本文關(guān)鍵詞：針刀鏡治療急性膝痛風(fēng)性關(guān)節(jié)炎的療效觀察及機(jī)制研究　出處：《廣州中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 急性膝痛風(fēng)性關(guān)節(jié)炎 微創(chuàng)針刀鏡 臨床研究 機(jī)制研究

【摘要】：急性痛風(fēng)性關(guān)節(jié)炎(Acute Gout Arthritis)是由于機(jī)體內(nèi)嘌呤代謝紊亂,導(dǎo)致尿酸鹽關(guān)節(jié)內(nèi)沉積,導(dǎo)致發(fā)作性急性關(guān)節(jié)紅腫熱痛的一種疾病,是臨床常見的關(guān)節(jié)炎之一。中醫(yī)認(rèn)為痛風(fēng)的發(fā)生多因患者肆食酒肉膏粱厚味等品為外因,內(nèi)因為痰濕日久損傷脾胃,導(dǎo)致脾胃運(yùn)化失調(diào),致氣血虧虛。微創(chuàng)針刀鏡是一種以中醫(yī)理論為指導(dǎo)、西醫(yī)手術(shù)操作為基礎(chǔ)的微創(chuàng)診療技術(shù)。該技術(shù)融合了傳統(tǒng)醫(yī)學(xué)的小針刀技術(shù)、現(xiàn)代醫(yī)學(xué)的微創(chuàng)外科技術(shù)和內(nèi)窺鏡設(shè)備,在診療過程中能夠不破壞整體結(jié)構(gòu),處理體內(nèi)微細(xì)組織結(jié)構(gòu)的病變,是傳統(tǒng)針刀療法和普通開刀手術(shù)所無法替代的新技術(shù)。目的:對微創(chuàng)針刀鏡治療急性痛風(fēng)性關(guān)節(jié)炎的近期療效及遠(yuǎn)期療效進(jìn)行綜合評價,探討其治療急性痛風(fēng)性關(guān)節(jié)炎的部分作用機(jī)理,為微創(chuàng)針刀鏡的在臨床上的應(yīng)用提供理論依據(jù)。方法:根據(jù)隨機(jī)、對照、非盲的臨床試驗原則,收集符合診斷納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn)的急性痛風(fēng)性關(guān)節(jié)炎患者42例。其中針鏡治療組21例,入組后立即給予依托考昔120mg/次,1次/日,連服8日,之后改為60mg/日,1次/日;入院第2天下午行微創(chuàng)針刀鏡。對照組21例,入組后治療上立即予口服依托考昔120mg/次,1次/日,連服8日,之后改為60mg/日,1次/日。兩組患者在入組后均給予基礎(chǔ)治療,兩周后開始常規(guī)控尿酸治療,之后隨訪半年,計算半年內(nèi)兩組患者的總復(fù)發(fā)人次數(shù)。對兩組患者分別于治療前、入組第3天(微創(chuàng)針刀鏡治療第2天)、第7天、第10天及第14天進(jìn)行評價。臨床觀察指標(biāo)包括關(guān)節(jié)腫脹、疼痛、壓痛、關(guān)節(jié)灼熱、關(guān)節(jié)疼痛評分(VAS評分)。實驗室指標(biāo)包括檢測患者血清尿酸、ESR、CRP、D-二聚體水平;使用ELISA法及RT-PCR法檢測血清中IL-1β、IL-6及TNF-α的水平。分析各實驗室及觀察檢測指標(biāo),并對其進(jìn)行統(tǒng)計學(xué)分析。結(jié)果:微創(chuàng)針刀鏡治療急性痛風(fēng)性關(guān)節(jié)炎療效確切,對比單純運(yùn)用藥物的對照組,能降低血清中血沉、C反應(yīng)蛋白、D二聚體、IL-1β、IL-6及TNF-α水平,差異具有統(tǒng)計學(xué)意義(P0.05);能緩解關(guān)節(jié)腫脹、疼痛、壓痛、關(guān)節(jié)灼熱癥狀,其中關(guān)節(jié)疼痛評分差異具有統(tǒng)計學(xué)意義(P0.05);在隨后為期半年的隨訪中,治療組急性痛風(fēng)性關(guān)節(jié)炎的復(fù)發(fā)率更低,差異具有統(tǒng)計學(xué)意義(P0.05)。本研究在整個治療和觀察過程中無病例脫落。在治療期間,治療組和對照組中無一例患者出現(xiàn)不良反應(yīng)。結(jié)論:微創(chuàng)針刀鏡治療急性痛風(fēng)性關(guān)節(jié)炎對比單純藥物治療組近期療效及遠(yuǎn)期療效更為顯著,具有療效優(yōu)、創(chuàng)傷小、術(shù)后恢復(fù)時間短,無明顯毒副作用等優(yōu)點,患者接受度高,值得在臨床推廣和運(yùn)用。
[Abstract]:Acute Gout arthritisis is caused by the disturbance of purine metabolism in the body, resulting in the deposition of uric acid salt in the joint. It is one of the most common arthritis in clinic. Chinese medicine thinks gout occurs mostly because patients eat wine, meat, paste, thick taste and other products as external cause, which is caused by dampness of phlegm and dampness of spleen and stomach for a long time. Minimally invasive needle knife mirror is a minimally invasive diagnosis and treatment technology based on the theory of traditional Chinese medicine and the operation of western medicine. This technique combines the small needle knife technology of traditional medicine. Modern medical minimally invasive surgical techniques and endoscopes, in the course of diagnosis and treatment can not destroy the overall structure, the treatment of the body of micro-tissue structure lesions. It is a new technique that can not be replaced by traditional needle-knife therapy and general operation. Objective: to evaluate the short-term and long-term effects of minimally invasive needle knife endoscope in the treatment of acute gouty arthritis. To explore the mechanism of the treatment of acute gouty arthritis and provide the theoretical basis for the clinical application of minimally invasive needle knife. Methods: according to the principles of randomized, controlled and non-blind clinical trials. A total of 42 patients with acute gouty arthritis who met the diagnostic inclusion criteria and exclusion criteria were collected. Among them, 21 cases in the acupuncture treatment group were given etacoxib 120 mg / d once a day on 8th. Then it was changed to 60 mg / day / day; In the afternoon of the second day of admission, the patients in the control group were treated with minimally invasive needle-knife endoscope. The patients in the control group were given orally etacoxib 120mg / d once a day immediately after admission, then 60 mg / day on 8th. Once a day. Two groups of patients were given basic treatment after entering the group, two weeks after the routine control of uric acid treatment, and then follow up for half a year, calculate the total number of relapse in the two groups within half a year. The two groups of patients before treatment. The third day (day 2, day 7, day 10 and day 14) of minimally invasive needle knife therapy were evaluated. The clinical parameters included swelling, pain, tenderness and burning of joints. Joint pain score and VAS score. The laboratory indexes included the detection of serum uric acid (ESRA) CRP- dimer level. The levels of IL-1 尾 -IL-6 and TNF- 偽 in serum were detected by ELISA and RT-PCR. The indexes of IL-1 尾 -IL-6 and TNF- 偽 were analyzed. Results: the curative effect of minimally invasive needle knife microscope on acute gouty arthritis was definite. Compared with the control group, the serum ESR C reactive protein D dimer could be reduced. The levels of IL-1 尾 -IL-6 and TNF- 偽 were significantly different (P 0.05). Can alleviate the joint swelling, pain, tenderness, joint burning symptoms, in which the difference in joint pain score was statistically significant (P 0.05); The recurrence rate of acute gouty arthritis in the treatment group was lower during the subsequent half year follow-up. The difference was statistically significant (P 0.05). No cases fell off during the whole course of treatment and observation. There were no adverse reactions in the treatment group and control group. Conclusion: the treatment of acute gouty arthritis with minimally invasive needle knife endoscope is more effective than that of the control group. It is worth popularizing and applying in clinic because of the advantages of small trauma, short recovery time and no obvious side effects.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R246.9

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