本文選題：痛風(fēng) + 超聲電導(dǎo)儀　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討應(yīng)用超聲電導(dǎo)儀局部給予地塞米松治療急性痛風(fēng)性關(guān)節(jié)炎的療效與安全性。方法:通過(guò)臨床篩選2015年11月至2016年10月在青島大學(xué)附屬醫(yī)院代謝性疾病科及痛風(fēng)專(zhuān)病門(mén)診診治的痛風(fēng)性關(guān)節(jié)炎患者(急性發(fā)作期)56例作為研究對(duì)象,使用隨機(jī)數(shù)表將患者隨機(jī)分組至試驗(yàn)組30例與對(duì)照組26例兩組。對(duì)所有受試者進(jìn)行為期14天的觀察。對(duì)照組治療方案為:安康信120mg qd應(yīng)用3天,第4天起改為60mg qd再連續(xù)應(yīng)用4天;秋水仙堿早晚各0.5mg,碳酸氫鈉早中晚各1.0g,持續(xù)應(yīng)用14天;試驗(yàn)組治療方案:在對(duì)照組治療方案的基礎(chǔ)上第1~5天于發(fā)作關(guān)節(jié)局部應(yīng)用超聲電導(dǎo)儀局部給予地塞米松治療。分別于第1~14天觀察比較兩組患者關(guān)節(jié)疼痛評(píng)分(VAS評(píng)分)、腫脹評(píng)分,分別于第1、3、5、7、14天留取靜脈血檢測(cè)及比較兩組患者的實(shí)驗(yàn)室生化指標(biāo):血尿酸(UA)、C反應(yīng)蛋白(CRP)、血沉(ESR)、白介素1β(IL-1β)、腫瘤壞死因子α(TNF-α),并觀察評(píng)估兩組患者試驗(yàn)前后胃腸道反應(yīng)、血糖、血壓及肝腎功能等變化情況。統(tǒng)計(jì)分析使用SPSS17.0軟件進(jìn)行數(shù)據(jù)處理,定量資料采用t檢驗(yàn)和方差分析,定性資料用百分率表示并使用c2檢驗(yàn)進(jìn)行分析(因n30,統(tǒng)計(jì)時(shí)采用Fisher確切概率法)。統(tǒng)計(jì)結(jié)果以P0.05作為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:共有56例患者納入試驗(yàn),其中4例患者因?yàn)槭гL而被剔除,最終試驗(yàn)組28例、對(duì)照組24例完成隨訪,納入統(tǒng)計(jì)對(duì)象。試驗(yàn)組與對(duì)照組關(guān)節(jié)疼痛評(píng)分(VAS評(píng)分)比較,第3、4、5、6、7、8、9、10、11、12、13、14天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=3.98~9.31,P0.05,0.01);試驗(yàn)組與對(duì)照組關(guān)節(jié)腫脹評(píng)分比較,第3、4、5、6、7、8、9、10、11、12、13、14天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=3.98~9.73,P0.05,0.01);試驗(yàn)組與對(duì)照組實(shí)驗(yàn)室生化指標(biāo)比較,IL1-β第3、5、7天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=4.12、4.02,P0.05),TNF-α第5、7天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=4.02、4.02,P0.05),ESR第3、5、7天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=4.02、4.12,P0.05),CRP第3、5、7天試驗(yàn)組均低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(F=4.02、4.50,P0.05);試驗(yàn)組與對(duì)照組藥物副作用發(fā)生率比較,胃腸道反應(yīng)(輕度惡心、胃部不適)發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(c2=0.59,P0.05),血壓波動(dòng)(SBP升高20mm Hg)發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異(c2=0.21,P0.05),且兩組均未出現(xiàn)血糖明顯升高及肝腎功異常的病例。結(jié)論:應(yīng)用超聲電導(dǎo)儀局部給予地塞米松治療急性痛風(fēng)性關(guān)節(jié)炎可以提高消炎鎮(zhèn)痛療效,且安全性好
[Abstract]:Objective: to investigate the efficacy and safety of local administration of dexamethasone with ultrasonic conductometer in the treatment of acute gouty arthritis. Methods: from November 2015 to October 2016, 56 patients with gouty arthritis were selected from metabolic diseases department and outpatient clinic of Qingdao University affiliated Hospital. Patients were randomly divided into trial group (n = 30) and control group (n = 26). All subjects were observed for 14 days. In the control group, 120mg QD was used for 3 days and changed to 60mg QD for 4 days, colchicine 0.5 mg in the morning and evening, sodium bicarbonate at 1.0 g in the morning and evening for 14 days. The experimental group was treated with dexamethasone on the 5th day after the local application of ultrasonic conductance instrument on the basis of the control group. The joint pain scores, VAS scores and swelling scores were observed and compared between the two groups on the 1st day of 14 days. Venous blood samples were collected at 714 days after the first trimester, and the biochemical indexes of the two groups were compared: CRPU, ESR, IL-1 尾, TNF- 偽, TNF- 偽, and observed and evaluated the gastrointestinal reaction and blood glucose in the two groups before and after the trial, and compared the two groups of patients before and after the trial, and compared the biochemical indexes of the two groups, such as CRPU, ESR, IL-1 尾, TNF- 偽, TNF- 偽, et, TNF- 偽, TNF- 偽, TNF- 偽, TNF- 偽. Changes in blood pressure and liver and kidney function. Statistical analysis uses SPSS17.0 software to process data, quantitative data is analyzed by t test and variance analysis, qualitative data is expressed by percentage and analyzed by c2 test (because of n30, Fisher exact probability method is used in statistics). Statistical results with P0.05 as the difference was statistically significant. Results: a total of 56 patients were included in the trial, among which 4 patients were excluded because of missing visit. 28 cases in the trial group and 24 cases in the control group were followed up and included in the statistics. Compared with the control group, the joint pain scores of the trial group and the control group were significantly lower than that of the control group on the 3rd day (P < 0.05), and the joint swelling scores of the test group and the control group were lower than those of the control group on the day 344.98 ~ 9.31g / P 0.05 / 0.01g / d, respectively, and that of the control group was lower than that of the control group on the day of 34D, and the score of joint pain in the experimental group was significantly lower than that in the control group on day 1314, and the difference was statistically significant (P < 0.05), and the score of joint swelling in the trial group was lower than that in the control group on day 1314. The difference was statistically significant (P < 0.01), the biochemical indexes of the experimental group were lower than that of the control group on the 7th day, and the difference was statistically significant (P < 0.05). The experimental group was lower than the control group on the 57th day of TNF- 偽. The difference was statistically significant (P < 0.05). The ESR group was lower than the control group on the 3rd day of ESR, and the difference was statistically significant (P < 0.05). The difference was statistically significant in the experimental group (P < 0.05) and the control group (P < 0.05). The incidence of side effects in the experimental group was significantly lower than that in the control group (P < 0.05), and the incidence of side effects in the experimental group was significantly lower than that in the control group. There was no significant difference in the incidence of gastrointestinal reaction (mild nausea, stomach discomfort) between the two groups. There was no significant difference in the incidence of gastrointestinal reaction (mild nausea, stomach discomfort). There was no significant difference between the two groups in the incidence of elevated blood glucose and abnormal liver and kidney function. Conclusion: local administration of dexamethasone with ultrasonic conductometer can improve the anti-inflammatory and analgesic effect, and the safety is good.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R589.7

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