本文關(guān)鍵詞：帕金森病“病機(jī)證素”分布規(guī)律研究暨益腎除顫湯治療40例臨床療效觀察　出處：《南京中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

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【摘要】：目的:制訂帕金森病中醫(yī)病機(jī)證素診斷量表,對(duì)300例患者的病機(jī)證素分布情況進(jìn)行流行病學(xué)調(diào)查研究,總結(jié)其分布及兼夾組合規(guī)律,探討帕金森病的病機(jī)本質(zhì)。根據(jù)本病肝腎不足、風(fēng)痰瘀阻的病機(jī)本質(zhì),采用滋補(bǔ)肝腎、熄風(fēng)化痰通絡(luò)法治療,研究觀察益腎除顫湯治療帕金森病的臨床療效。方法:調(diào)查300例帕金森病患者一般情況:年齡、性別、職業(yè)、病程、文化程度、既往史、家族史、簡(jiǎn)要病史、HOehnYahr(H-Y)分期情況、中醫(yī)四診資料、服用西藥治療情況,通過流行病學(xué)現(xiàn)場(chǎng)調(diào)查問卷的形式,完成患者《帕金森病者中醫(yī)調(diào)查表》,由中醫(yī)專家根據(jù)調(diào)查表的四診信息進(jìn)行病機(jī)證素的判定,然后得出其分布規(guī)律及兼夾組合規(guī)律。臨床將86例帕金森病患者按照隨機(jī)數(shù)字表法隨機(jī)分為治療組和對(duì)照組各43例,以美多芭加益腎除顫湯作為治療組,以美多芭加安慰劑治療作為對(duì)照組,分別于治療前、治療后1個(gè)月和治療后2個(gè)月,完成患者帕金森病運(yùn)動(dòng)功能評(píng)定量表(MDRSPD)、統(tǒng)一帕金森病評(píng)定量表第三部分(UPDRSⅢ)、計(jì)時(shí)運(yùn)動(dòng)試驗(yàn)次數(shù)、非運(yùn)動(dòng)癥狀評(píng)價(jià)量表(NMSS)、帕金森病日常生活質(zhì)量量表(PDQ-39)、簡(jiǎn)易精神量表(MMSE)、帕金森病唾液分泌臨床分級(jí)量表(SCS-PD)、帕金森病綜合癥狀積分量化表評(píng)估,并運(yùn)用綜合癥狀積分量化表進(jìn)行療效評(píng)定。結(jié)果:(1)300例患者陰虛、氣虛、血虛、陽虛、風(fēng)、火、痰、瘀八種病機(jī)證素共出現(xiàn)1180頻次,其中風(fēng)、陰虛、痰、瘀4種病機(jī)證素所占比例最多,分別為22.88%、22.12%、14.89%、17.54%,以上4種病機(jī)證素相互兼夾患者占總患者數(shù)的32.33%。(2)帕金森病運(yùn)動(dòng)功能評(píng)定量表(MDRSPD)比較:兩組治療后1個(gè)月、2個(gè)月不同時(shí)間點(diǎn)的運(yùn)動(dòng)癥狀評(píng)分比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。對(duì)照組治療后2個(gè)月與治療前比較有統(tǒng)計(jì)學(xué)差異(P0.05)。治療組治療后1個(gè)月、治療后2個(gè)月與治療前比較,均有統(tǒng)計(jì)學(xué)差異(P0.05 和 P0.01)。(3)UPDRSIII評(píng)分比較:治療后1個(gè)月,兩組UPDRSⅢ評(píng)分比較無統(tǒng)計(jì)學(xué)差異(P0.05),治療2個(gè)月比較,有統(tǒng)計(jì)學(xué)意義(P0.05);兩組治療后2個(gè)月與治療前相比,均有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。(4)計(jì)時(shí)運(yùn)動(dòng)試驗(yàn)次數(shù)比較:治療后1個(gè)月,兩組相比無統(tǒng)計(jì)學(xué)差異(P0.05),治療后2個(gè)月,兩組相比差異有統(tǒng)計(jì)學(xué)意義(P0.05);組內(nèi)比較,兩組治療后均較治療前有所改善,治療后2個(gè)月,有顯著統(tǒng)計(jì)學(xué)差異(P0.01)。(5)非運(yùn)動(dòng)癥狀評(píng)價(jià)量表(NMSS)評(píng)分比較:兩組組間相比,治療后1個(gè)月差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后2個(gè)月有顯著統(tǒng)計(jì)學(xué)差異(P0.01);組內(nèi)比較,治療組NMSS評(píng)分逐步下降,治療后2個(gè)月較治療前有顯著統(tǒng)計(jì)學(xué)差異(P0.01),對(duì)照組治療后1個(gè)月、2個(gè)月評(píng)分與治療前比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。(6)帕金森病日常生活質(zhì)量量表(PDQ-39)評(píng)分比較:組間比較,兩組治療后1月差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后2月有顯著統(tǒng)計(jì)學(xué)差異(P0.01);組內(nèi)比較,治療后治療組PDQ-39評(píng)分逐步下降,治療后1個(gè)月與治療前相比有統(tǒng)計(jì)學(xué)差異(P0.05),治療后2個(gè)月與治療前比較有顯著統(tǒng)計(jì)學(xué)差異(P0.01),對(duì)照組治療后1個(gè)月和2個(gè)月評(píng)分與治療前比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。(7)簡(jiǎn)易精神量表(MMSE)評(píng)分比較:兩組組間比較,治療后1個(gè)月、2個(gè)月均無統(tǒng)計(jì)學(xué)差異(P0.05);兩組組內(nèi)比較,治療后1個(gè)月、2個(gè)月與治療前相比無統(tǒng)計(jì)學(xué)差異(P0.05)。(8)唾液分泌臨床分級(jí)量表(SCS-PD)評(píng)分比較:兩組組間比較,治療后1個(gè)月相比有統(tǒng)計(jì)學(xué)差異(P0.05),治療后2個(gè)月相比有顯著統(tǒng)計(jì)學(xué)差異(P0.01);組內(nèi)比較,治療組治療后1個(gè)月與治療前相比有統(tǒng)計(jì)學(xué)差異(P0.05),治療后2個(gè)月與治療前相比有顯著統(tǒng)計(jì)學(xué)差異(P0.01),對(duì)照組治療后1個(gè)月、2個(gè)月與治療前比均無統(tǒng)計(jì)學(xué)差異(P0.05)。(9)帕金森病綜合癥狀積分量化表比較:兩組組間比較,治療后1月兩組相比無統(tǒng)計(jì)學(xué)差異(P0.05),治療后2個(gè)月兩組比較有統(tǒng)計(jì)學(xué)差異(P0.05)。兩組組內(nèi)比較,治療后治療組評(píng)分逐步下降,治療后1個(gè)月與治療前比差異有統(tǒng)計(jì)學(xué)意義(P0.05),治療后2個(gè)月較治療前有顯著統(tǒng)計(jì)學(xué)差異(P0.01);對(duì)照組治療后1個(gè)月、2個(gè)月評(píng)分與治療前比較均有統(tǒng)計(jì)學(xué)差異(P0.05)。(10)帕金森病綜合癥狀積分量化表療效評(píng)定比較:治療組痊愈3例,顯效9例,有效18例,改善8例,無效2例,總有效率75%;對(duì)照組痊愈1例,顯效7例,有效19例,改善10例,無效2例,總有效率67.5%。兩組相比療效有統(tǒng)計(jì)學(xué)差異(P=0.0370.05),治療組優(yōu)于對(duì)照組。結(jié)論:(1)肝腎不足是帕金森病的病理基礎(chǔ),風(fēng)痰瘀阻為中心病理環(huán)節(jié);肝腎不足,風(fēng)痰瘀阻證為帕金森的主要證型。(2)益腎除顫湯可有效改善帕金森病患者的運(yùn)動(dòng)癥狀。(3)益腎除顫湯在改善帕金森病患者運(yùn)動(dòng)癥狀的同時(shí),亦可緩解患者的非運(yùn)動(dòng)癥狀,提高患者的生活質(zhì)量。(4)滋補(bǔ)肝腎,化痰熄風(fēng)通絡(luò)法為帕金森病治療的主要治法,益腎除顫湯為治療帕金森病的有效驗(yàn)方。
[Abstract]:Objective: to establish the Parkinson disease TCM syndrome diagnostic scale, 300 patients of the disease distribution of epidemiological survey, summarized the distribution and combination of law and clip, to discuss the pathogenesis of Parkinson's disease. According to the nature of the disease of liver and kidney deficiency, phlegm and blood stasis pathogenesis wind essence, nourishing the the liver and kidney, Xifeng huatantongluo treatment of clinical observation of the treatment of Parkinson's disease Yishen Decoction. Defibrillation methods: 300 cases of patients with Parkinson's disease in general: age, gender, occupation, duration, degree of culture, history, family history, a brief history of HOehnYahr (H-Y) staging and TCM Diagnostic data. Taking western medicine treatment, through the epidemiological survey questionnaire, patients completed questionnaire > < Parkinson disease of traditional Chinese medicine, Chinese medicine experts by questionnaire according to the four diagnostic information of disease judgment, then obtains its distribution And clip combination rule. 86 clinical cases of Parkinson disease were randomly divided into treatment group and control group with 43 cases in each group, with the United States Duobajia Yishen Decoction defibrillation as treatment group, to the United States Duobajia placebo as control group, respectively before treatment, 1 months after treatment and after treatment 2 months, completed in patients with Parkinson disease motor dysfunction rating scale (MDRSPD), unified Parkinson's Disease Rating Scale (UPDRS III), the third part time exercise test times, non motor symptom assessment scale (NMSS), Parkinson disease quality of life scale (PDQ-39), Mini Mental Scale (MMSE), Parkinson disease of salivary secretion clinical Rating Scale (SCS-PD), Parkinson disease symptom integral quantization table assessment, and using the comprehensive symptom integral quantization table was used to evaluate the curative effect. Results: (1) 300 cases of patients with Yin deficiency, Qi deficiency, blood deficiency, Yang deficiency, wind, fire, phlegm and blood stasis, eight kinds of disease were out 鐜，

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