and so on, suggested that after the baseline of the two research groups was consistent and comparable, the treatment group was given modified Huangqi Guizhi Wuwu decoction during three weeks of study period, the treatment group was treated with modified Huangqi Guizhi Wuwu decoction. The control group took Mecobao tablets and intravenous injection of alprostadil. The indexes of FBG,2hPBG, hemorheology and ESR,ABI in the two groups were compared before and after treatment, and the whole body and foot symptoms before and after treatment were evaluated with reference to the whole body symptom scale and the foot symptom scale (see Appendix 3, 4). To evaluate the clinical efficacy of the two methods in the treatment of diabetic foot. All data were analyzed in computer with software SPSS22. The statistical data were counted by chi-square test or rank sum test. The units of measurement were expressed as mean 鹵standard deviation (x 鹵s), and the independent sample t-test was used between groups, and the statistical data were counted by chi-square test or rank-sum test. Paired sample t-test was used in the group, and non-parametric test was used in the group. There was significant difference between the two groups (P0.05), and there was a very significant difference between the two groups (P0.01). Results: through the comparison between the treatment group and the control group before and after treatment, it can be concluded that the prescription has no obvious therapeutic effect on the improvement of blood glucose, and the improvement degree of several indexes in the hemorheology of the prescription is more obvious than that of the simple western medicine treatment. The improvement of ABI was superior to that of western medicine group, and the improvement of TCM syndrome was better than that of western medicine group. Overall, the efficacy of the prescription in the treatment of grade 0 1 DF is better than that of the control group. Conclusion: according to the clinical results, the curative effect of this prescription is better than that of the control group in the pre-treatment of DF. It is worth further studying the clinical curative effect of the combination of traditional Chinese medicine and western medicine.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R259

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