發(fā)布時間：2018-03-04 13:05

  本文選題：急性化膿性中耳炎　切入點：針刺　出處：《廣州中醫(yī)藥大學》2017年博士論文　論文類型：學位論文

【摘要】：臨床研究部分目的:通過隨機對照的方法比較針刺結合西藥為主的治療組和以西藥為主的對照組的療效優(yōu)劣及不良反應,對急性化膿性中耳炎中西醫(yī)結合治療方法的臨床療效進行客觀評價。方法:將60例符合納入標準的急性化膿性中耳炎患者隨機分為治療組和對照組各30例。治療組采用針刺耳門、聽會、翳風、足三里、丘墟,并采用0.3%氧氟沙星滴耳液滴耳治療,對照組采用單純西藥治療,針刺每日1次,連續(xù)5次,休息2天為1周,西藥每日1次,共2周。治療結束后比較兩組患者臨床改善總有效率及不良反應率,以評估針刺對本病療效的影響。結果:治療組與對照組患者臨床改善總有效率分別為92.9%、82.8%,治療組臨床改善總有效率明顯高于對照組,兩組比較差異有統計學意義(K0.05)。而治療組與對照組患者耳部刺痛發(fā)生率分別為3.57%、10.34%,耳部瘙癢發(fā)生率分別為7.14%、13.79%,治療組患者耳部刺痛及耳部瘙癢發(fā)生率雖都低于對照組,兩組比較差異無統計學意義(P0.05)。結論:相比于西藥組,針刺聯合西藥治療急性化膿性中耳炎具有緩解患者病情,減少不良反應,預后優(yōu)勢明顯等優(yōu)點,具有臨床推廣使用價值。實驗研究部分目的:通過觀察電針及氧氟沙星滴耳液分別對急性化膿性中耳炎模型的大鼠血清中致炎因子TNF-α、IL-6、耳蝸血流動力學指標及炎癥狀態(tài)等相關指標的改變,探討電針對本病的作用機制。方法:挑選39只符合標準的雄性大鼠接受急性中耳炎模型造模,造模成功后(造模過程中死亡3只)隨機分成3組,每組12只。造模3天后,①組給予0.2ml的0.9%氯化鈉鹽水滴耳,②組采用皮內針電針大鼠雙側耳部,治療20min,③組給予氧氟沙星滴耳液0.2ml滴耳。各組均2次/天,共治療7天。各組測定血清致炎因子TNF-a、IL-6在造模前、造模完成后、治療3天、治療7天后的水平;試驗結束后再各自檢測耳蝸微循環(huán)血液流動學指標,包括耳蝸血流量、平均動脈壓;處死豚鼠后記錄中耳炎癥情況及細菌培養(yǎng)計數。結果:電針組和西藥組的血清致炎因子TNF-a、IL-6低于對照組,差異有顯著統計學意義(P0.05);電針組與西藥組比較,差異無統計學意義(P0.05)。實施干預的兩個組與對照組比較,平均動脈壓、耳蝸血流量等血流動力學指標都有所上升,差異有統計學意義(P0.01,P0.05);實施干預的兩組之間比較,差異無統計學意義(P0.05)。實施干預的兩組與對照組比較,中耳炎癥評分、細菌培養(yǎng)計數水平都有所下降,差異有顯著統計學意義(P0.01);實施干預的兩組之間比較,中耳炎癥評分差異無統計學意義(P0.05),細菌培養(yǎng)計數差異有顯著統計學意義(P0.05)。結論:電針或氧氟沙星滴耳液均能夠降低血清致炎因子以及升高平均動脈壓、耳蝸血流量,降低中耳炎癥評分及減少細菌培養(yǎng)計數,具有加快耳蝸微循環(huán)血流及殺菌、消炎的優(yōu)點,使其促進豚鼠中耳炎達到痊愈。在抗菌方面,電針較氧氟沙星西藥組效果更佳,具有臨床推廣使用價值。
[Abstract]:Clinical study objective: the therapeutic effect and adverse reaction of treatment group by randomized controlled comparison of acupuncture combined with western medicine and the control group with western medicine based on the acute suppurative otitis media clinical curative effect of combined treatment of traditional Chinese and Western medicine method of objective evaluation. Methods: 60 cases of acute suppurative otitis media in accordance with the inclusion criteria patients were randomly divided into treatment group and control group with 30 cases in each group. The treatment group with acupuncture, Tinghui, Yifeng, Zusanli, Qiuxu, and the 0.3% Ofloxacin Ear Drops ear treatment, control group was treated with western medicine, acupuncture 1 times a day, 5 times, 2 days of rest for 1 weeks, Western Medicine 1 times a day, a total of 2 weeks after the end of treatment. Compared two groups of patients with clinical improvement of the total efficiency and adverse reaction rate, to evaluate the effect of acupuncture on the disease curative effect. Results: the treatment group and the control group clinical improvement rate were 92.9 %, 82.8%, treatment group total effective rate of clinical treatment was significantly higher than the control group, there was significant difference between two groups (K0.05). The treatment group and control group patients with ear tingling were 3.57% and 10.34%, ear pruritus occurred in 7.14%, 13.79%, treatment group patients with ear tingling and itching ear although the rate is lower than the control group, the two groups had no statistically significant difference (P0.05). Conclusion: compared with western medicine group, acupuncture combined with western medicine treatment can alleviate the disease in patients with acute suppurative otitis media, reduce the adverse reactions and prognosis have obvious advantages and other advantages, is worthy of clinical application. The experimental study objective: through the observation of acupuncture and Ofloxacin Ear Drops rat serum on acute suppurative otitis media model respectively in inflammatory factor TNF- alpha, IL-6, relevant indicators of cochlear blood flow index and inflammation change effect of Electroacupuncture on The mechanism of this disease. Methods: to select 39 only in accordance with the standards of the male rats received acute otitis media model, after the success of modeling (death modeling process = 3) were randomly divided into 3 groups, 12 rats in each group. After 3 days, the 0.2ml group was given 0.9% sodium chloride brine ear, 2 group adopted the treatment of 20min with intradermal needle electroacupuncture in rats with bilateral ear, the group received the Ofloxacin Ear Drops 0.2ml. Some groups were 2 times / day, 7 days of treatment. The determination of serum inflammatory factors in TNF-a groups, IL-6 before modeling, after modeling, for 3 days, 7 days after treatment the level of test results; after each test beam of cochlear microcirculation blood flow indexes, including cochlear blood flow, mean arterial pressure; middle ear inflammation records and bacterial culture counting. Results: Serum guinea pigs were sacrificed after electroacupuncture group and Western medicine group of inflammatory factor TNF-a, IL-6 lower than the control group, the difference was statistically significant (P0.05); Electro acupuncture group and Western medicine group, the difference was not statistically significant (P0.05). The two group compared with the control group intervention, mean arterial pressure, cochlear blood flow and other hemodynamic parameters were increased, the difference was statistically significant (P0.01, P0.05); the implementation of the intervention between the two groups, the difference was not statistically significant (P0.05). The two intervention group compared with the control group, the middle ear inflammation score, bacterial levels decreased, the difference was statistically significant (P0.01); the implementation of the intervention between the two groups, there was no significant difference of middle ear inflammation score (P0.05), the difference of bacterial culture counting was statistically significant (P0.05) conclusion: Electroacupuncture or Ofloxacin Ear Drops are able to reduce the serum inflammatory factors and increased mean arterial pressure, cochlear blood flow, reduce the middle ear inflammation score and reduce bacterial culture counting, has enhanced the cochlear microcirculation The advantages of blood flow, bactericidal and anti-inflammatory make it promote the healing of guinea pig's otitis media. In terms of antibacterial aspect, electroacupuncture is better than ofloxacin and Western medicine, and it has the value of clinical popularization and application.

【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：博士
【學位授予年份】：2017
【分類號】：R764.21

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