發(fā)布時(shí)間：2018-05-08 01:40

  本文選題：三聯(lián)排石療法 + 膽石癥��； 參考：《安徽中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:觀察三聯(lián)排石療法治療膽總管結(jié)石(CBDS)的臨床療效。方法:選擇安徽中醫(yī)藥大學(xué)第一附屬醫(yī)院普外科2013年1月-2015年12月收治的CBDS患者73例,隨機(jī)分為2組,治療組37例,按時(shí)間節(jié)點(diǎn)有規(guī)律地使用中藥、西藥、針灸及脂肪餐的療法排石治療;對(duì)照組36例,在西藥治療的基礎(chǔ)上,給予利膽排石片,療程1周,觀察對(duì)比兩組的臨床療效。結(jié)果:臨床研究結(jié)果表明三聯(lián)排石法相對(duì)于對(duì)照組,在治療中醫(yī)臨床癥狀上,總有效率分別為94.59.94%和75.00%,兩者都有明顯療效,但治療組效果更好,有顯著性差異(P0.05)。治療組疾病總有效率為81.08%;影像學(xué)療效總有效率為83.79%;對(duì)照組疾病總有效率為66.67%;影像學(xué)效總有效率為63.89%。兩組療效對(duì)比,均有顯著性差異(P0.05),表明三聯(lián)排石療法有更好的排石效果。結(jié)論:臨床研究表明三聯(lián)排石療法緩解其臨床癥狀具有較好的效果,能明顯消除或改善右上腹疼痛(壓痛)、噯氣、納呆、惡心、厭食油膩等癥狀,能明顯提高排石率,為治療CBDS提供新思路,新途徑。其作用機(jī)制考慮為以下幾方面:一、中藥具有疏泄肝膽的作用,防止膽汁淤積肝臟,促進(jìn)肝臟大量分泌膽汁,增加膽道內(nèi)壓力,起到內(nèi)沖洗作用,促進(jìn)結(jié)石排出,為膽道結(jié)石排出提供條件;二、中藥能調(diào)節(jié)膽汁成分,消除膽道內(nèi)炎癥因子,破壞結(jié)石形成條件,改善膽道內(nèi)環(huán)境,溶解膽道內(nèi)結(jié)石,為排出較大結(jié)石提供條件;三、中藥結(jié)合針灸刺激相應(yīng)穴位,能加強(qiáng)膽囊及膽管收縮,進(jìn)一步加強(qiáng)膽道內(nèi)壓力,同時(shí)能松弛oddi括約肌,促進(jìn)結(jié)石排出;四、根據(jù)人體膽汁分泌、排泄規(guī)律,膽管括約肌擴(kuò)張收縮規(guī)律,結(jié)石堵塞膽管下端等特點(diǎn),結(jié)合相關(guān)藥物的療效,將中藥、西藥、針灸以及其他治療措施,按時(shí)間點(diǎn)順序有機(jī)地結(jié)合起來,集中治療優(yōu)勢(shì),取得排石的最大可能性,以達(dá)到最大程度消除或改善臨床癥狀,提高排石率。
[Abstract]:Objective: to observe the clinical effect of triple lithotomy therapy on choledocholithiasis (CBDS). Methods: from January 2013 to December 2015, 73 patients with CBDS were randomly divided into two groups: treatment group (n = 37), using Chinese medicine and western medicine regularly according to time node. Acupuncture and moxibustion and fat meal therapy for lithotomy treatment, control group of 36 cases, on the basis of western medicine treatment, given Lidan Pai stone tablets, the course of one week, the two groups were observed and compared the clinical efficacy. Results: compared with the control group, the total effective rate of the triple method was 94.59.94% and 75.00%, respectively, but the effect of the treatment group was better than that of the control group (P 0.05). The total effective rate of disease in treatment group was 81.08; the total effective rate of imaging effect was 83.79; the total effective rate of disease in control group was 66.67; the total effective rate of imaging effect was 63.89. There was significant difference between the two groups (P 0.05), which indicated that the triple therapy had better lithogenic effect. Conclusion: the clinical study shows that triple lithotomy therapy has a better effect on relieving clinical symptoms, can obviously eliminate or improve the pain of right upper abdomen (tenderness, belching, anorexia, nausea, anorexia and other symptoms), and can obviously increase the rate of removing stone. To provide a new way for the treatment of CBDS. The mechanism is considered as follows: first, Chinese medicine has the effect of relieving liver and gallbladder, preventing cholestasis of liver, promoting large amount of bile secretion of liver, increasing internal pressure of bile duct, playing an internal washing role, and promoting the excretion of stones. The Chinese medicine can regulate the bile composition, eliminate the inflammatory factors in the bile duct, destroy the conditions for the formation of the stones, improve the internal environment of the bile duct, dissolve the stones in the bile duct, and provide the conditions for the discharge of larger stones; third, Chinese medicine combined with acupuncture and moxibustion to stimulate the corresponding acupoints can strengthen the contraction of the gallbladder and bile duct, further strengthen the pressure in the biliary tract, at the same time relax the sphincter of oddi and promote the excretion of stones; fourthly, according to the rules of bile secretion and excretion of human body, The characteristics of bile duct sphincter dilatation and contraction, stones blocking the lower end of the bile duct, combined with the curative effect of related drugs, the combination of traditional Chinese medicine, western medicine, acupuncture and other treatment measures, combined organically according to the time point sequence, concentrated treatment advantage, The maximum possibility of removing stone is obtained in order to eliminate or improve the clinical symptoms and increase the rate of stone removal.
【學(xué)位授予單位】：安徽中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R575.62

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