本文選題：急性痛風性關節(jié)炎　切入點：金黃活血散　出處：《山西省中醫(yī)藥研究院》2017年碩士論文

【摘要】：目的:本研究通過觀察金黃活血散外敷治療濕熱蘊結(jié)型急性痛風性關節(jié)炎的臨床療效,初步探討該藥針對患病關節(jié)的鎮(zhèn)痛消腫作用以及降低血尿酸和相關炎癥指標的效果,并對其安全性進行評價,為該藥的進一步推廣應用提供依據(jù)。方法:本研究設計遵循平行對照、隨機化原則,選取2015年1月~2016年12月期間就診于山西省中醫(yī)院疼痛科和風濕科住院部的患者,納入患者均符合西醫(yī)診斷標準和中醫(yī)病證診斷標準,共納入患者96例,隨機分為治療組(48例)和對照組(48例)。治療組外敷金黃活血散,對照組外敷扶他林(雙氯芬酸二乙胺乳膠劑),兩組患者每日敷藥2次,治療10天。觀察金黃活血散在改善關節(jié)疼痛、腫脹以及恢復關節(jié)功能等方面的作用,同時觀察其降低血尿酸和相關炎癥指標的作用。分別觀察并記錄兩組患者治療前后中醫(yī)證候評分、疼痛VAS評分,以及實驗室指標:血尿酸(UA)、血清C反應蛋白(CRP)、紅細胞沉降率(ESR)的變化,同時注意監(jiān)測可能出現(xiàn)的不良反應。采用SPSS23.0統(tǒng)計軟件對全部數(shù)據(jù)進行分析處理。結(jié)果:1.兩組臨床總療效比較:經(jīng)過為期10天的治療,治療組總有效率為87.23%,對照組總有效率為76.60%,通過比較兩組之間差異有統(tǒng)計學意義(P0.05),治療組臨床總療效優(yōu)于對照組。2.兩組中醫(yī)證候評分比較:治療后兩組患者中醫(yī)證候評分較治療前均有大幅度的降低,通過比較兩組之間差異有統(tǒng)計學意義(P0.01),治療組緩解各項關節(jié)主癥及次癥效果優(yōu)于對照組。3.兩組疼痛VAS評分比較:治療后兩組患者疼痛評分較治療前均有明顯的下降,通過比較兩組之間差異有統(tǒng)計學意義(P0.01),治療組緩解關節(jié)疼痛情況優(yōu)于對照組。4.兩組實驗室指標比較:治療后兩組UA、CRP、ESR均較治療前有明顯的降低,治療后組間比較,UA差別無統(tǒng)計學意義(P0.05),CRP、ESR差別有統(tǒng)計學意義(P0.05),CRP、ESR治療后組間比較無臨床意義,兩種治療方案均能有效降低血尿酸和改善炎癥反應。5.兩組安全性指標比較:兩組患者治療前后進行三大常規(guī)、心電圖及肝腎功能比較,均無明顯異常變化,不良反應發(fā)生率比較差別無統(tǒng)計學意義(P0.05)。結(jié)論:通過臨床觀察,外敷金黃活血散可有效緩解患者關節(jié)疼痛、紅腫、功能障礙等主要癥狀,且能有效抑制患病關節(jié)的炎癥反應,同時無明顯不良反應,在降低血尿酸方面,與扶他林無明顯差異。因此,運用金黃活血散外敷治療急性痛風性關節(jié)炎,臨床療效良好,值得進一步推廣應用。
[Abstract]:Objective: to observe the clinical efficacy of Jinhuang Huoxue Powder in treating acute gouty arthritis with damp-heat accumulation, and to explore the effect of this medicine on relieving pain and swelling and reducing serum uric acid and related inflammatory indexes.The safety of the drug was evaluated to provide the basis for the further application of the drug.Methods: according to the principle of parallel control and randomization, the patients who were admitted to the Department of pain and Rheumatology of Shanxi traditional Chinese Medicine Hospital from January 2015 to December 2016 were selected.All the patients were in accordance with the diagnostic criteria of western medicine and traditional Chinese medicine. 96 patients were randomly divided into treatment group (n = 48) and control group (n = 48).The treatment group was treated with Jinhuang Huoxue Powder and the control group with Fentalin (diclofenac diethylamine emulsion) twice a day for 10 days.To observe the effect of Jinhuang Huoxue Powder on improving joint pain, swelling and restoring joint function, and to observe the effect of Jinhuang Huoxue Powder on reducing blood uric acid and related inflammatory indexes.To observe and record the changes of TCM syndrome score, pain VAS score and laboratory indexes before and after treatment in two groups: serum uric acid, serum C-reactive protein (CRP), erythrocyte sedimentation rate (ERR), and to monitor the possible adverse reactions.All the data are analyzed and processed by SPSS23.0 software.The result is 1: 1.After 10 days of treatment, the total effective rate of the treatment group was 87.23 and the total effective rate of the control group was 76.60. The difference between the two groups was statistically significant (P 0.05). The total clinical efficacy of the treatment group was better than that of the control group.Comparison of TCM syndromes between the two groups: after treatment, the scores of TCM syndromes in the two groups were significantly decreased compared with those before treatment, and the difference between the two groups was statistically significant (P 0.01). The effect of relieving the main symptoms and secondary symptoms of joints in the treatment group was better than that in the control group (3. 3).Comparison of pain VAS score between the two groups: after treatment, the pain scores of the two groups were significantly lower than those before treatment, the difference between the two groups was statistically significant (P 0.01), the relief of joint pain in the treatment group was better than that in the control group (.4).Comparison of laboratory indexes between the two groups: after treatment, the ESR of UAP was significantly lower than that of before treatment, and there was no significant difference in ESR between the two groups after treatment. There was no significant difference in ESR between the two groups after treatment, and there was no clinical significance between the two groups after treatment.Both can effectively reduce serum uric acid and improve inflammatory response.Comparison of safety indexes between the two groups: before and after treatment, there were no obvious abnormal changes in electrocardiogram and liver and kidney function, and there was no significant difference in the incidence of adverse reactions between the two groups before and after treatment (P 0.05).Conclusion: through clinical observation, application of Jinhuang Huoxue Powder can effectively relieve the main symptoms of joint pain, redness and swelling, dysfunction and so on, and can effectively inhibit the inflammatory reaction of the diseased joint, without obvious adverse reaction, so it can reduce blood uric acid.There was no significant difference between the two groups.Therefore, the application of Jinhuang Huoxue Powder in the treatment of acute gouty arthritis has a good clinical effect and is worth further popularizing.
【學位授予單位】：山西省中醫(yī)藥研究院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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