本文選題：毫火針刺絡(luò)放血療法 + 下肢靜脈曲張��； 參考：《南京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本研究通過觀察毫火針刺絡(luò)放血治療下肢靜脈曲張,明確該法的療效,并對病變最常涉及的大小隱靜脈瓣膜功能不全,交通靜脈瓣膜功能不全和兩者兼有的混合型瓣膜功能不全等三種不同類型的LEW治療作用進行了比較分析,明確它們之間的的差別,從而在臨床上能更好地、有針對性地發(fā)揮毫火針對下肢靜脈曲張的治療作用,同時,通過研究也為進一步闡明毫火針治療下肢靜脈曲張的機理研究提供思路和部分臨床依據(jù)。方法:將符合納入標準的55例下肢靜脈曲張患者為研究對象,采用自身前后對照臨床實驗設(shè)計原則,首先,對所有研究對象進行詳細問診及�？茩z查,結(jié)合下肢動靜脈多普勒B超及加壓試驗的結(jié)果,明確下肢靜脈曲張的類型,采用靜脈曲張臨床表現(xiàn)嚴重程度評分(VCSS),靜脈曲張功能損害程度評分(VDS)及靜脈曲張患者生活質(zhì)量調(diào)查表(CIVIQ)等三種臨床調(diào)查問卷對患者進行整體的評價,然后,采用用毫火針刺絡(luò)放血療法對研究對象進行1-3次的治療,每2-4周一次,具體治療次數(shù)及間隔時間需視患者局部火針創(chuàng)傷修復(fù)情況及臨床療效評估而定,首次治療結(jié)束后2-4周評估一次療效,三次治療或不足三次,但患者已經(jīng)達顯效標準的即為治療療程結(jié)束,其后一個月左右進行一次療效評價,以此作為最終療效及結(jié)局指標。通過觀察VCSS,VDS,CIVIQ量表的積分變化情況,以及其他的相應(yīng)檢查項目,對臨床療效進行評定、分析。數(shù)據(jù)收集及統(tǒng)計分析采用SPSS 20.0統(tǒng)計軟件包。結(jié)果:最終完成治療及觀察的病例43例,通過對數(shù)據(jù)的分析得出以下結(jié)論:①經(jīng)過2-3次的毫火針治療以及治療前和治療后一個月的觀察,43例患者總體顯效率與有效率分別為32.56%、74.42%,且VCSS與VDS及CIVIQ積分的前后比較,有統(tǒng)計學(xué)意義,說明毫火針對下肢靜脈曲張癥狀有較好的治療效果,且可以改善下肢靜脈曲張患的者的生活質(zhì)量。;②三種不同類型的下肢靜脈曲張患者在毫火針治療前,在年齡、性別、病程、癥狀積分及生活質(zhì)量積分等,經(jīng)比較分析,無統(tǒng)計學(xué)差異(P0.05),具有可比性。③三種不同類型的靜脈曲張的臨床療效:大小隱靜脈瓣膜功能不全及混合型的顯效率和有效率分別為8.33%、0.00%;41.67%、70.00%,明顯低于交通支瓣膜功能不全的患者61.91%、95.24%,且有統(tǒng)計學(xué)意義;而從三者的VCSS、VDS、CIVIQ積分在治療后及前后差值的比較來看,除了 CIVIQ的前后差值比較沒有統(tǒng)計學(xué)差異外,其余都有統(tǒng)計學(xué)差異。提示:毫火針對交通支瓣膜功能不全的臨床表現(xiàn)嚴重程度、靜脈功能損害程度的改善能力要明顯好于大小隱靜脈瓣膜功能不全與混合型的瓣膜功能不全。對下肢靜脈曲張患者的生活質(zhì)量的改善方面也是毫火針對交通支靜脈瓣膜功能不全的最好。結(jié)論:毫火針刺絡(luò)放血治療下肢靜脈曲張療效肯定,且具有安全性,可有效改善床表現(xiàn)嚴重程度和靜脈功能損害程度,提高了患者的生活質(zhì)量。而對臨床常見的三種不同類型的下肢靜脈曲張中,對交通支瓣膜功能不全類型療效最為顯著。
[Abstract]:Objective: To investigate the curative effect of the treatment of varicose veins of the lower extremities by observing the acupuncture and collaterals of the milli fire on the varicose veins of the lower extremities, and the effect of the three different types of LEW treatment on the most common lesions of the small size saphenous venous valvular insufficiency, the insufficiency of the venous valve function and the mixed type of the mixed valve function were compared and analyzed. The difference between them can be better in clinical and the therapeutic effect of the milli fire on the varicose veins of the lower extremities, and the mechanism of the study of the mechanism of the healing of the varicose veins of the lower extremities is also provided through the study. Methods: 55 cases of varicose veins of lower extremity were conformed to the standard. The patient was the subject of the study, using the principle of clinical experiment design before and after self control. First, all the subjects were examined in detail and the special examination, combined with the results of Doppler B ultrasound and pressure test of the lower limbs, the types of varicose veins of the lower extremities were clearly defined, and the varicose function of varicosity (VCSS) and the function of varicose veins were used. Three kinds of clinical questionnaires, such as the degree of damage score (VDS) and the quality of life questionnaire (CIVIQ) of patients with varicose veins, were evaluated as a whole. Then, the patients were treated with 1-3 times of treatment by using the acupuncture collaterals and blood letting therapy. Every 2-4 weeks, the number of treatment and interval time should be treated with the repair of local fire injury. And the clinical efficacy evaluation was determined. 2-4 weeks after the first treatment, a curative effect was evaluated, three treatment or less than three times, but the patient had reached the standard of the treatment at the end of the treatment course. After a month or so, a therapeutic evaluation was carried out as a final outcome and outcome index. The changes in the VCSS, VDS, CIVIQ scale were observed. The clinical effects were evaluated and analyzed. Data collection and statistical analysis were carried out by SPSS 20 software package. Results: 43 cases were finished with the final treatment and observation. Through the analysis of the data, the following conclusions were drawn: (1) after 2-3 times of hot needle therapy, before treatment and one month after treatment. The overall efficiency and efficiency of the 43 patients were 32.56% and 74.42% respectively, and the comparison of the VCSS and VDS and CIVIQ scores was statistically significant, indicating that the milli fire was better for the symptoms of varicose veins of the lower extremities, and could improve the living quality of the patients with varicose veins of the lower limbs. (2) three different types of varicose veins of the lower limbs. The age, sex, course of disease, symptom score, and quality of life score were compared, and there was no statistical difference (P0.05). (3) the clinical efficacy of three different types of varicose veins: 8.33%, 0%, 41.67%, 70%, respectively, of small size saphenous venous valvular insufficiency and mixing type, respectively. There were statistically significant differences in the difference values of VCSS, VDS and CIVIQ after treatment and before and after the treatment of the three VCSS, VDS, and CIVIQ points. The degree of clinical manifestation, the improvement of the degree of venous dysfunction should be better than the insufficiency of the valvular insufficiency of the saphenous vein and the mixed type of valve insufficiency. The improvement of the quality of life of the patients with varicosity of the lower extremity is also the best for the insufficiency of the venous valve function. The lower extremity varicosity is effective and safe. It can effectively improve the severity of the bed and the damage of venous function, and improve the quality of life of the patients. In the three different types of lower extremity varicose veins, the most significant effect on the insufficiency type of the traffic branch valve is the most effective.

【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.1

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