本文選題：糖尿病周圍神經(jīng)病變　切入點(diǎn)：硫辛酸　出處：《湖北中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的觀察硫辛酸聯(lián)合中藥足浴治療血瘀型DPN的臨床療效,并探討二者中西醫(yī)結(jié)合治療本病的作用機(jī)制和優(yōu)勢。方法選擇收集2014年3月一2015年8月在武漢市第三醫(yī)院中醫(yī)科及內(nèi)分泌科住院診治的血瘀型DPN患者80例,隨機(jī)分為2組(對照組、治療組)。兩組均行一般治療,對照組行西藥硫辛酸(600mg,配0.9%Na Cl250m L靜脈滴注,每天1次)治療;治療組在對照組的基礎(chǔ)上加用中藥足浴,每天1次,兩組療程均為2周。分別記錄兩組患者治療前后的FBG、2h PG、空腹C肽、餐后2h C肽、血脂四項(xiàng)、肱動(dòng)脈收縮壓、雙側(cè)脛后動(dòng)脈及足背動(dòng)脈收縮壓、ABI、VPT、TCSS評分及臨床癥狀積分,并對研究數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果1、化驗(yàn)檢查:(1)血糖、C肽:治療后兩組患者的FBG、2h PG、空腹C肽及餐后2h C肽與治療前比較均無顯著差異(P0.05)。(2)血脂四項(xiàng):未服用降脂藥的患者血脂四項(xiàng)在對照組中于治療前后無顯著差異(P0.05),治療組中TC和LDL-L較治療前明顯下降,差異具統(tǒng)計(jì)學(xué)意義(P0.05);服用降脂藥的患者對照組中TC及LDL-L較治療前明顯下降(P0.05),治療組的血脂四項(xiàng)均較治療前明顯下降,差異具統(tǒng)計(jì)學(xué)意義(P0.05)。2、臨床檢查:(1)血壓:兩組患者的肱動(dòng)脈收縮壓、足背動(dòng)脈收縮壓及脛后動(dòng)脈收縮壓經(jīng)治療后均較治療前明顯下降,差異顯著(P0.05),但治療組下降程度明顯優(yōu)于對照組。(2)ABI:對照組治療前后無明顯變化(P0.05),而治療組則下降明顯,治療前后差異顯著(P0.05),且治療組較多的患者ABI值恢復(fù)到正常。(3)VPT:對照組治療前后無明顯變化(P0.05),而治療組治療后較治療前明顯改善,有統(tǒng)計(jì)學(xué)意義(P0.01)。3、臨床療效分析:(1)DPN臨床等級分布:對照組治療前后其臨床等級分布無明顯變化(P0.05),而治療組變化明顯(P0.05),且治療組較多患者向較輕的等級轉(zhuǎn)變。(2)TCSS評分及臨床癥狀總積分:治療后兩組患者的TCSS評分及臨床癥狀總積分均較治療前明顯下降,差異顯著(P0.01),但對照組的下降度不及治療組明顯。(3)主要單項(xiàng)癥狀:治療后兩組患者在四肢疼痛、麻木、發(fā)涼、肢軟無力、感覺減退方面均有明顯改善,治療后癥狀積分明顯下降,具統(tǒng)計(jì)學(xué)意義(P0.05),但治療組有效率均明顯高出對照組。(4)總體臨床療效:對照組與治療組的臨床總有效率分別為70.0%、92.5%,兩組療效比較差異顯著(P0.05)。4、兩組患者在治療過程中均未見明顯不良反應(yīng)。結(jié)論1、硫辛酸聯(lián)合中藥足浴治療能夠改善血瘀型DPN患者的血脂(TC、LDL-L)、血壓及ABI等,明顯改善肢體血循環(huán)。2、硫辛酸聯(lián)合中藥足浴治療能夠明顯改善血瘀型DPN患者的臨床癥狀及體征,提高臨床療效,明顯改善患者的生活質(zhì)量。3、中藥足浴簡便、安全、經(jīng)濟(jì)、有效,聯(lián)合西藥治療能顯著提高治療效果,且沒有不良反應(yīng)。
[Abstract]:Objective to observe the clinical effect of lipoic acid combined with traditional Chinese medicine foot bath in the treatment of blood stasis type DPN. Methods 80 cases of DPN with blood stasis were selected and collected from March 1st 2014 to August 2015 in the Department of traditional Chinese Medicine and Endocrinology Department of Wuhan third Hospital. They were randomly divided into two groups (control group, treatment group). The two groups were treated with general treatment. The control group received 600mg lipoic acid, combined with 0.9 Cl250m L intravenous drip once a day, and the treatment group was treated with traditional Chinese medicine foot bath once a day on the basis of the control group. The two groups were treated for 2 weeks. Before and after treatment, the FBGG 2h PGG, fasting C-peptide, postprandial C-peptide, four items of blood lipids, systolic blood pressure of brachial artery, systolic blood pressure of bilateral posterior tibial artery and dorsum pedis artery, TCSS score and clinical symptom score were recorded. The data of the study were analyzed statistically. Results 1. Blood glucose C peptide: FBG 2 h, fasting C peptide and postprandial 2 h C peptide in the two groups were not significantly different from those before treatment. In the control group, there was no significant difference in blood lipids before and after treatment. TC and LDL-L in the treatment group were significantly lower than those before treatment. The difference was statistically significant (P 0.05), TC and LDL-L in the control group were significantly lower than those before treatment, and the four items of blood lipids in the treatment group were significantly lower than those before treatment. Blood pressure: the systolic blood pressure of brachial artery, dorsalis pedis artery and posterior tibial artery were significantly decreased after treatment. The difference was significant (P 0.05), but the degree of decrease in the treatment group was significantly better than that in the control group. There was no significant change in the control group before and after treatment, but the decrease in the treatment group was significant. The difference was significant before and after treatment, and the ABI value of more patients in the treatment group returned to normal. There was no significant change in the control group before and after treatment, while in the treatment group, it was significantly improved after treatment. Clinical grade distribution: there was no significant change in clinical grade distribution before and after treatment in the control group, while in the treatment group, the change was significant (P 0.05), and more patients in the treatment group changed to a lighter grade. Total score of clinical symptoms: after treatment, the TCSS score and the total score of clinical symptoms of the two groups were significantly lower than those before treatment. The difference was significant (P 0.01), but the degree of decrease in the control group was not as obvious as that in the treatment group. The main single symptom was: after treatment, the patients in the two groups had obvious improvement in limb pain, numbness, cooling, weakness in limbs, weakness in limbs, and decrease in symptom score after treatment. The effective rate of the treatment group was significantly higher than that of the control group. The total clinical efficacy of the control group and the treatment group was 70.05 and 92.5, respectively. The difference between the two groups was significant (P0.05. 4) during the course of treatment, the total effective rate of the two groups was all significantly higher than that of the control group (P < 0.05), but the total effective rate of the treatment group was significantly higher than that of the control group (P < 0.05). Conclusion 1. Lipoic acid combined with traditional Chinese medicine foot bath therapy can improve the blood lipids, blood pressure and ABI in patients with blood stasis type DPN. The treatment with lipoic acid combined with traditional Chinese medicine foot bath can obviously improve the clinical symptoms and signs of DPN patients with blood stasis, improve the clinical efficacy, improve the quality of life of the patients, and improve the quality of life of the patients. The traditional Chinese medicine foot bath is simple, safe, economical and effective. Combination of western medicine can significantly improve the therapeutic effect, and there is no adverse reaction.
【學(xué)位授予單位】：湖北中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R587.2

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