本文選題：痛風(fēng) + 濕熱蘊(yùn)結(jié)證�。� 參考：《中國中醫(yī)科學(xué)院》2016年碩士論文

【摘要】：研究目的分析比較痛風(fēng)濕熱蘊(yùn)結(jié)證治療前后癥狀體征、疼痛緩解時(shí)間、實(shí)驗(yàn)室指標(biāo)(血尿酸、血沉、C-反應(yīng)蛋白)的改善情況,對虎黃通腑泄?jié)岢苑降挠行院桶踩宰鞒鲈u價(jià),為進(jìn)一步臨床推廣應(yīng)用提供臨床依據(jù),也為緩解患者病痛提供新的方法。研究內(nèi)容及方法：共收集66例,采用隨機(jī)對照研究方法隨機(jī)分為兩組,試驗(yàn)組和對照組,試驗(yàn)過程中兩組因?yàn)榛颊咭缽男圆疃髅撀?例,脫落后總病例數(shù)為64例,兩組各32例。對照組服用雙氯芬酸鈉緩片治療；試驗(yàn)組給予雙氯芬酸鈉緩釋片加虎黃通腑泄?jié)岢苑街委煟粌山M均嚴(yán)格戒酒、低嘌呤飲食、足量飲水、避免勞累、受寒,治療7天后,用統(tǒng)計(jì)軟件綜合分析比較各項(xiàng)觀察指標(biāo),最后評定臨床效果。研究結(jié)果1兩組基線比較試驗(yàn)組32例,男30例,女2例,平均年齡47.56±13.75歲,平均病程343.44±597.7天；癥狀體征證候總分21.93±4.49分；對照組32例,男31例,女1例,平均年齡46.28±12.97歲,平均病程362.97±513.2天；癥狀體征證候總分21.28±4.18分；上訴各項(xiàng)指標(biāo)、癥狀體征證候各項(xiàng)指標(biāo)及實(shí)驗(yàn)室各項(xiàng)指標(biāo)(UA、ESR、CRP)經(jīng)過分析比較,結(jié)果均無統(tǒng)計(jì)學(xué)差異(P0.05),證明兩組具有可比性。2兩組總體療效比較試驗(yàn)組總體有效率為93.75%,其中達(dá)到臨床控制15例,顯效11例,有效4例,無效2例；對照組有效率為78.13%,其中達(dá)到臨床控制8例,顯效10例,有效7例,無效7例；經(jīng)統(tǒng)計(jì)軟件分析差異有統(tǒng)計(jì)學(xué)意義(P0.05),說明試驗(yàn)組較對照組總體療效更好,總有效率更高。3兩組組內(nèi)及組間比較組內(nèi)療效比較：研究結(jié)果顯示治療后試驗(yàn)組和對照組組內(nèi)各項(xiàng)指標(biāo)比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05),兩組治療后在關(guān)節(jié)疼痛、關(guān)節(jié)腫脹、壓痛、活動(dòng)受限、發(fā)熱、口渴、心煩不安、小便短黃及實(shí)驗(yàn)室指標(biāo)(UA、ESR、CRP)方面均有改善。組間療效比較：(1)癥狀體征證候治療前后差值組間療效比較,結(jié)果表明兩組在改善患者疼痛、發(fā)熱、口渴、心煩不安、小便短黃及總分方面,差異有統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組在改善上訴方面療效優(yōu)于對照組；兩組在壓痛、腫脹、活動(dòng)受限方面的差異無統(tǒng)計(jì)學(xué)意義(P0.05),不能證明試驗(yàn)組在改善患者壓痛、腫脹、活動(dòng)受限方面療效優(yōu)于對照組。 (2)兩組疼痛緩解時(shí)間組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),試驗(yàn)組與對照組比較,疼痛緩解更為迅速。(3)實(shí)驗(yàn)室指標(biāo)治療前后差值組間比較,結(jié)果表明兩組在改善血沉上差異無統(tǒng)計(jì)學(xué)意義(P0.05)；在改善C-反應(yīng)蛋白、血尿酸上的差異有統(tǒng)計(jì)學(xué)意義(P0.05),說明在降低患者C-反應(yīng)蛋白、血尿酸方面,試驗(yàn)組較對照效果更佳,但是在降低血沉方面,尚不能證明試驗(yàn)組優(yōu)于對照組。4兩組治療后安全性比較兩組患者治療后血常規(guī)、便潛血、肝腎功均正常；對照組發(fā)生1例胃腸不適,3個(gè)小時(shí)后自行緩解,未予特殊處理,判斷應(yīng)屬于藥物不良反應(yīng)。研究結(jié)論虎黃通腑泄?jié)岢苑铰?lián)合雙氯芬酸鈉緩釋片與單用雙氯芬酸鈉緩釋片治療痛風(fēng)濕熱蘊(yùn)結(jié)證在改善患者關(guān)節(jié)疼痛、關(guān)節(jié)腫脹、壓痛、活動(dòng)受限、發(fā)熱、口渴、心煩不安、小便短黃及實(shí)驗(yàn)室指標(biāo)方面均有效果,但是前者較后者總體療效更好,總有效率更高,改善中醫(yī)證候方面效果更突出,疼痛緩解更迅速�？梢�,虎黃通腑泄?jié)岢苑铰?lián)合雙氯芬酸鈉緩釋片治療痛風(fēng)濕熱蘊(yùn)結(jié)證具有較好的臨床療效及安全性,值得進(jìn)一步臨床推廣應(yīng)用,治療過程中尚需要注意雙氯芬酸的不良反應(yīng)。
[Abstract]:Study objective: to analyze and compare the pain before and after treatment of symptoms and signs of stagnation of rheumatic fever, pain relief time, laboratory indexes (serum uric acid, ESR, C- reactive protein) to improve the situation, to evaluate the effectiveness and safety of tiger yellow Tongfu Xiezhuo ChuBi decoction, to provide clinical basis for further clinical application, but also provide a new method to alleviate the pain of patients. The research contents and methods: 66 cases were collected, using randomized study were randomly divided into two groups, experimental group and control group, two groups in the experimental process because of poor compliance of patients and the loss in 1 cases, total cases after falling number for 64 cases, two groups of 32 cases. The control group taking diclofenac sodium tablets in the treatment of slow; the experimental group was given the Diclofenac Sodium Sustained Release Tablets tiger yellow Tongfu Xiezhuo ChuBi decoction treatment; two groups were strictly abstinence, low purine diet, drinking enough water, avoid fatigue and cold, 7 days after treatment, with statistical software A comprehensive analysis and comparison of the observed indicators, finally, to assess the clinical effect of two groups. The results of 1 baseline test group 32 cases, male 30 cases, female 2 cases, mean age 47.56 + 13.75 years old, the average duration of 343.44 + 597.7 days; symptom syndrome score 21.93 + 4.49; control group 32 cases, male 31 cases, female 1 cases, mean age 46.28 + 12.97 years old, the average duration of 362.97 + 513.2 days; symptom syndrome score 21.28 + 4.18; the indicators of appeal, indexes and laboratory indexes of symptoms and signs of TCM syndrome (UA, ESR, CRP) after analysis and comparison, the results were not statistically significant (P0.05), that the two groups were comparable in two groups of.2 overall efficacy comparison test group total effective rate was 93.75%, which reached 15 cases of clinical control, 11 cases markedly effective 4 cases, invalid 2 cases; the control group was 78.13%, which reached 8 cases of clinical control, 10 cases markedly effective in 7 cases. The 7 cases are invalid; Statistical analysis software, the difference was statistically significant (P0.05), the experimental group compared with the control group, the overall effect is better, the total efficiency of higher.3 in the two groups and between groups within the group effect: the results showed that after treatment in experimental group and control group in the indexes of the differences were statistically significant (P0.05). The two groups after treatment in joint pain, joint swelling, tenderness, activity limitation, fever, thirst, restlessness, short yellow urine and laboratory indexes (UA, ESR, CRP) were improved. The curative effect were compared between: (1) signs of syndrome symptoms for comparing the difference between two groups before and after treatment the curative effect, results show that the two groups in the improvement of pain, fever, thirst, restlessness, short yellow urine and total score, the difference was statistically significant (P0.05), the experimental group to improve the appeal has better effect than the control group; the two group in tenderness, swelling, limitation of activity difference aspects of no statistical significance Yi (P0.05), can not prove that the experimental group in improving patients with tenderness, swelling, limitation of activity has better effect than the control group (2). Two groups of pain relief time were statistically significant difference (P0.05), the test group and control group, pain relief was more rapid. (3) laboratory indicators of the difference between before and after treatment comparison between groups, the results showed that the two groups in the improvement of erythrocyte sedimentation rate had no significant difference (P0.05); in the improvement of C- reactive protein, there was significant difference on serum uric acid (P0.05), in patients with lower C- reactive protein, blood uric acid, the experimental group than the control effect is better, but in reducing ESR, still can not prove that the experimental group than the control treatment safety of the two groups of.4 after treatment in the two groups after the blood routine, fecal occult blood, liver and kidney function were normal; the control group occurred in 1 cases of gastrointestinal discomfort, after 3 hours of self relief, no special treatment, the judgment should be In adverse drug reactions. Conclusion Huhuang Tongfu xiezhuochubi decoction combined with Diclofenac Sodium Sustained Release Tablets Diclofenac Sodium Sustained Release Tablets for the treatment of gout rdhs improvement in patients with joint pain, joint swelling, tenderness, activity limitation, fever, thirst, restlessness, short yellow urine and laboratory indexes were both effective, but the former than the latter in general better curative effect, the total efficiency is higher, improve the effect of TCM syndrome is more prominent, more rapid pain relief. Therefore, tiger yellow Tongfu Xiezhuo ChuBi decoction combined with Diclofenac Sodium Sustained Release Tablets pain rheumatic fever therapy has good clinical efficacy and safety of stagnation, and is worthy of further clinical application in the treatment process, still need to pay attention to the bad the reaction of diclofenac.

【學(xué)位授予單位】：中國中醫(yī)科學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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