本文選題：慢性盆腔痛 + 婦科如意散��； 參考：《云南中醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本課題運(yùn)用臨床對(duì)照觀察研究,觀察全國(guó)名中醫(yī)易修珍教授的經(jīng)驗(yàn)方“婦科如意散”外治協(xié)同逍遙散加減治療肝脾不調(diào)夾瘀型慢性盆腔痛(CPP)的臨床療效。通過(guò)對(duì)患者治療前后其盆腔疼痛、伴隨癥候及體征、生活質(zhì)量改善等情況進(jìn)行療效觀察和統(tǒng)計(jì)分析,評(píng)價(jià)中藥內(nèi)外綜合治療療效,探尋中醫(yī)藥治療CPP更加有效的藥物和方法。方法:將56例符合納入標(biāo)準(zhǔn)的慢性盆腔痛(肝脾不調(diào)夾瘀型)患者隨機(jī)分為觀察組和對(duì)照組,33例為觀察組(婦科如意散外用+逍遙散加減口服),23例為對(duì)照組(僅逍遙散加減口服)。經(jīng)凈后第一天開(kāi)始用藥,連續(xù)用藥10天為一療程,一個(gè)月經(jīng)周期治療一個(gè)療程,連續(xù)治療兩個(gè)療程。通過(guò)觀察兩組患者治療前后中醫(yī)臨床癥狀(下腹疼痛、腰骶部疼痛、帶下異常等)、局部體征、盆腔積液、疼痛評(píng)分的變化及健康狀況調(diào)查問(wèn)卷等方面的變化進(jìn)行總結(jié)歸納,利用SPSS21.0統(tǒng)計(jì)軟件,對(duì)臨床收集的數(shù)據(jù)通過(guò)秩和檢驗(yàn)、卡方及t檢驗(yàn)等方法,進(jìn)行統(tǒng)計(jì)分析。結(jié)果:1、兩組綜合療效比較,觀察組與對(duì)照組的總療效分別為93.9%和78.2%,觀察組臨床療效優(yōu)于對(duì)照組(P=0.036㩳0.05)。2、各項(xiàng)指標(biāo)相比,組內(nèi)比較,兩組治療在慢性盆腔痛、帶下異常及煩躁易怒方面療效比較,差異均有統(tǒng)計(jì)學(xué)意義,其中觀察組在減輕慢性盆腔痛、改善帶下異常方面有顯著性差異(P㩳0.01);組間比較,觀察組患者在腹痛、腰骶部疼痛、帶下異常等指標(biāo)改善方面,觀察組療效優(yōu)于對(duì)照組(P㩳0.05),尤其在帶下異常、疼痛在勞累、性交后及經(jīng)期前后加重方面明顯優(yōu)于對(duì)照組(P㩳0.01);局部體征方面,治療后子宮活動(dòng)度、附件區(qū)增粗壓痛改善方面差異有統(tǒng)計(jì)學(xué)意義,觀察組優(yōu)于對(duì)照組(P㩳0.05);而在月經(jīng)不調(diào)、煩躁易怒、失眠等方面,兩組療效相當(dāng),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。3、理化檢查方面,療后組內(nèi)比較,兩組治療對(duì)盆腔積液改善方面均有效果(P㩳0.05);組間比較,差異具有統(tǒng)計(jì)學(xué)意義,觀察組優(yōu)于對(duì)照組(P㩳0.05);觀察組外周血紅細(xì)胞壓積(HCT)較治療前降低(P㩳0.05),血常規(guī)白細(xì)胞總數(shù)及其中性分類(lèi)(WBC、NEUT#)治療前后變化無(wú)統(tǒng)計(jì)學(xué)差異(P㧐0.05);對(duì)照組外周血WBC、NEUT#、HCT治療前后變化無(wú)統(tǒng)計(jì)學(xué)差異(P㧐0.05);且兩組比較,外周血HCT指標(biāo)改善方面觀察組優(yōu)于對(duì)照組(P㩳0.05)。4、兩組患者治療后疼痛程度評(píng)分水平均下降,兩組療后較療前比較,疼痛數(shù)字分級(jí)法(NRS評(píng)分)、疼痛口述分級(jí)法(VRS評(píng)分)差異均有統(tǒng)計(jì)學(xué)意義(P㩳0.05);NRS評(píng)分、VRS評(píng)分組間比較差異亦有統(tǒng)計(jì)學(xué)意義(P㩳0.05),表明二組均能降低盆腔疼痛評(píng)分,且內(nèi)外合治組對(duì)鎮(zhèn)痛療效優(yōu)于口服中藥組。5、對(duì)生存質(zhì)量各維度積分值的影響:治療后內(nèi)外合治組八個(gè)維度積分與治療前比較,差異均有顯著性(P㩳0.01),均高于治療前;口服中藥組八個(gè)維度積分與治療前比較雖均有提高,但僅一般健康狀況、生理機(jī)能、生理職能、軀體疼痛四個(gè)維度治療前后比較差異有統(tǒng)計(jì)學(xué)意義(P㩳0.05);治療后內(nèi)外合治組維度積分高于口服中藥組,一般健康狀況、情感職能、社會(huì)功能、軀體疼痛、精力、精神健康維度比較差異具有統(tǒng)計(jì)學(xué)意義(P㩳0.05)。結(jié)論:1、婦科如意散協(xié)同逍遙散加減口服治療慢性盆腔痛療效顯著。婦科如意散外敷能有效治療慢性盆腔痛。2、婦科如意散外治+逍遙散加減口服、逍遙散加減口服對(duì)于肝脾不調(diào)夾瘀型慢性盆腔痛患者的疼痛程度、中醫(yī)癥狀及局部體征等方面均有改善,且婦科如意散外治協(xié)同逍遙散加減療效優(yōu)于單純逍遙散加減,值得進(jìn)一步研究和推廣使用。3、婦科如意散外治協(xié)同逍遙散加減內(nèi)外合治能夠更好的提高慢性盆腔痛患者的生活質(zhì)量。
[Abstract]:Objective: To observe the clinical effect of the experience of Professor Yi Xiuzhen, a Chinese traditional Chinese medicine, on the treatment of chronic pelvic pain (CPP) with stagnation of liver and spleen with stasis of stagnation and stasis in the treatment of liver spleen and spleen stasis syndrome, and the improvement of the quality of life, such as the symptoms and signs, and the improvement of the quality of life. To observe the curative effect and statistical analysis, evaluate the curative effect of traditional Chinese medicine and internal and external treatment, explore the more effective medicine and methods of Chinese medicine treatment of CPP. Methods: 56 cases of chronic pelvic pain (liver and spleen unadjusted and stasis type) were randomly divided into the observation group and the control group, and 33 cases were the observation group (gynecologist Ruyi powder external use + Xiaoyao Powder Plus and minus mouth) 23 cases as the control group (only Xiaoyao Powder plus or minus oral). After the first day after the net use of medication, continuous medication for 10 days as a course of treatment, a menstrual cycle for a course of treatment, a continuous treatment of two courses. Through the observation of the clinical symptoms of the two groups of patients before and after the treatment of traditional Chinese medicine (lower abdominal pain, lumbosacral pain, abnormality, etc.), local signs, pelvic effusion, The changes in pain score and health status questionnaire were summarized, and SPSS21.0 statistical software was used to analyze the clinical data through rank and test, chi square and t test. Results: 1, the total curative effect of the two groups was compared, the total curative effect of the observation group and the control group was 93.9% and 78.2% respectively, the observation group was 93.9% and the observation group respectively. The clinical effect was better than that of the control group (P=0.036? 0.05).2. Compared with each other, the curative effect of the two groups in the treatment of chronic pelvic pain, abnormality and irritability were statistically significant. There were significant differences between the observation group in alleviating chronic pelvic pain and improving the abnormality of the band (P? 0.01); the group was compared with the observation group. The observation group was better than the control group (P? 0.05) in abdominal pain, lumbosacral pain, and abnormality, especially in the subband, the pain was overworked, and the aggravation of after and before and after the menstrual period was obviously superior to the control group (P? 0.01); in the local sign, the difference of the uterine activity after treatment and the improvement of the adnexal thickening and tenderness in the appendix area was statistically significant Learning significance, the observation group was better than the control group (P? 0.05); while in the irregular menstruation, irritability, insomnia, and other aspects, the two groups had the equivalent effect, the difference was not statistically significant (P0.05).3, the physical and chemical examination, after the treatment group, the two groups were effective (P? 0.05) in the improvement of the pelvic effusion (P? 0.05); the difference between the groups was statistically significant, the observation group was better than the observation group. The control group (P? 0.05); the hematocrit (HCT) of peripheral blood cells in the observation group decreased (P? 0.05), the total number of blood routine white blood cells and its neutral classification (WBC, NEUT#) had no statistical difference before and after treatment (P? 0.05); the changes of WBC, NEUT#, and HCT in the control group were not statistically significant before and after treatment (P? 0.05); and the two groups were compared, and the HCT index of peripheral blood was improved. The observation group was superior to the control group (P? 0.05).4, and the level of pain degree in the two groups decreased after treatment. The two groups were compared with before the treatment, the pain digital classification (NRS score), and the pain oral classification (VRS score) difference were statistically significant (P? 0.05); the NRS score was also statistically significant (P? 0.05) in the VRS score group (P? 0.05). The two groups can all reduce pelvic pain score, and the effect of internal and external treatment group on analgesic effect is better than that of oral Chinese medicine group.5, the effect on the integral value of each dimension of quality of life: after treatment, the eight dimensions of internal and external treatment group and before treatment, the difference is significant (P? 0.01), all higher than before treatment; oral Chinese medicine group eight dimension integral and before treatment before treatment Although the four dimensions of general health, physiological function, physiological function and somatic pain were significantly different before and after treatment (P? 0.05); the dimension integral of the internal and external treatment group after treatment was higher than that of the oral Chinese medicine group, and the general health, emotional function, social function, somatic pain, energy and mental health were different. Statistical significance (P? 0.05). Conclusion: 1, gynecologic Ruyi powder combined with Xiaoyao Powder plus or minus oral treatment of chronic pelvic pain is effective. Gynecologic such as external application can effectively treat chronic pelvic pain,.2, gynecologic treatment plus Xiaoyao Powder plus or minus oral, Xiaoyao Powder plus or minus oral treatment of chronic pelvic pain patients with liver spleen and spleen stasis type chronic pelvic pain patients pain degree, The curative effect of medical symptoms and local signs is improved, and the curative effect of the Department of gynaecology is better than simple Xiaoyao Powder Plus subtract. It is worth further studying and popularizing the use of.3.

【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R271.9

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