本文選題：肝硬化門靜脈高壓癥　切入點：益氣　出處：《北京中醫(yī)藥大學》2017年碩士論文

【摘要】：目的:本課題主要目的是觀察益氣解毒通絡方治療肝硬化門靜脈高壓癥的臨床療效,通過比較治療前后肝硬化門靜脈高壓癥患者的癥狀/體征、凝血功能、肝功能、腹部超聲等變化來探討和驗證本治療方案的臨床有效性和實用性,同時觀察臨床使用中的不良反應以評價其安全性,發(fā)揮中醫(yī)藥的特點和優(yōu)勢,為肝硬化門靜脈高壓癥的臨床治療提供新思路。方法:研究對象均為北京中醫(yī)藥大學東直門醫(yī)院肝炎門診就診的患者,且符合本課題的入選標準,共34例。34例研究對象均服用益氣解毒通絡方治療6個月,記錄、觀察、比較治療前后研究對象的中醫(yī)癥候積分、凝血功能、肝功能及門靜脈內徑、脾靜脈內徑等變化情況,使用SPSS21.0計算機統(tǒng)計分析軟件對統(tǒng)計數據進行統(tǒng)計分析。結果:(1)治療后患者的脅肋疼痛、納呆食少、倦怠乏力、脘腹脹滿癥狀和脅下痞塊、肝病面容較治療前明顯減輕(P0.01),出血癥狀(P0.05)較治療前減輕,但赤絲紅縷體征在治療前后無明顯變化(P0.05)。(2)血凝PT、PTA指標在治療3個月與治療6個月較治療前均有明顯改善(P0.01),說明此方案在改善凝血功能方面起到作用。治療6個月的數據與治療第3個月數據比較,凝血功能獲得進一步改善(P0.01)。(3)治療3個月、治療6個月后患者的ALT、AST、ALB、TBIL、GGT均有改善(P0.01),證明此治療方案在改善肝功能方面效果顯著。治療6個月的數據與治療第3個月數據比較,肝功能獲得進一步改善(P0.01)。(4)治療后肝臟超聲下門靜脈主干內徑、脾靜脈內徑、脾臟長度、脾臟厚度均有改善,差異具有非常顯著的統(tǒng)計學意義(P0.01),說明本方案對于降低門靜脈壓力方面有較好的療效。(5)主要不良事件:個別患者在治療過程中出現了多夢、大便次數增多、皮疹癥狀,后均自行緩解,未再出現特殊不適。結論:(1)益氣解毒通絡方可以改善癥狀/體征、凝血功能、肝功能、腹部彩色多普勒超聲的檢測指標,說明益氣解毒通絡方治療肝硬化門靜脈高壓癥具有臨床效果。(2)肝硬化門靜脈高壓癥患者的病情會隨著時間推移逐漸加重,需要長期堅持正確的治療方案進行治療,對于益氣解毒通絡方治療效果的長期療效也需要進行長期的隨訪。
[Abstract]:Objective: to observe the clinical effect of Yiqi jiedu Tongluo recipe in treating cirrhotic portal hypertension and compare the symptoms / signs, coagulation function and liver function before and after treatment.The changes of abdominal ultrasound were used to explore and verify the clinical effectiveness and practicability of this treatment, and to observe the adverse reactions in clinical use to evaluate its safety, and to give full play to the characteristics and advantages of traditional Chinese medicine.To provide a new idea for the clinical treatment of cirrhotic portal hypertension.Methods: the subjects were all the patients with hepatitis in Dongzhimen Hospital of Beijing University of traditional Chinese Medicine, and according with the selection criteria of this study, 34 patients were treated with Yiqi jiedu Tongluo decoction for 6 months, recorded and observed.The changes of TCM symptom score, coagulation function, liver function, portal vein diameter and splenic vein diameter were compared before and after treatment. The statistical data were analyzed by SPSS21.0 software.Results (1) after treatment, the patients suffered from pain in the rib, less food intake, fatigue, abdominal distension and hypochondriac bulge. The face of liver disease was significantly reduced than that before treatment, and the symptoms of hemorrhage were alleviated than that before treatment (P0.05).However, there was no significant change in P0.05 P0.05. 2) the blood coagulation PTT PTA index was significantly improved in 3 months and 6 months after treatment compared with that before treatment, indicating that this scheme plays an important role in improving coagulation function.Compared with the data of the 3rd month, the coagulation function was further improved for 3 months. After 6 months of treatment, the patients with ALT AST and TBILG GT all improved P0.01G GT, which proved that the treatment regimen was effective in improving liver function.Compared with the data of the 3rd month after treatment, the liver function was further improved (P0.01U. 4) after the treatment, the diameter of portal vein, the diameter of splenic vein, the length of spleen and the thickness of spleen were all improved.The difference was statistically significant (P 0.01), indicating that this regimen had a better effect on reducing portal vein pressure.) the main adverse events were: some patients had more dreams, more defecations, and rash symptoms during the course of treatment.After the relief, there was no special discomfort again.Conclusion (1) Yiqi jiedu Tongluo prescription can improve symptoms / signs, coagulation function, liver function, abdominal color Doppler ultrasound detection index.It shows that Yiqi jiedu Tongluo recipe has clinical effect in treating cirrhotic portal hypertension.The long-term effect of Yiqi-jiedu Tongluo prescription also needs long-term follow-up.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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