本文關(guān)鍵詞： 重癥肌無力 強(qiáng)肌健力方 圍術(shù)期 重癥肌無力危象 PLR NLR　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討在強(qiáng)肌健力方的干預(yù)下,對(duì)我院收治的重癥肌無力患者觀察其圍術(shù)期療效及臨床特點(diǎn),分析是否能改善和調(diào)節(jié)重癥肌無力患者在圍手術(shù)期的炎癥和免疫水平、術(shù)后危象發(fā)生率、西藥治療重癥肌無力不良反應(yīng)指標(biāo)等方面。方法:回顧性分析在我院收治符合標(biāo)準(zhǔn)的99例行胸腺擴(kuò)大切除術(shù)MG患者相關(guān)臨床資料,通過術(shù)前有無服用強(qiáng)肌健力方分為實(shí)驗(yàn)組及對(duì)照組,對(duì)所收集到臨床資料進(jìn)行統(tǒng)計(jì)學(xué)分析,分析比較兩組主要療效觀察指標(biāo):包括圍手術(shù)期(術(shù)前,術(shù)后第3天)血液分析中各指標(biāo)、血糖值指標(biāo)變化規(guī)律以及術(shù)后MG危象發(fā)生情況,次要療效觀察指標(biāo):包括術(shù)后住院天數(shù)、術(shù)后氣管插管、胃管留置時(shí)間等。采用SPSS20.0進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:99例病人中,實(shí)驗(yàn)組52例,對(duì)照組47例。本研究中術(shù)后出現(xiàn)重癥肌無力危象共8例,其中實(shí)驗(yàn)組3例,對(duì)照組5例,兩組的危象發(fā)生率分別為5.76%和10.63%,8例危象患者均順利出院,可以看出實(shí)驗(yàn)組危象發(fā)生情況要低于國內(nèi)外同期平均水平,對(duì)照組與國內(nèi)外平均水平基本持平,可能受樣本量的影響,兩組術(shù)后危象發(fā)生情況比較無明顯統(tǒng)計(jì)學(xué)差異,故其有效性需前瞻性大樣本數(shù)據(jù)進(jìn)一步考證。兩組患者在術(shù)后NLR、PLR的變化比較以及術(shù)后差值的比較中,均有明顯的統(tǒng)計(jì)學(xué)差異(P0.05),說明強(qiáng)肌健力方能明顯干預(yù)NLR和PLR指標(biāo)的變化;兩組患者在術(shù)后血糖、白細(xì)胞、血小板藥物安全性指標(biāo)未能得出較為一致的統(tǒng)計(jì)學(xué)差異,但在白細(xì)胞和血小板的差值比較中兩組患者是有明顯的統(tǒng)計(jì)學(xué)差異(P0.05),說明強(qiáng)肌健力方的干預(yù)能在一定程度上改善單純西藥治療重癥肌無力的藥效不良反應(yīng),但其有效性亦需進(jìn)一步的前瞻性大樣本數(shù)據(jù)考證;兩組患者在術(shù)后住院天數(shù)、氣管插管和胃管留置時(shí)間、術(shù)后首次排便時(shí)間比較無明顯統(tǒng)計(jì)學(xué)差異(P0.05),故強(qiáng)肌健力方在改善以上各康復(fù)指標(biāo)的作用與否還需進(jìn)一步實(shí)驗(yàn)研究考證。結(jié)論:強(qiáng)肌健力方的干預(yù)可改善術(shù)后MG危象的發(fā)生情況,并能一定程度上改善和調(diào)節(jié)重癥肌無力患者的圍手術(shù)期免疫狀態(tài)水平、機(jī)體的應(yīng)激及炎癥反應(yīng)。但因本研究為回顧性分析,其有效性需前瞻性大樣本隨機(jī)對(duì)照實(shí)驗(yàn)進(jìn)一步證實(shí)。在強(qiáng)肌健力方的干預(yù)下,與淋巴細(xì)胞水平、NLR和PLR水平變化相關(guān)性值得進(jìn)一步探索研究。強(qiáng)肌健力方聯(lián)合西藥治療MG其術(shù)后血糖、白細(xì)胞、血小板的藥物安全性評(píng)價(jià)中是否要明顯好于單純西藥治療,亦需前瞻性的大樣本研究數(shù)據(jù)證實(shí)。
[Abstract]:Objective: to investigate the perioperative efficacy and clinical characteristics of patients with myasthenia gravis treated in our hospital under the intervention of Qiangjijianli recipe. To analyze whether it can improve and regulate the inflammation and immunity of patients with myasthenia gravis during the perioperative period, and the incidence of postoperative crisis. Methods: the clinical data of 99 patients with MG treated with extended thymectomy in our hospital were retrospectively analyzed. Through the preoperative use of Qiangjijianli prescription divided into experimental group and control group, collected clinical data were statistically analyzed, analysis and comparison of the two groups of main therapeutic indicators: including perioperative period (preoperative). On the third day after operation, the indexes of blood analysis, the change rule of blood glucose index, the occurrence of MG crisis after operation, the secondary curative effect observation index: including postoperative hospitalization days, postoperative tracheal intubation. Results there were 52 cases in the experimental group and 47 cases in the control group. In this study, there were 8 cases of myasthenia gravis crisis after operation. There were 3 cases in the experimental group and 5 cases in the control group. The incidence of crisis in the two groups was 5.76% and 10.63 respectively. It can be seen that the incidence of crisis in the experimental group is lower than the average level at home and abroad in the same period, and the average level of the control group is basically the same as that at home and abroad. There was no significant difference in the incidence of postoperative crisis between the two groups, so the effectiveness of the two groups need to be further verified by prospective large sample data. The two groups of patients in postoperative NLR. There was significant statistical difference in the change of PLR and the difference of postoperative value (P 0.05), which indicated that Qiangjijianli prescription could significantly interfere with the changes of NLR and PLR. Two groups of patients in postoperative blood sugar, white blood cell, platelet drug safety indicators can not reach a more consistent statistical difference. However, there was a significant statistical difference between the two groups in the difference between white blood cells and platelets (P 0.05). The results showed that the intervention of Qiangjijianli recipe could improve the side effects of western medicine in treating myasthenia gravis to a certain extent, but its effectiveness also needed to be verified by further prospective and large sample data. There was no significant difference between the two groups in the days of hospitalization, the time of tracheal intubation and gastric tube indwelling, and the first defecation time after operation (P 0.05). Therefore, the effect of Qiangjijianli recipe in improving the above rehabilitation indexes needs further experimental research. Conclusion: the intervention of Qiangjijianli prescription can improve the occurrence of MG crisis after operation. And to some extent can improve and regulate the patients with myasthenia gravis perioperative immune state, body stress and inflammatory response. But this study is a retrospective analysis. Its effectiveness needs to be further confirmed by a prospective, large sample randomized controlled trial. Under the intervention of Qiangjianli recipe, the level of lymphocytes was increased. The correlation between NLR and PLR levels is worth further study. Qiangjianli prescription combined with western medicine in the treatment of MG postoperative blood glucose, white blood cells. Whether the drug safety evaluation of platelets is significantly better than that of western medicine alone needs to be confirmed by prospective large sample data.
【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】：2017
【分類號(hào)】：R746.1;R655

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本文編號(hào)：1479975