本文選題：芪實顆粒 + 盆底肌訓練�。� 參考：《中國中醫(yī)科學院》2016年博士論文

【摘要】：1研究目的1.1通過對中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁療效的系統(tǒng)評價,為臨床實踐提供循證醫(yī)學證據(jù)；1.2觀察芪實顆粒治療女性壓力性尿失禁的ICI-Q-SF評分變化及尿墊試驗變化,評價其療效：觀察芪實顆粒聯(lián)合盆底肌訓練治療女性壓力性尿失禁的ICI-Q-SF評分及I-QOL評分變化,24小時尿失禁頻次評價其療效。為中醫(yī)藥治療女性壓力性尿失禁提供臨床依據(jù)；1.3研究芪實顆粒聯(lián)合盆底肌訓練治療女性壓力性尿失禁的癥狀時點緩解規(guī)律。2試驗方法2.1檢索中文數(shù)據(jù)庫包括相關期刊論文(CNKI)、維普中文科技期刊全文數(shù)據(jù)庫(VIP)、萬方全文數(shù)據(jù)庫、中國生物醫(yī)學文獻數(shù)據(jù)庫(CBM)；外文數(shù)據(jù)庫包括PubMed等。所有檢索時間為各數(shù)據(jù)庫建庫時間至2016年1月。文獻檢索語言為中英文。手工檢索相關雜志、會議的中英文文獻,用谷歌(Google)等搜索引擎在互聯(lián)網上查找相關文獻并追查已檢出文獻的參考文獻,查找灰色文獻,所查文獻包括期刊、會議文章匯編及研究生論文。系統(tǒng)評價中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁的療效。2.2選擇中國中醫(yī)科學院西苑醫(yī)院泌尿外科門診輕中度壓力性尿失禁(SUI)患者70例,按隨機數(shù)字表法將患者隨機分為兩組,治療組、對照組各35例。治療組采用芪實顆粒；對照組采用盆底肌訓練療法。觀察兩組患者ICI-Q-SF評分、尿失禁量的變化和臨床療效比較,均連續(xù)治療4周后統(tǒng)計療效。2.3納入西苑醫(yī)院泌尿外科的成年女性輕中度SUI患者,共62例。進行平行對照、隨機、雙盲臨床試驗。治療組選用芪實顆粒聯(lián)合盆底肌功能訓練治療；對照組選用安慰劑聯(lián)合盆底肌功能訓練治療。連續(xù)服藥56天,每兩周訪視一次。通過ICI-Q-SF評分、I-QOL評分、24小時排尿日記的尿失禁頻率記錄進行療效評估。3結果3.1中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁的meta分析結果中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁有效：中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁優(yōu)于單純使用盆底肌訓練治療。由于納入的文獻質量偏低,本研究得出結論的應用需要謹慎。尿失禁的病位以脾、腎為主,臨床應用補脾益腎的中藥聯(lián)合盆底肌訓練對于壓力性尿失禁的預防和治療有一定的療效。但是由于目前研究的患者數(shù)量少,質量偏低,各家對結局的判定指標不統(tǒng)一等問題,不能完全說明中醫(yī)藥對治療女性壓力性尿失禁有一定的療效,還需要大量的隨機樣本研究,統(tǒng)一的量化評定標準來進一步評價。3.1.1文獻的一般情況從納入文獻的基本情況來看,文獻發(fā)表的數(shù)量相對較少,文獻的真實性和可信度較高,但目前文獻的基金支持少,且多為單中心研究。3.1.2隨機化、分配方案、盲法本系統(tǒng)評價納入的4篇研究文獻僅提及為隨機分組,未顯示分組方法,不能判定隨機分組的正確性,隨機化的整體質量不高。都未描述是否實施分配方案的隱匿,因此存在選擇偏移的可能性大。均未描述盲法的具體應用,使用盲法率低,從質量評價標準來看,不可避免存在偏倚。3.1.3退出、失訪、不良反應病例記錄4篇研究文獻均未提及隨訪時間的標準,均未描述退出與失訪病例,從研究結果看無退出與失訪病例。均未描述嚴重不良事件,無法判斷使用藥物的安全性。3.1.4療效判定指標、統(tǒng)計學方法療效觀測指標不統(tǒng)一,影響療效的判定和結論的分析,整體研究缺少中醫(yī)特色。本研究4篇文章中未說明具體統(tǒng)計學方法,從報道提供的資料看4篇文獻的統(tǒng)計方法正確,有具體的統(tǒng)計量和P值。3.2芪實顆粒及盆底肌訓練對女性壓力性尿失禁影響的臨床觀察結果3.2.1兩組治療后ICI-Q-SF評分與尿失禁量比較治療后2周兩組ICI-Q-SF評分與尿失禁量均較同組治療前明顯改善(P0.01)；治療后4周與同組治療后2周比較,治療組差異有統(tǒng)計學意義(P0.01),對照組則無明顯變化(P0.05)。治療組治療后2周、4周與對照組同時間段比較,差異有統(tǒng)計學意義(P0.05、P0.01)3.2.2臨床療效比較治療后治療組總有效率為67.7%,對照組為37.0%,兩組總有效率比較,差異有顯著性意義(P0.01)。3.3芪實顆粒聯(lián)合盆底肌訓練對Ⅰ-Ⅲ度女性壓力性尿失禁ICI-Q-SF及I-QOL評分影響的臨床觀察結果3.3.1試驗組和對照組ICI-Q-SF評分比較組內比較,試驗組ICI-Q-SF分數(shù)從治療后2周起,均與前一次訪視時有減少,減少的分值具有統(tǒng)計學意義(2周時P值0.005,4周、6周、8周P值均0.0001)。對照組ICI-Q-SF分數(shù)在療后2周時與基線相比,療效變化無統(tǒng)計學意義,從療后4周起與前一次訪視相比,分數(shù)有所減少,減少值有統(tǒng)計學意義(P值均0.0001)試驗組和對照組的ICI-Q-SF基線值比較,P值為0.6825,二者無統(tǒng)計學意義：自服藥2周,直至4周后,試驗組和對照組的ICI-Q-SF值比較均無統(tǒng)計學意義(P值分別為0.2625和0.1063)；但當服藥至6周P值為0.0095,8周P值為0.0003,兩組比較差異顯著。3.3.2試驗組和對照組I-QOL評分比較組內比較,試驗組QOL分數(shù)從療后2周起,均與前一次訪視時有增加,增加的分值具有統(tǒng)計學意義(2周時P值0.05,4周、6周、8周P值均0.0001)。對照組QOL分數(shù)在療后2周時與基線相比,療效變化無統(tǒng)計學意義,從療后4周起與前一次訪視相比增加量有統(tǒng)計學意義(P值均0.0001)。試驗組和對照組的I-QOL基線值比較,P值為0.687,二者無統(tǒng)計學意義；服藥2周試驗組和對照組的ICI-Q-SF值比較無統(tǒng)計學意義,P值為0.905；但當服藥至4周、6周及8周后,P值為0.0317、0.0003、0.0001,統(tǒng)計學差異顯著。3.3.3試驗組和對照組24h尿失禁頻次比較組內比較,試驗組尿失禁頻次從療后2周起,均與前一次訪視時有減少,減少的頻次數(shù)具有統(tǒng)計學意義(2周、4周P值0.0005,6周、8周P值0.0001)。對照組尿失禁頻次在療后2周時與基線相比,變化無統(tǒng)計學意義,從療后4周起與前一次訪視相比,減少的尿失禁頻次有統(tǒng)計學意義(P值均0.0001)。試驗組和對照組的尿失禁頻次基線值比較,P值為0.498,二者無統(tǒng)計學意義；服藥2周、4周后試驗組和對照組的尿失禁頻次比較無統(tǒng)計學意義,P值為0.0938和0.078；但當服藥至6周及8周后,P值為0.0071、0.0002,統(tǒng)計學差異顯著。3.3.4治療前后漏尿情況分析試驗組在咳嗽或打噴嚏時漏尿和在活動或體育運動時漏尿兩項的好轉率大于對照組。4結論4.1 meta分析結果顯示中醫(yī)藥聯(lián)合盆底肌訓練治療女性壓力性尿失禁有效；4.2單純運用芪實顆粒治療女性輕中度壓力性尿失禁療效優(yōu)于盆底肌訓練組；4.3芪實顆粒聯(lián)合盆底肌訓練可以改善輕中度女性壓力性尿失禁的ICI-Q-SF評分、I-QOL評分及24小時尿失禁頻次；且療效優(yōu)于盆底肌訓練對照組；4.4芪實顆粒聯(lián)合盆底肌訓練治療女性壓力性尿失禁有明顯的癥狀時點緩解規(guī)律。
[Abstract]:Objective 1.1 To provide evidence for evidence - based medicine in clinical practice through systematic evaluation of the curative effect of Chinese medicine combined with pelvic floor muscle training on female stress urinary incontinence ;
1.2 To observe the change of ICI - Q - SF score and the change of urinary pad test in female stress urinary incontinence , and evaluate its curative effect by observing the changes of the ICI - Q - SF score and I - QOL score in female stress urinary incontinence .
1.3 To study the rule of point relief in the treatment of female stress urinary incontinence by the combination of Qi - solid granule and pelvic floor muscle training . The test method 2.1 retrieves Chinese database including Chinese journal full - text database ( CNKI ) , full - text database ( VIP ) of Vip Chinese sci - tech periodicals , full - text database of Wanfang , Chinese Biomedical Literature Database ( CBM ) ;
The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . According to the Chinese and English literature of the conference , the author searches the relevant literature on the Internet and looks up the literature references . The system evaluates the curative effect of Chinese medicine combined with pelvic floor muscle training on female stress urinary incontinence .
In the control group , pelvic floor muscle training was used to observe the effects of ICI - Q - SF score , urinary incontinence and clinical curative effect in two groups .
In the control group , the therapeutic effect of traditional Chinese medicine combined with pelvic floor muscle training on the prevention and treatment of female stress urinary incontinence was discussed . The results showed that the clinical application of traditional Chinese medicine combined with pelvic floor muscle training was superior to the treatment of female stress urinary incontinence .
Compared with the control group , the total effective rate was 67.7 % in the treatment group and 37.0 % in the control group . Compared with the control group , the total effective rate was 67.7 % in the treatment group and 37.0 % in the control group .
Compared with baseline , the QOL scores of the control group were significantly different from baseline ( P < 0.05 , 4 weeks , 6 weeks , 8 weeks P < 0.0001 ) . Compared with baseline , the scores of QOL in the control group were statistically significant ( P < 0 . 0001 ) .
The ICI - Q - SF values of the two week test group and the control group were not statistically significant , and the P value was 0.905 ;
Compared with baseline at 2 weeks after treatment , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) . Compared with baseline in the control group , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) . Compared with baseline in the control group , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) .
The frequency of urinary incontinence in the test group and the control group was not statistically significant after 2 weeks , 0 . 0938 and 0.078 , respectively .
The results showed that the combined pelvic floor muscle training in the treatment of female stress urinary incontinence was effective in the treatment of female stress urinary incontinence .
4.2 The curative effect of treating female with mild and moderate pressure urinary incontinence was better than that of pelvic floor muscle training group .
4 . The ICI - Q - SF score , I - QOL score and 24 - hour urinary incontinence frequency of female stress urinary incontinence in women with mild and moderate pressure were improved by the combination of Qi - solid granule and pelvic floor muscle .
and the curative effect is superior to that of the pelvic floor muscle training control group ;
4.4 Qi - solid granule combined with pelvic floor muscle training in the treatment of female stress urinary incontinence has obvious symptom time point relief rule .

【學位授予單位】：中國中醫(yī)科學院
【學位級別】：博士
【學位授予年份】：2016
【分類號】：R711.59

【參考文獻】

相關期刊論文 前10條

1 馮鳳英;宋睿;;生物反饋-電刺激+盆底肌肉鍛煉治療女性尿失禁的療效觀察[J];中國社區(qū)醫(yī)師;2015年01期

2 李春茹;;探討壓力性尿失禁的解剖學改變與治療[J];中外醫(yī)學研究;2011年12期

3 盛少琴;李東輝;;中西醫(yī)結合治療老年女性壓力性尿失禁療效觀察[J];浙江中西醫(yī)結合雜志;2011年03期

4 陳軍;葛醫(yī);;補中益氣湯加味配合理療治療女性壓力性尿失禁80例療效觀察[J];中國醫(yī)藥指南;2010年18期

5 羅少波;賈金銘;馬衛(wèi)國;董佳晨;焦擁政;;益精方治療少弱精癥207例[J];陜西中醫(yī);2010年04期

6 周倩;張寶平;張平;;中藥內服外用治療女性壓力性尿失禁105例[J];河北中醫(yī);2010年03期

7 胡長效;朱靜;;中藥桑螵蛸的研究進展[J];農業(yè)與技術;2007年05期

8 李美紅;楊雪瓊;萬直劍;楊亞濱;李t，

本文編號：1828608