本文選題：黃體酮　切入點(diǎn)：硬結(jié)　出處：《河北醫(yī)科大學(xué)》2016年碩士論文

【摘要】：目的:芒硝具有清熱解毒、瀉熱軟堅、散積消腫的作用,非常適用于熱實(shí)積滯之證。外用貼敷可消炎去腫。黃體酮長期肌肉注射導(dǎo)致局部炎性反應(yīng),嚴(yán)重者可導(dǎo)致人工脂膜炎。本次實(shí)驗選擇接受黃體酮肌肉注射的患者為研究對象,比較芒硝外敷與硫酸鎂濕敷對治療黃體酮肌注所致局部不良反應(yīng)的療效觀察,以期對臨床護(hù)理做出指導(dǎo)。方法:1選擇2015年3月-2015年12月到河北省中醫(yī)院婦科門診、病房的72例需要進(jìn)行長期肌注黃體酮注射液的先兆流產(chǎn)患者,年齡22~40歲,要求符合先兆流產(chǎn)的診斷標(biāo)準(zhǔn),肌注黃體酮注射液(40mg),每天1次,采用劑型20mg/ml,兩側(cè)臀部交替注射,直到妊娠4~8周后緩慢減量至最后停止用藥。2分組:本次研究采用的是病例自身對照研究的方法。按照注射部位分為對照組和觀察組:(1)對照組(右側(cè)臀部、奇數(shù)次注射):Z型手法預(yù)沖少量空氣肌肉注射黃體酮2小時后,將50%硫酸鎂溶液浸透紗布外敷在注射部位,每日1次,每次持續(xù)2小時,濕敷期間,保持紗布濕潤;(2)觀察組(左側(cè)臀部、雙數(shù)次注射):Z型手法預(yù)沖少量空氣肌注黃體酮2小時后,取裝有芒硝碎屑的藥袋一個,外敷于肌肉注射部位,并適當(dāng)固定,同樣每日1次,每次外敷2小時。3療效判斷指標(biāo):以每次肌肉注射前評估前一天輔助治療情況并記錄。(1)肌肉注射部位的不同程度炎性反應(yīng)發(fā)生情況。(2)注射部位體表溫度。(3)肌肉注射部位皮下硬結(jié)出現(xiàn)時間。(4)患者注射時的疼痛指數(shù)。(5)患者在藥物外敷過程中舒適度指數(shù)。4統(tǒng)計學(xué)分析:數(shù)據(jù)處理采用SPSS13.0統(tǒng)計軟件包,結(jié)果等級資料采用秩和檢驗,計量資料采用t檢驗,計數(shù)資料采用x2檢驗。結(jié)果:1兩種外敷方法在輔助治療黃體酮肌注所致局部炎癥的治療和預(yù)防方面有統(tǒng)計學(xué)意義(P0.01),芒硝外敷組治療效果顯著優(yōu)于硫酸鎂濕敷組。2兩組患者肌肉注射部位體表溫度有統(tǒng)計學(xué)意義(P0.01),芒硝外敷組治療效果顯著優(yōu)于硫酸鎂濕敷組。3兩組患者肌肉注射部位皮下硬結(jié)出現(xiàn)時間有統(tǒng)計學(xué)意義(P0.01),芒硝外敷組治療效果顯著優(yōu)于硫酸鎂濕敷組。4在外敷治療過程舒適度方面兩組數(shù)據(jù)比較,芒硝外敷的使用效果與硫酸鎂濕敷也占較大優(yōu)勢(P0.01),有統(tǒng)計學(xué)意義。外敷時不僅不會污染敷料,而且不太受體位的限制,大大提高病人的依從性。5兩種外敷治療方法對改善肌肉注射的疼痛程度方面無統(tǒng)計學(xué)意義。6在治療過程中,兩組患者均沒有出現(xiàn)不良反應(yīng),該治療安全可靠。結(jié)論:芒硝外敷對于預(yù)防和治療由于黃體酮長期肌肉注射所致的局部炎癥效果優(yōu)于硫酸鎂濕敷。芒硝外敷與硫酸鎂濕敷相比較具有舒適度較高的優(yōu)點(diǎn),而且安全可靠。作為治療和預(yù)防黃體酮所致局部炎癥的輔助方法芒硝外敷具有值得推廣的意義。對于肌肉注射時疼痛的觀察有待于進(jìn)一步研究。
[Abstract]:Objective: mirabilite has the function of clearing heat and detoxifying, reducing heat soft and strong, spreading heat and reducing swelling, which is very suitable for the syndrome of heat accumulation and stagnation. Topical application can reduce inflammation and remove swelling. Long term intramuscular injection of progesterone leads to local inflammatory reaction. Severe cases may lead to artificial panniculitis. In this experiment, patients receiving intramuscular injection of progesterone were selected as study subjects to compare the efficacy of topical application with magnesium sulfate in the treatment of local adverse reactions caused by intramuscular injection of progesterone. Methods from March 2015 to December 2015, 72 patients with threatened abortion, aged 22 to 40 years, who needed long-term intramuscular injection of progesterone, were selected to go to the gynecological clinic of Hebei Provincial Hospital of traditional Chinese Medicine. According to the diagnostic criteria of threatened abortion, 40 mg of progesterone injection was injected intramuscularly, once a day, with 20 mg / ml dosage form, alternately injected on both sides of the buttocks. After 4 weeks of gestation, the drug was gradually reduced to the final withdrawal of medication. 2 groups: this study was conducted using a case-control study. It was divided into two groups according to the injection site: the control group and the observation group: the control group (right buttocks), the right buttocks, the right buttocks. After 2 hours of intramuscular injection of progesterone, 50% magnesium sulfate solution was immersed in gauze at the injection site, once a day for 2 hours, during wet compress. The observation group (left buttocks, double times injection: Z type manipulation pre-flushing a small amount of air intramuscular injection of progesterone 2 hours later, take a medicine bag containing mirabilite crumbs, apply it to the intramuscular injection site and fix it properly, again once a day, Outcome measures of external application for 2 hours: the adjuvant therapy was evaluated one day before each intramuscular injection and the incidence of different degree of inflammatory reaction at the intramuscular injection site was recorded. 2) body surface temperature (SST) of the injection site. 3) intramuscular injection. The pain index at the time of injection. 5) the comfortableness index of the patients in the course of drug application was analyzed statistically: the data was processed by SPSS13.0 software package. Results Rank sum test was used for grade data and t test was used for measurement data. Results there was significant difference in the treatment and prevention of local inflammation caused by intramuscular injection of progesterone by using the two methods of external application. The curative effect of the application group of mirabilite was better than that of the wet compress group of magnesium sulfate (.2%) in the treatment and prevention of local inflammation caused by intramuscular injection of progesterone. There was significant difference in the body surface temperature of the two groups of patients with intramuscular injection site (P 0.01). The curative effect of the external application group was significantly better than that of the magnesium sulfate wet compress group. 3. There was significant difference in the time of subcutaneous hardening of the intramuscular injection site between the two groups. The therapeutic effect of the group was significantly better than that of the group of magnesium sulfate wet compress (group 4), and compared with the data of the two groups in terms of comfort in the course of external application. The application effect of external application of mirabilite and the wet application of magnesium sulfate also have a great advantage. There is statistical significance. Not only does it not pollute dressing, but also it is not restricted by body position. There was no significant difference between the two methods of external application in improving the pain degree of intramuscular injection. During the course of treatment, there were no adverse reactions in both groups. Conclusion: the effect of external application of glauberite on prevention and treatment of local inflammation caused by long-term intramuscular injection of progesterone is better than that of wet compress of magnesium sulfate. As an auxiliary method for the treatment and prevention of local inflammation induced by progesterone, it is worth popularizing the application of glauberite. The observation of pain during intramuscular injection needs further study.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R248.3

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