本文關(guān)鍵詞： 重癥肌無力 肌力 膏方 用藥經(jīng)驗(yàn)　出處：《南京中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的：本課題旨在通過收集重癥肌無力患者的臨床資料,觀察顧錫鎮(zhèn)教授膏方治療重癥肌無力的臨床療效,總結(jié)臨床用藥經(jīng)驗(yàn),為中醫(yī)臨床治療提供參考依據(jù)。研究方法：納入2013年10月至2015年12月江蘇省中醫(yī)院顧錫鎮(zhèn)教授膏方門診MG患者共34例,符合中醫(yī)痿證診斷,服用膏方,療程8周,在治療前、治療4周及8周時(shí)分別進(jìn)行肌力評(píng)分。用SPSS軟件進(jìn)行統(tǒng)計(jì)分析,對(duì)治療前后評(píng)分進(jìn)行對(duì)比以評(píng)估療效。對(duì)膏方所用中藥進(jìn)行頻數(shù)分析,結(jié)合中醫(yī)組方理論及辨證論治,總結(jié)顧錫鎮(zhèn)教授膏方用藥經(jīng)驗(yàn)。研究結(jié)果：1.治療4周、治療8周與治療前絕對(duì)評(píng)分分別相比,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05),同時(shí),治療8周與治療4周絕對(duì)評(píng)分相比,差異同樣具有統(tǒng)計(jì)學(xué)意義(P0.05),因此,治療4周、治療8周后肌力均可改善,且治療8周后肌力改善更明顯。2.治療4周與治療8周相對(duì)評(píng)分總體均數(shù)均超過25%,說明兩個(gè)階段的治療總體上均可達(dá)到好轉(zhuǎn)及以上水平,以相對(duì)評(píng)分計(jì)算總有效率,治療4周為76.47%,治療8周為91.18%,治療8周時(shí)有效率更高。3.眼瞼、眼球活動(dòng)、四肢、面部肌群的肌力絕對(duì)評(píng)分在治療4周、治療8周時(shí)均有明顯下降,與治療前絕對(duì)評(píng)分對(duì)比P0.05,表明兩個(gè)治療階段后肌力均有所改善,治療8周絕對(duì)評(píng)分與治療4周絕對(duì)評(píng)分相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05),說明8周后肌力改善更明顯；咀嚼吞咽肌群在治療4周后與治療前相比,差別有統(tǒng)計(jì)學(xué)意義(P0.05),但治療8周后較治療4周后肌力評(píng)分無變化;呼吸肌治療4周與治療前相比,評(píng)分無變化,肌力無改善,但治療8周后與治療4周相比,差異有統(tǒng)計(jì)學(xué)意義(P0.05),表明呼吸困難需要較長(zhǎng)療程治療后才能得到改善。4.顧錫鎮(zhèn)教授膏方治療MG療效無明顯性別、分型差別,不同性別、不同分型(Ⅰ、 ⅡA、ⅡB型)患者均能取得可靠療效。5.顧錫鎮(zhèn)教授膏方治療MG常用補(bǔ)益藥、安神藥、消食藥,注重升提引經(jīng)藥物,同時(shí)重視預(yù)防外感,隨證加減。6.顧錫鎮(zhèn)教授膏方治療MG用藥特點(diǎn)可歸納為：補(bǔ)益脾腎,兼顧五臟；緊扣主證,兼顧他證；升清降濁,調(diào)理氣機(jī)；運(yùn)脾和中,和胃安神；扶正祛邪,化濕解毒。研究結(jié)論：顧錫鎮(zhèn)教授膏方治療Ⅰ、Ⅱ型重癥肌無力療效確切,除咀嚼吞咽、呼吸肌以外的肌群肌力均可明顯持續(xù)改善,療效不受性別、分型的影響。顧錫鎮(zhèn)教授膏方治療MG用藥常用補(bǔ)益藥、安神藥、消食藥,注重升提引經(jīng)藥物,同時(shí)重視預(yù)防外感,隨證加減;用藥特點(diǎn)可歸納為：補(bǔ)益脾腎,兼顧五臟；緊扣主證,兼顧他證；升清降濁,調(diào)理氣機(jī)；運(yùn)脾和中,和胃安神;扶正祛邪,化濕解毒。
[Abstract]:Objective: through collecting the clinical data of myasthenia gravis patients, the purpose of this study was to observe the clinical effect of professor Gu Xizhen plaster on myasthenia gravis, and to summarize the experience of clinical medication. Methods: from October 2013 to December 2015, 34 patients with MG were included in the outpatient clinic of Professor Gu Xizhen of Jiangsu Provincial Hospital of traditional Chinese Medicine. The patients were diagnosed with TCM impotence syndrome and were treated with ointment for 8 weeks. After 4 weeks and 8 weeks of treatment, muscle strength scores were scored respectively. SPSS software was used for statistical analysis, and the scores before and after treatment were compared in order to evaluate the curative effect. The frequency of traditional Chinese medicine for ointment was analyzed, combined with the theory of traditional Chinese medicine prescription and differentiation of symptoms and signs. The results showed that there were significant differences in absolute scores for 4 weeks, 8 weeks after treatment and before treatment, respectively. At the same time, the absolute scores of 8 weeks of treatment and 4 weeks of treatment were significantly higher than those of 4 weeks of treatment. The difference was also statistically significant (P 0.05). Therefore, muscle strength could be improved after 4 weeks of treatment and 8 weeks of treatment. After 8 weeks of treatment, the improvement of muscle strength was more obvious. 2. The total mean of relative scores of 4 weeks and 8 weeks of treatment exceeded 25, which indicated that the two stages of treatment could reach the level of improvement and above, and the total effective rate was calculated by relative score. The effective rate was higher at 8 weeks. The absolute score of muscle strength of eyelid, eyeball movement, limbs and facial muscles decreased significantly at 4 weeks of treatment and 8 weeks of treatment. Compared with the absolute score before treatment, P0.05 showed that the muscle strength was improved after the two stages of treatment. The difference between the absolute score of 8 weeks and the absolute score of 4 weeks was statistically significant (P 0.05), which indicated that the improvement of muscle strength was more obvious after 8 weeks. The difference of masticatory swallowing muscle group after 4 weeks treatment was statistically significant compared with that before treatment, but there was no change in muscle strength score after 8 weeks treatment compared with that after 4 weeks treatment, but there was no change in muscle strength score and muscle strength in respiratory muscle group after 4 weeks treatment compared with that before treatment. But after 8 weeks of treatment and 4 weeks of treatment, the difference was statistically significant (P 0.05), which indicated that dyspnea needed a long course of treatment before it could be improved. Different types of patients (鈪，

本文編號(hào)：1541864