本文關(guān)鍵詞： 膝骨性關(guān)節(jié)炎 中醫(yī)外治法 穴位離子導(dǎo)入 中藥敷貼 臨床療效評價　出處：《成都中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

【摘要】：目的通過開展多中心隨機(jī)對照試驗,綜合評價穴位離子導(dǎo)入聯(lián)合中藥敷貼治療膝骨性關(guān)節(jié)炎關(guān)節(jié)疼痛的臨床療效,為制定膝骨性關(guān)節(jié)炎的中醫(yī)外治方案提供可靠的臨床試驗依據(jù)。方法采用多中心、隨機(jī)、對照研究方法,將符合納入排除標(biāo)準(zhǔn)的117例膝骨性關(guān)節(jié)炎患者隨機(jī)分為試驗組和對照組。試驗組采用穴位中藥離子導(dǎo)入聯(lián)合中藥巴布膏敷貼,對照組采用扶他林乳膠劑導(dǎo)入聯(lián)合酮洛芬貼片敷貼,兩組受試者每天接受1次治療,連續(xù)治療14次。以疼痛強(qiáng)度、疼痛頻度、疼痛持續(xù)時間等疼痛相關(guān)指標(biāo)為主要指標(biāo),以壓痛指數(shù)、關(guān)節(jié)功能、生活質(zhì)量等疾病相關(guān)指標(biāo)為次要指標(biāo),依據(jù)各指標(biāo)治療前后組內(nèi)比較及治療后組間比較,綜合評價中醫(yī)外治方案治療膝骨性關(guān)節(jié)炎關(guān)節(jié)疼痛的臨床療效。結(jié)果1、基線情況：兩組受試者基線均衡,具有可比性(P0.05)。2、所有疼痛相關(guān)指標(biāo),試驗組治療后較治療前均有極顯著改善(P0.01)。①疼痛強(qiáng)度：WOMAC疼痛強(qiáng)度總分及“平地走路時”、“上下山”得分治療結(jié)束時試驗組低于對照組(P0.05),經(jīng)治療后各項改善值組間無顯著性差異(P0.05),連續(xù)觀測顯示W(wǎng)OMAC疼痛強(qiáng)度總分在治療第4-14天試驗組低于對照組(P0.05)；治療期14天的疼痛平均緩解百分?jǐn)?shù)試驗組高于對照組(P0.01),治療第8-14天的疼痛緩解百分?jǐn)?shù)試驗組高于對照組(P0.05)；疼痛開始緩解時間組間無顯著性差異(P0.05)；疼痛完全消失比率試驗組高于對照組(P0.05)。②疼痛頻度：在治療7天、治療結(jié)束時試驗組低于對照組(P0.05),經(jīng)治療后改善值試驗組高于對照組(P0.05)；③疼痛持續(xù)時間：治療結(jié)束時試驗組低于對照組(P0.05),經(jīng)治療后改善值組間無顯著性差異(P0.05)。3、所有疾病相關(guān)指標(biāo),試驗組治療后較治療前均有極顯著改善(P0.01)。①壓痛指數(shù)：在治療3天、7天后試驗組低于對照組(P0.05),經(jīng)治療后改善值組間無顯著性差異(P0.05)；②關(guān)節(jié)功能：WOMAC關(guān)節(jié)功能總分在治療7天、治療結(jié)束時試驗組低于對照組(P0.05),經(jīng)治療后改善值組間無顯著性差異(P0.05)；③生活質(zhì)量：AIMS2-SF總分及癥狀方面得分治療后試驗組高于對照組(P0.05),經(jīng)治療后AIMS2-SF總分、軀體功能、癥狀、工作方面改善值試驗組高于對照組(P0.05)。4、隨訪期各指標(biāo)試驗組均較治療前極顯著改善(P0.01),WOMAC疼痛強(qiáng)度總分在12周、24周隨訪時試驗組優(yōu)于對照組(P0.05)。疼痛頻度、WOMAC關(guān)節(jié)功能總分、AIMS2-SF總分在12周隨訪時試驗組優(yōu)于對照組(P0.05)。5、兩組均未出現(xiàn)嚴(yán)重不良事件,組間無顯著性差異(P0.05)。兩組依從性均90%,組間無顯著性差異(P0.05)。結(jié)論1.穴位離子導(dǎo)入聯(lián)合中藥敷貼能有效改善膝骨性關(guān)節(jié)炎患者疼痛癥狀、功能活動障礙及生活質(zhì)量,且具有較好的遠(yuǎn)期效應(yīng),其在降低疼痛強(qiáng)度和疼痛頻度、提高治療期疼痛平均緩解程度、促進(jìn)疼痛完全消失、改善生活質(zhì)量方面優(yōu)于“扶他林乳膠劑導(dǎo)入療法+酮洛芬貼片劑敷貼療法”組成的西醫(yī)外治方案。2.該治療方案安全有效,操作簡便,具有較強(qiáng)的臨床適用性。
[Abstract]:Objective to carry out multicenter randomized controlled trials, comprehensive evaluation of acupoint iontophoresis combined with traditional Chinese medicine acupoint application clinical curative effect of treatment of osteoarthritis of the knee joint pain, provide a reliable basis for clinical trials to develop knee osteoarthritis TCM external treatment program. Methods a multicenter, randomized, controlled study method, will meet the inclusion criteria 117 cases of knee osteoarthritis were randomly divided into experimental group and control group. The experimental group was treated with acupoint iontophoresis combined with traditional Chinese medicine Babu paste application, the control group using Votalin emulgel import joint Ketoprofen Patch applicator, two groups of subjects received daily treatment for 1 times, for 14 consecutive times. Pain intensity, pain frequency the duration of pain, pain and other related indicators as the main index, the pain index, joint function, disease related quality of life indicators as secondary indexes on the basis of each index before and after treatment Within the group and between two groups after treatment, the clinical curative effect of comprehensive evaluation of traditional Chinese medicine treatment of osteoarthritis of knee joint pain. Results: 1. Baseline: two groups of subjects baseline, comparable to.2 (P0.05), all the pain index, the test group after treatment than before treatment were extremely significant improvement (P0.01). The pain intensity: WOMAC pain intensity score and "flat walk", "end down" treatment scores of the experimental group than the control group (P0.05), after treatment, the improvement of value did not differ between the two groups (P0.05), continuous observation showed WOMAC score in the treatment of pain intensity 4-14 days in the experimental group than the control group (P0.05); pain treatment period of 14 days the average remission percentage of experimental group were higher than control group (P0.01), the 8-14 day of the treatment of pain relief percentage of experimental group were higher than control group (P0.05); the pain began to ease the time between the two groups Significant differences (P0.05); the ratio of pain disappeared completely in experimental group were higher than control group (P0.05). The frequency of pain: in the treatment of 7 days, at the end of treatment, the experimental group than the control group (P0.05), after treatment to improve the value of experimental group was higher than control group (P0.05); the pain duration: at the end of treatment the experimental group than the control group (P0.05), after treatment, improve the values did not differ between the two groups (.3, P0.05) of all disease related index, the test group after treatment than before treatment were significantly improved (P0.01). The pain index: in the treatment of 3 days, 7 days after the test group was lower than the control group (P0.05), after treatment improved value did not differ between the two groups (P0.05); the joint function: WOMAC joint function score in the treatment of 7 days, at the end of treatment, the experimental group than the control group (P0.05), after treatment, improve the values did not differ between the two groups (P0.05); quality of life: the total score of AIMS2-SF and symptoms The scores of the experimental group after treatment was higher than the control group (P0.05), the AIMS2-SF score after treatment, symptoms, physical function, work to improve the value of experimental group was higher than control group (P0.05.4), the test groups during the follow-up period than before treatment significantly improved (P0.01), WOMAC pain intensity score at week 12, 24 week of follow-up test group than the control group (P0.05). The frequency of pain, WOMAC joint function score, the total score of AIMS2-SF in the test group than the control group after 12 weeks (P0.05.5), the two groups were no serious adverse events, no significant difference between groups (P0.05). The two groups were 90% non compliance. Significant differences between the groups (P0.05). Conclusion 1. acupoint iontophoresis combined with traditional Chinese medicine plaster can effectively improve the patients with knee osteoarthritis pain symptoms, functional disorder and quality of life, and has better long-term effect, the reduction in pain intensity and pain frequency, improve the treatment of pain level Both the degree of ease, promote the pain completely disappeared, which improve the quality of life is better than "Votalin emulgel iontophoresis + Ketoprofen Patch agent applicator therapy of the western medicine the treatment scheme of.2. is safe and effective, simple operation, clinical has strong applicability.

【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2016
【分類號】：R274.9

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