本文選題：痛風(fēng)性關(guān)節(jié)炎　切入點(diǎn)：濕熱蘊(yùn)結(jié)　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:隨著大眾飲食結(jié)構(gòu)及生活習(xí)慣的改變,痛風(fēng)的患病率呈逐年升高的趨勢(shì)。痛風(fēng)一病嚴(yán)重影響著患者的生活質(zhì)量,西醫(yī)對(duì)本病尚無(wú)根治方法,且多伴有明顯的毒副作用。隨著祖國(guó)醫(yī)學(xué)對(duì)痛風(fēng)一病的進(jìn)一步了解,目前中醫(yī)及中西醫(yī)聯(lián)合治療痛風(fēng)已取得較好療效。目的:通過(guò)觀(guān)察關(guān)節(jié)鏡微創(chuàng)手術(shù)結(jié)合清熱涼血方治療濕熱蘊(yùn)結(jié)型膝痛風(fēng)性關(guān)節(jié)炎的臨床療效及研究分析其作用機(jī)理,為臨床治療膝痛風(fēng)性關(guān)節(jié)炎提供一種更加有效、安全的治療方法。方法:本次研究對(duì)象選取符合納入標(biāo)準(zhǔn)的自2016年2月份至2017年2月份在廣州中藥大學(xué)第三附屬醫(yī)院住院的59例膝痛風(fēng)性關(guān)節(jié)炎患者,中醫(yī)辨證均為濕熱蘊(yùn)結(jié)證型。然后按入院順序依次編號(hào),通過(guò)采用隨機(jī)數(shù)字表法,分為治療組(30例)和對(duì)照組(29例)。兩組患者入院后均完善術(shù)前常規(guī)檢查及手術(shù)評(píng)估,無(wú)手術(shù)絕對(duì)禁忌癥后,行膝關(guān)節(jié)鏡微創(chuàng)清理術(shù)及術(shù)后相同的常規(guī)處理。并且從術(shù)后第2天起,給予口服苯溴馬隆片(昆山龍燈瑞迪制藥有限公司國(guó)藥準(zhǔn)字J20130141),50mg/次,1次/d,早餐后服用,連續(xù)治療4周。在治療期間所有患者須定期復(fù)查肝腎功能,若提示肝腎功能?chē)?yán)重異常者,須終止治療。治療組在上述治療下,術(shù)后第二天起同時(shí)予清熱涼血方水煎口服,1劑/天,以4周為一療程。通過(guò)觀(guān)察治療1周、4周時(shí)的臨床療效,疼痛、關(guān)節(jié)功能積分,試驗(yàn)室指標(biāo)(血尿酸、血沉、C-反應(yīng)蛋白)水平變化。然后進(jìn)行統(tǒng)計(jì)分析(SPSS19.0統(tǒng)計(jì)軟件)。結(jié)果:1.治療1周時(shí),治療組總有效率為90.0%,對(duì)照組總有效率為82.7%,治療組的臨床療效雖優(yōu)于對(duì)照組,但兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。而在治療4周,治療組總有效率為100%,對(duì)照組總有效率為93.1%,治療組的臨床療效較對(duì)照組明顯改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.治療前,兩組患者的疼痛積分、關(guān)節(jié)功能積分、BUA、ESR、CRP指標(biāo)比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3.治療1周及4周時(shí),兩組的疼痛、關(guān)節(jié)功能積分均低于治療前(P0.05),且治療組在降低疼痛、關(guān)節(jié)功能積分方面效果優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.在治療1周時(shí),兩組復(fù)測(cè)的BUA、ESR、CRP水平均較治療前下降,同時(shí)治療組ESR、CRP水平低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),而治療組BUA水平雖低于對(duì)照組,但兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在治療4周時(shí),復(fù)測(cè)的BUA、ESR、CRP水平,治療組均明顯低于對(duì)照組,兩組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05);并且治療4周與治療1周時(shí)相比較,BUA、ESR、CRP水平進(jìn)一步降低。結(jié)論:本次臨床研究表明,關(guān)節(jié)鏡微創(chuàng)手術(shù)結(jié)合清熱涼血方治療濕熱蘊(yùn)結(jié)型膝痛風(fēng)性關(guān)節(jié)炎的療效確切,可有效緩解臨床癥狀,減輕疼痛,改善關(guān)節(jié)活動(dòng),降低血尿酸及炎性指標(biāo)水平,是治療膝關(guān)節(jié)痛風(fēng)性關(guān)節(jié)炎的一種有效、微創(chuàng)、安全的治療方法,值得在臨床上推廣。
[Abstract]:Background: with the changes of dietary structure and lifestyle, the prevalence of gout is increasing year by year.Gout disease seriously affects the quality of life of patients, Western medicine has no cure for the disease, and often with obvious side effects.With the further understanding of gout disease in traditional Chinese medicine, the treatment of gout with TCM and western medicine has achieved good curative effect.Objective: to observe the clinical effect and mechanism of arthroscopic minimally invasive operation combined with Qingreliangxue recipe in the treatment of knee gouty arthritis of damp-heat accumulation type, so as to provide a more effective method for the treatment of knee gouty arthritis.A safe treatment.Methods: 59 patients with knee gouty arthritis who were admitted to the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine from February 2016 to February 2017 were selected.The patients were divided into treatment group (n = 30) and control group (n = 29).The preoperative routine examination and surgical evaluation were improved in both groups after admission, and the knee arthroscopic minimally invasive debridement and the same routine management were performed after operation without absolute contraindication.And from the second day after operation, oral benzbromarone tablets were given (Kunshan Longlanliangruidi Pharmaceutical Co., Ltd.) J20130141C 50mg / once a day, taken after breakfast and treated continuously for 4 weeks.During treatment, all patients should regularly review their liver and kidney function, and if severe abnormal liver and kidney function are indicated, the treatment should be terminated.The treatment group was treated with Qingre Liangxue decoction for 4 weeks as a course of treatment.The changes of clinical efficacy, pain, joint function score and laboratory indexes (hematuria, erythrocyte sedimentation rate, C-reactive protein) were observed at 1 week and 4 weeks after treatment.Then statistical analysis was carried out by SPSS 19.0 software.The result is 1: 1.After one week of treatment, the total effective rate of the treatment group was 90.0 and the total effective rate of the control group was 82.7. The clinical effect of the treatment group was better than that of the control group, but there was no significant difference between the two groups.The total effective rate in the treatment group was 100 and the total effective rate in the control group was 93.1.The clinical efficacy of the treatment group was significantly improved than that of the control group, and the difference was statistically significant (P 0.05).Before treatment, there was no significant difference in pain score, joint function score and ESR-CRP between the two groups.After 1 and 4 weeks of treatment, the scores of pain and joint function in both groups were lower than those before treatment (P 0.05), and the effect of the treatment group in reducing pain and joint function score was better than that in the control group, the difference was statistically significant (P 0.05).At 1 week after treatment, the levels of BUAS CRP in the two groups were lower than those before treatment, and the level of BUA in the treatment group was lower than that in the control group (P 0.05). Although the level of BUA in the treatment group was lower than that in the control group, there was no significant difference between the two groups (P 0.05).At the 4th week of treatment, the level of BUAESR-CRP in the treatment group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P 0.05), and the level of BUAESR-CRP decreased further after 4 weeks of treatment and 1 week of treatment.Conclusion: this clinical study shows that arthroscopic minimally invasive surgery combined with Qingreliangxue prescription in the treatment of knee gouty arthritis with dampness and heat accumulation can effectively relieve clinical symptoms, relieve pain and improve joint activity.Reducing the level of serum uric acid and inflammatory index is an effective, minimally invasive and safe method for treating knee joint gouty arthritis, which is worth popularizing in clinic.
【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(lèi)號(hào)】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 劉彬;;關(guān)節(jié)鏡在骨性關(guān)節(jié)炎中的臨床應(yīng)用[J];中國(guó)現(xiàn)代藥物應(yīng)用;2016年08期

2 劉楊從;李妍;張耕;;18例苯溴馬隆不良反應(yīng)/事件分析[J];中國(guó)醫(yī)院藥學(xué)雜志;2016年06期

3 鄭敏;麻駿武;;高尿酸血癥和痛風(fēng)的遺傳學(xué)研究進(jìn)展[J];遺傳;2016年04期

4 張舸;;關(guān)節(jié)鏡微創(chuàng)手術(shù)治療膝關(guān)節(jié)痛風(fēng)性關(guān)節(jié)炎的效果觀(guān)察[J];中國(guó)醫(yī)藥指南;2015年22期

5 孫海林;;全膝表面置換術(shù)治療晚期痛風(fēng)性膝關(guān)節(jié)炎臨床療效[J];世界最新醫(yī)學(xué)信息文摘;2015年43期

6 鄭維蓬;魏合偉;鄧偉捷;劉彬;;魏合偉教授治療痛風(fēng)性關(guān)節(jié)炎之經(jīng)驗(yàn)介紹[J];陜西中醫(yī)學(xué)院學(xué)報(bào);2015年03期

7 楊婷;路敏;周穎;崔一民;;非布司他和別嘌醇治療痛風(fēng)有效性和安全性的Meta分析[J];中國(guó)臨床藥理學(xué)雜志;2015年02期

8 魏合偉;黃梓基;鄭維蓬;;清熱涼血方治療痛風(fēng)性關(guān)節(jié)炎的療效觀(guān)察[J];廣州中醫(yī)藥大學(xué)學(xué)報(bào);2014年06期

9 崔炎;王平;張榜;王莉杰;劉陽(yáng);王永志;;急性痛風(fēng)性關(guān)節(jié)炎與血尿酸及尿酸鹽結(jié)晶的關(guān)系[J];中國(guó)中西醫(yī)結(jié)合外科雜志;2014年05期

10 楊雪芳;王永昌;王苗慧;郭紅云;蘇海翔;;痛風(fēng)的發(fā)病機(jī)制與藥物治療研究進(jìn)展[J];中醫(yī)藥導(dǎo)報(bào);2014年06期

相關(guān)會(huì)議論文 前1條

1 灑玉萍;文紹敦;;火針刺絡(luò)放血治療急性痛風(fēng)性關(guān)節(jié)炎臨床觀(guān)察[A];2011中國(guó)針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

相關(guān)博士學(xué)位論文 前1條

1 國(guó)偉婷;5'-磷酸腺苷誘導(dǎo)低溫治療急性痛風(fēng)性關(guān)節(jié)炎的實(shí)驗(yàn)研究[D];青島大學(xué);2012年

，

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