本文選題：臁瘡 + 靜脈性潰瘍　； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的:1.從脈絡(luò)濕瘀病因病機(jī)著手,研究臁瘡發(fā)病的主要病機(jī),區(qū)別臨床中以熱盛肉腐作為主要病機(jī)特點(diǎn)的傳統(tǒng)認(rèn)識,區(qū)分靜脈性潰瘍和動脈性潰瘍的不同之處;2.將淤積性皮炎洗劑聯(lián)合壓迫纏縛療法運(yùn)用于治療臁瘡患者,觀察用藥前后潰瘍面變化情況,研究該療法治療臁瘡的有效性和安全性,探索中醫(yī)外治治療臁瘡的關(guān)鍵技術(shù);3.初步探索臁瘡四畔療法局部熏洗及壓迫纏縛療法的療效和操作規(guī)范。研究方法:本研究采用隨機(jī)對照的研究方法,納入50例患者,隨機(jī)分為2組,每組各25例,治療組給予四畔熏洗藥物"淤積性皮炎洗劑"(桃仁、杏仁、郁李仁、薏苡仁、大黃、黃柏、黃芩、黃連、桑白皮、茯苓皮、白鮮皮、大腹皮)熏洗患處,然后以臁瘡創(chuàng)面為中心,濕敷洗劑紗布后,用8cm寬低彈力繃帶加壓包扎,每日一次;對照組給予常規(guī)清潔換藥,每日一次,總療程為8周。不足8周瘡面愈合者隨即結(jié)束治療。試驗(yàn)期間定期觀察并記錄創(chuàng)面面積,創(chuàng)面色澤、新生肉芽組織、創(chuàng)面滲液量、疼痛程度變化等情況,并記錄治療前后小腿交通支靜脈反流程度變化情況。研究結(jié)果:1.治療組與對照組創(chuàng)面愈合率比較:治療組愈合9例,顯效6例,有效8例,無效2例,總有效率為92%;對照組愈合3例,顯效5例,有效14,無效6例,總有效率為76%,應(yīng)用SPASS20.0統(tǒng)計學(xué)軟件,經(jīng)檢驗(yàn)P0.05,有統(tǒng)計學(xué)意義,淤積性皮炎洗劑聯(lián)合壓迫纏縛療法治療臁瘡組臨床療效優(yōu)于常規(guī)換藥對照組。2.不同時間瘡面積分情況:治療前、第2周、第4周、第8周治療組創(chuàng)面積分分別為:18.84±3.64,14.00±5.62,9.40±6.57,6.24±6.35;對照組積分分別為:20.04±3.90,17.04±5.09,13.24±5.71,11.12±5.29。經(jīng)檢驗(yàn)治療前及治療后第 2周創(chuàng)面積分無顯著差異,無統(tǒng)計學(xué)意義(P0.05),治療第4周,治療組與對照組創(chuàng)面積分均減小,但治療組優(yōu)于對照組,經(jīng)檢驗(yàn)有統(tǒng)計學(xué)意義(P0.05);治療第8周,兩組創(chuàng)面積分繼續(xù)減小,但對照組變化較小,治療組積分繼續(xù)減小,仍優(yōu)于對照組,經(jīng)檢驗(yàn)有統(tǒng)計學(xué)意義(P0.05)。3.不同時間段疼痛計分:經(jīng)檢驗(yàn)兩組患者在治療前、第2周、第4周疼痛計分差異不明顯,經(jīng)檢驗(yàn)無統(tǒng)計學(xué)意義(P0.05);治療第8周兩組患者疼痛積分明顯縮小,但治療組優(yōu)于對照組,經(jīng)檢驗(yàn)有統(tǒng)計學(xué)意義(P0.05)。4.治療前后小腿交通靜脈反流情況:治療前治療組患肢交通靜脈反流值為2.28士0.458,對照組為2.24±0.453,兩組差異較小,經(jīng)檢驗(yàn)無統(tǒng)計學(xué)意義(P0.05);治療8周后治療組患肢交通靜脈反流值2.12±0.665,較治療前有所下降,但是不明顯。對照組治療前后交通支靜脈反流值無變化,說明常規(guī)換藥對交通支靜脈壁反流無改善作用。但兩組數(shù)據(jù)通過非參數(shù)經(jīng)驗(yàn),無統(tǒng)計學(xué)意義(P0.05)。
[Abstract]:Objective: 1.Based on the etiology and pathogenesis of choroid dampness and stasis, the main pathogenesis of ecthyma was studied. The traditional understanding of heat and meat rot as the main pathogenesis of ecthyma and the difference between venous ulcer and arterial ulcer were distinguished. 2.The combined treatment of accretion dermatitis lotion and compression and binding therapy was applied to the treatment of ecthyma patients. The changes of ulcer surface before and after treatment were observed, the efficacy and safety of the treatment were studied, and the key technique of ecthyma treatment was explored.To explore the curative effect and operation standard of ecthyma four-side therapy for local fumigation and compression and binding therapy.Methods: in this study, 50 patients were randomly divided into two groups (25 cases in each group). The treatment group was treated with "silting dermatitis lotion" (peach kernel, almond, tulip kernel, Coix seed, rhubarb), the treatment group was treated with "silting dermatitis lotion" (peach kernel, almond, Yu Li ren, Coix seed, rhubarb).Radix Phellodendri, Radix Scutellariae, Coptis chinensis, Cortex Mori, Poria cocos skin, White fresh skin, large abdominal skin) fumigation and washing the affected area, then take the wound of ecthyma as the center, wet apply the gauze of lotion agent, use 8cm wide and low elastic bandage to press the bandage, once a day;The control group was given routine cleaning and dressing change once a day, the total course of treatment was 8 weeks.Less than 8 weeks after the healing of the sores, treatment ended immediately.The changes of wound area, wound color, new granulation tissue, wound effusion and pain degree were observed and recorded regularly during the experiment. The changes of the degree of reflux of the shank communicating branch vein before and after treatment were recorded.The result of the study was: 1.There were 9 cases of healing, 6 cases of remarkable effect, 8 cases of effective and 2 cases of ineffective in the treatment group, and the total effective rate was 922% in the treatment group, 3 cases in the control group, 5 cases in the marked effect, 14 cases in the treatment group, 6 cases in the failure.The total effective rate was 76g. The clinical curative effect of ecthyma group was better than that of routine dressing change control group (P 0.05) by using SPASS20.0 statistical software and test (P0.05), and there was statistical significance in the treatment of ecthyma in the treatment of ecthyma ulcer treated with silt dermatitis lotion combined with compression and binding therapy.Before treatment, at the 2nd week, the 4th week, the 8th week, the wound score of the treatment group was respectively: 1 18.84 鹵3.64g 14.00 鹵5.62U 9.40 鹵6.57N 6.24 鹵6.35, and the control group the score of the control group was 20.04 鹵3.90g 17.04 鹵5.0913.24 鹵5.71U 11.12 鹵5.29 respectively.There was no significant difference in wound score between the treatment group and the control group before and after treatment. There was no significant difference (P 0.05). At the 4th week of treatment, the wound score of the treatment group and the control group decreased, but that of the treatment group was better than that of the control group.At the 8th week of treatment, the wound score of the two groups continued to decrease, but the change of the control group was smaller, and the score of the treatment group was still lower than that of the control group, which was significantly better than that of the control group.Pain score in different time period: there was no significant difference in pain score between the two groups before treatment, at the 2nd week and the 4th week, but there was no significant difference in pain score between the two groups after the test, and the pain score of the two groups decreased significantly at the 8th week of treatment, but the treatment group was superior to the control group.The results showed that there was statistical significance (P 0.05). 4.Before and after treatment, the reflux of the shank communicating vein was 2.28 鹵0.458 in the treatment group and 2.24 鹵0.453 in the control group.After 8 weeks of treatment, the reflux value of communicating vein of the affected limb in the treatment group was 2.12 鹵0.665, which was lower than that before treatment, but it was not obvious.There was no change in the reflux value of the communicating branch vein before and after treatment in the control group, indicating that routine dressing change had no effect on the reflux of the communicating branch vein wall.However, there was no significant difference between the two groups by non-parametric experience (P 0. 05).
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R269

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