本文關鍵詞： 急性痛風性關節(jié)炎 加減木防己湯 香連金黃散 臨床研究　出處：《成都中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：本課題采用中藥制劑加減木防己湯內(nèi)服聯(lián)合香連金黃散外敷治療濕熱蘊結(jié)證急性痛風性關節(jié)炎的方法,旨在評價其近期臨床療效、安全性,從而彰顯中醫(yī)治療優(yōu)勢,力求為廣大急性痛風性關節(jié)炎患者提供一種方便、安全、實用的中醫(yī)治療方法,并推進其臨床的進一步應用。方法：擇符合受試條件的急性痛風性關節(jié)炎濕熱蘊結(jié)證的患者60例,采用隨機數(shù)字表法按1：1分為中醫(yī)治療組(治療組)30例和西醫(yī)治療組(對照組)30例,治療組應用內(nèi)服加減木防己湯聯(lián)合外敷香連金黃散的中醫(yī)綜合治療方案治療,對照組給予口服雙氯芬酸鈉雙釋放腸溶膠囊和碳酸氫鈉片,兩組療程均為7天。記錄各組治療前、治療3天后、治療7天后各項中醫(yī)癥狀體征積分、中醫(yī)證候積分、鎮(zhèn)痛起效時間、血沉、C-反應蛋白、血尿酸指標的變化以及不良事件。采用SPSS21.0統(tǒng)計軟件對所得數(shù)據(jù)進行統(tǒng)計分析,然后對各組的臨床治療效果進行深入探討,評價其臨床療效及安全性。結(jié)果：兩組患者治療七天后的總有效率、臨床痊愈率、愈顯率相當(P0.05)。兩組的治療方案均可改善患者中醫(yī)證候積分,且治療組的治療方案在改善患者中醫(yī)證候積分方面優(yōu)于對照組(P0.05)。兩組的治療方案均可改善關節(jié)疼痛、關節(jié)壓痛、關節(jié)腫脹、關節(jié)屈伸不利、關節(jié)發(fā)熱、關節(jié)表面皮色、發(fā)熱、頭身困重、口干、汗出、心煩、小便短黃、大便黏滯不爽、舌質(zhì)、舌苔等方面(P0.05)。治療組在改善關節(jié)疼痛、關節(jié)腫脹、頭身困重、口干、 汗出、心煩、大便黏滯不爽、舌質(zhì)、舌苔、脈象等方面優(yōu)于對照組(P0.05)。兩組的治療方案在改善關節(jié)壓痛、關節(jié)屈伸不利、關節(jié)發(fā)熱、關節(jié)表面皮色、發(fā)熱、小便短黃等方面療效相當(P0.05)。治療組患者的關節(jié)腫脹、頭身困重、口干、汗出、大便黏滯不爽、舌質(zhì)、舌苔表現(xiàn)的消失率優(yōu)于對照組(P0.05),而關節(jié)疼痛、關節(jié)壓痛、關節(jié)屈伸不利、關節(jié)發(fā)熱、關節(jié)表面皮色、發(fā)熱、心煩、小便短黃、脈象表現(xiàn)的消失率兩組療效相當(P0.05)。兩組患者鎮(zhèn)痛起效時間方面比較無明顯差異(P0.05)。兩組治療方案均可降低患者C-反應蛋白、血尿酸、血沉水平(P0.05),兩組的治療方案在降低患者C-反應蛋白、血尿酸、血沉水平方面無明顯差異(P0.05)。本治療方案具有較好的安全性。結(jié)論：中藥制劑加減木防己湯內(nèi)服聯(lián)合香連金黃散外敷可以有效地治療急性痛風性關節(jié)炎濕熱蘊結(jié)證患者,改善患者臨床癥狀體征,并能降低血沉、C-反應蛋白、血尿酸的濃度,且安全性良好,值得臨床推廣及應用。
[Abstract]:Objective: to evaluate the clinical efficacy and safety of traditional Chinese medicine preparation plus Xianmu Fangji decoction combined with external application of Xianglian Jinhuang Powder in the treatment of acute gouty arthritis with dampness and heat accumulation syndrome. In order to highlight the advantages of traditional Chinese medicine treatment, and strive to provide a convenient, safe and practical Chinese medicine treatment for the vast number of patients with acute gouty arthritis. Methods: 60 cases of acute gouty arthritis with damp-heat accumulation syndrome were selected. According to 1: 1, randomly divided into Chinese medicine treatment group (treatment group, 30 cases) and western medicine treatment group (control group, 30 cases). The treatment group was treated with internal administration of Xianmu Fangji decoction combined with external application of Xianglianjin Huangsan. The control group was given oral diclofenac sodium double release enteric capsule and sodium bicarbonate tablet. The course of treatment in both groups was 7 days. The scores of symptoms and signs of TCM, symptoms and signs of TCM, onset time of analgesia, erythrocyte sedimentation rate and C-reactive protein were recorded before treatment, 3 days after treatment and 7 days after treatment. The changes of serum uric acid index and adverse events were analyzed by SPSS21.0 software, and then the clinical effect of each group was discussed. Results: the total effective rate, clinical recovery rate and effective rate of the two groups were similar to that of P0.050.The two treatment schemes could improve the score of TCM syndromes of the patients. And the treatment group in the improvement of TCM syndrome score is better than the control group P0.05. both groups of treatment can improve joint pain, joint tenderness, joint swelling, joint flexion and extension unfavorable. Joint fever, joint surface color, fever, head and body weight, dry mouth, sweat, upset, short yellow urine, stool sticky discomfort, tongue, tongue coating and other aspects of P0.05. the treatment group in the improvement of joint pain. Joint swelling, head weight, dry mouth, sweating, upset, sticky stool, tongue, tongue coating, pulse and so on are better than the control group P0.050.The two groups of treatment in improving joint tenderness. Joint flexion and extension, joint fever, joint surface skin color, fever, short yellow urine and other aspects of the curative effect is quite P0.05. the treatment group patients with joint swelling, head and body weight, dry mouth, sweating, stool viscosity is not cool. The disappearance rate of tongue quality and tongue coating was better than that of control group (P 0.05), but joint pain, joint tenderness, joint flexion and extension disadvantage, joint fever, skin color of joint surface, fever, upset, short yellow urination. There was no significant difference in the onset time of analgesia between the two groups. Serum uric acid, ESR level, P0.05N, two groups of treatment in the reduction of patients with C-reactive protein, blood uric acid. There was no significant difference in ESR level (P0.05). Conclusion: internal administration of traditional Chinese medicine preparation plus Xianmu Fangji decoction combined with external application of Xianglian Jinhuang Powder can effectively treat acute gouty arthritis patients with damp-heat accumulation syndrome. To improve the clinical symptoms and signs of patients, and can reduce the concentration of erythrocyte sedimentation rate (ESR) C-reactive protein and serum uric acid, and the safety is good, it is worthy of clinical promotion and application.
【學位授予單位】：成都中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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