本文選題：痛風(fēng)性關(guān)節(jié)炎　切入點(diǎn)：急性發(fā)作　出處：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：本研究通過(guò)對(duì)痛風(fēng)性關(guān)節(jié)炎急性發(fā)作期患者火針點(diǎn)刺的治療指標(biāo)的觀察,客觀評(píng)價(jià)其療效,為該病的臨床治療方案提供可靠的循證醫(yī)學(xué)證據(jù)。方法：選擇2015年6月至2016年2月在廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院針灸科、風(fēng)濕科病房就診且符合研究納入標(biāo)準(zhǔn)的痛風(fēng)性關(guān)節(jié)炎急性發(fā)作患者,共60例,按照1：1的比例,隨機(jī)分配至試驗(yàn)組(基礎(chǔ)調(diào)護(hù)+火針點(diǎn)刺+西藥組)和對(duì)照組(基礎(chǔ)調(diào)護(hù)+西藥組),每組各30例。試驗(yàn)組在基礎(chǔ)調(diào)護(hù)前提下,采用火針點(diǎn)刺結(jié)合西藥治療的方法。①基礎(chǔ)調(diào)護(hù)；②火針常規(guī)選穴：阿是穴(3個(gè))隱白、解溪、太溪；結(jié)合辨證取穴(風(fēng)濕郁熱證加足三里、陰陵泉、曲池、內(nèi)庭)；局部選穴等,均患側(cè)取穴；③常規(guī)西藥治療：對(duì)照組在基礎(chǔ)調(diào)護(hù)上僅使用常規(guī)西藥治療(依托考昔片：120mg, qd；碳酸氫鈉片：1g, tid)。兩組西藥治療每日1次,連續(xù)使用8日；火針點(diǎn)刺隔日1次,5天為1療程,連續(xù)治療2個(gè)療程,療程間休息2日。治療前、后分別對(duì)患者進(jìn)行中醫(yī)癥狀體征分級(jí)量化及VAS疼痛評(píng)定量表進(jìn)行評(píng)分,采用SPSS20.0軟件進(jìn)行統(tǒng)計(jì)分析。結(jié)果：治療前,對(duì)兩組患者的性別、年齡、病程、病位等一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),組間具有可比性；對(duì)兩組患者中醫(yī)癥狀體征積分、VAS積分、血尿酸、血沉等實(shí)驗(yàn)室指標(biāo)的基線比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),組間具有可比性。治療2個(gè)療程后,兩組總體療效方面,試驗(yàn)組總有效率為93.33%,對(duì)照組總有效率100%,差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05)；鎮(zhèn)痛療效方面,試驗(yàn)組和對(duì)照組總有效率均為100%,經(jīng)秩和檢驗(yàn),組間比較差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)。兩組中醫(yī)癥狀體征總積分、關(guān)節(jié)VAS疼痛積分較治療前均有改善(P0.05),在活動(dòng)受限、次要癥狀兩方面,兩組總體改善效果沒(méi)有明顯差異(P＞0.05),其余中醫(yī)癥狀的總體改善效果試驗(yàn)組均優(yōu)于對(duì)照組(PO.05)。結(jié)論：1.在同樣的基礎(chǔ)調(diào)護(hù)前提下,火針點(diǎn)刺局部腧穴結(jié)合西藥治療與單純西藥治療痛風(fēng)性關(guān)節(jié)炎的急性發(fā)作均有效。2.兩組方案在治療結(jié)束時(shí)對(duì)患者關(guān)節(jié)活動(dòng)受限、次要癥狀兩方面的改善效果相當(dāng),其余中醫(yī)癥狀(關(guān)節(jié)疼痛、觸痛、腫脹)及總體改善效果,試驗(yàn)組均優(yōu)于對(duì)照組。3.療程結(jié)束后,試驗(yàn)組對(duì)局部疼痛的改善效果優(yōu)于對(duì)照組。針對(duì)痛風(fēng)性關(guān)節(jié)炎急性發(fā)作,火針療法能有效改善關(guān)節(jié)疼痛、關(guān)節(jié)觸痛、關(guān)節(jié)腫脹等癥狀,作為一種無(wú)明顯副作用的治療手段,值得臨床廣泛推廣。
[Abstract]:Objective: to evaluate the curative effect of acute gouty arthritis by observing the therapeutic indexes of fire acupuncture in patients with gouty arthritis. To provide reliable evidence-based medical evidence for the clinical treatment of the disease. Methods: selected from June 2015 to February 2016, Department of Acupuncture and moxibustion, first affiliated Hospital of Guangzhou University of traditional Chinese Medicine, A total of 60 patients with acute attack of gouty arthritis in rheumatic wards who met the criteria included in the study, according to the 1:1 ratio, They were randomly assigned to the experimental group (the basic control group) and the control group (30 cases in each group). The method of fire acupuncture combined with western medicine treatment .1 basic adjustment and nursing 2 fire needle routine selection points: Ashi (3) hidden white, Jiexi, Taixi, combined with syndrome differentiation (rheumatism and stagnation heat plus Zusanli, Yin Ling Quan, qu Chi, Inner chamber, etc., local points selection, etc.). The patients in the control group were treated with routine western medicine only on the basis of adjusting nursing. The control group was treated with routine western medicine only (1: 1 g sodium bicarbonate, QD). The two groups were treated with western medicine once a day for 8 consecutive days. Fire needle needling every other day for 5 days was a course of treatment, with two consecutive courses of treatment. Before and after the treatment, the patients were graded and quantified by TCM symptom and physical signs and VAS pain rating scale. Results: before treatment, there was no significant difference in sex, age, course of disease and disease position between the two groups (P > 0.05). There was no significant difference in VAS score, blood uric acid, erythrocyte sedimentation rate and other laboratory indexes between the two groups (P > 0.05), and there was comparability between the two groups. After two courses of treatment, the overall curative effect of the two groups was not significant (P > 0.05). The total effective rate was 93.33 in the trial group and 100 in the control group, with no significant difference (P > 0.05). In terms of analgesic effect, the total effective rate of the trial group and the control group was 100, with rank sum test. The difference between the two groups was statistically significant (P < 0.05). The total score of symptoms and signs of traditional Chinese medicine and the pain score of joint VAS in both groups were improved compared with those before treatment (P < 0.05). There was no significant difference between the two groups in the overall improvement effect (P > 0.05). The overall improvement effect of other TCM symptoms in the experimental group was better than that in the control group (P < 0.05). Conclusion: 1. Under the same basic condition, the experimental group is better than the control group. The acute attack of gouty arthritis treated with fire acupuncture and local acupoints combined with western medicine was effective. 2. At the end of the treatment, the joint movement of the patients was restricted, and the improvement of secondary symptoms was similar in two aspects. The other TCM symptoms (joint pain, tenderness, swelling) and the overall improvement effect were better in the experimental group than in the control group. 3. After the treatment, the improvement effect of local pain in the experimental group was better than that in the control group, and the acute attack of gouty arthritis was better in the experimental group than in the control group. Fire acupuncture therapy can effectively improve joint pain, joint tenderness, joint swelling and other symptoms, as a treatment without obvious side effects, it is worthy of extensive clinical promotion.
【學(xué)位授予單位】：廣州中醫(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)】：R246.1

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