本文選題：天灸 + 喘息性支氣管炎　； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：本次論文選用新疆圖木舒克市人民醫(yī)院內(nèi)科門診病人中診斷為慢性喘息性支氣管炎急性發(fā)作期(喘證：風(fēng)寒犯肺型)的患者來作為試驗(yàn)的研究對(duì)象,觀察在西醫(yī)基礎(chǔ)治療完全一致的標(biāo)準(zhǔn)上施加天灸療法是否能促進(jìn)患者癥狀的緩解或消失,分析該種方法是否在提高臨床療效,改善患者生存質(zhì)量等方面具有優(yōu)勢。近年來,我國慢性喘息性支氣管炎的患病率日趨上漲,其原因可能是人口老齡化速度加快和大氣污染日趨加劇,嚴(yán)重影響到人們的日常工作與生活質(zhì)量。小海子墾區(qū)是南疆兵團(tuán)三師三大墾區(qū)之一,屬干旱荒漠氣候,晝夜溫差大,沙塵暴頻發(fā),由于常年風(fēng)沙和寒冷空氣影響,慢性喘息性支氣管炎已然成為本地常見病之一。因此研究針對(duì)本病采用更有效的方法來進(jìn)行治療,從而提高對(duì)本病的療效是具有較大意義的,且天灸療法治療本病簡單易行,無明顯毒副作用,頗受好評(píng)。方法：本臨床研究收集的觀察病例100例均來源于新疆圖木舒克市人民醫(yī)院內(nèi)科門診病人,經(jīng)確診為慢性喘息性支氣管炎急性發(fā)作期(喘證：風(fēng)寒犯肺型)且符合科研納入標(biāo)準(zhǔn)。采用隨機(jī)對(duì)照實(shí)驗(yàn)的方法,按照1：1的比例分配,隨機(jī)將100例慢性喘息性支氣管炎患者分別分配至治療組(天灸組)與對(duì)照組(安慰劑組)。兩組基礎(chǔ)治療一致：患者口服茶堿緩釋膠囊(息川叮),每次0.1g,每日早、晚各服用1次,不間斷服用5周。治療組：在基礎(chǔ)治療上使用天灸療法。藥物組成：天灸膏包含有延胡索、白芥子、細(xì)辛、甘遂等藥物；藥物制備方法：由圖木舒克市人民醫(yī)院藥劑科專門負(fù)責(zé)提供,專人進(jìn)行配藥、清洗、粉碎,將藥物制作為粗細(xì)度80目篩規(guī)格的藥粉并均勻混合制成散劑待用；穴位組成： (1)雙側(cè)肺俞、胃俞、志室,膻中； (2)雙側(cè)風(fēng)門、脾俞、膏肓俞,天突； (3)雙側(cè)定喘、腎俞,心俞,中脘。交替選取三組穴位。操作方法：將生姜汁(生姜去皮絞汁過濾)與已制備成功的天灸藥粉均勻調(diào)和成藥膏(其中藥粉與姜汁的重量比例設(shè)為3：4),并將藥膏切成每個(gè)約1cm×1cm×1cm大小的藥塊,隨后讓患者取坐位,用鑷子將藥塊放置于約5cm×5cm的透氣膠布中央,將膠布準(zhǔn)確貼至穴位,囑受試者在貼夠2小時(shí)后便可自行撕下。對(duì)照組：在基礎(chǔ)治療上加用安慰劑貼敷。藥物組成：安慰劑(主要包括天灸散粉、紅曲紅色素粉,板栗殼棕色素粉、蕎麥粉,比例為1：1：3：6)藥物制備方法：將一般市場上買來的蕎麥粉、板栗殼棕色素粉、紅曲紅色素粉及天灸散粉這四種粉末均勻混合制成散劑代用。穴位組成：與治療組一致。操作方法：用水稀釋少量生姜汁(生姜汁與水的比例設(shè)為1：10),將安慰劑藥粉均勻調(diào)和成為與天灸膏外觀、質(zhì)地較為相似的藥膏,并切塊成每個(gè)約1cm×1cm×1cm大小的藥塊,隨后讓患者取坐位,用鑷子將藥塊放置于約5cm×5cm的透氣膠布中央,將膠布準(zhǔn)確貼至穴位,囑受試者在貼夠2小時(shí)后便可自行撕下。以上兩組受試者每周治療3次,總共治療5周時(shí)間,即共計(jì)15次,每次貼藥時(shí)間為2小時(shí),每次治療間隔時(shí)間需≥148小時(shí),治療完成12次以上(含12次)視為治療完成。在治療前、第9次治療后、療程結(jié)束時(shí)評(píng)估兩組患者的中醫(yī)證候總評(píng)分以及喘息性支氣管炎生存質(zhì)量量表(Asthmatic bronchitis quality of life questionnaire, AQLQ)的積分變化,療程結(jié)束時(shí)評(píng)價(jià)兩組臨床療效,計(jì)算有效率,并隨時(shí)記錄研究過程中發(fā)生的不良事件。統(tǒng)計(jì)方法：觀察結(jié)束后,統(tǒng)一采用SPSS19.0統(tǒng)計(jì)軟件包客觀地進(jìn)行各項(xiàng)數(shù)據(jù)的處理和分析。兩觀察組的計(jì)量資料采用配對(duì)設(shè)計(jì)資料的t檢驗(yàn)以及獨(dú)立樣本的t檢驗(yàn)進(jìn)行分析比較。兩觀察組的計(jì)數(shù)資料采用2×2表資料的卡方檢驗(yàn)進(jìn)行分析比較。采用秩和檢驗(yàn)比較等級(jí)資料。結(jié)果：1.基線資料經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),兩組受試人員在民族分布、性別分布、年齡構(gòu)成、病程分布上均無顯著性差異(P值分別為0.086、0.248、0.103、0.064)；治療前,兩組患者的中醫(yī)證候總評(píng)分、喘息性支氣管炎生存質(zhì)量量表總評(píng)分組間比較具有同質(zhì)性(P值分別為0.838、0.052)�？梢�,兩組治療前各項(xiàng)資料的差異比較的P0.05,提示無統(tǒng)計(jì)學(xué)意義,如此,證明兩組之間的基線資料是具有可比性的。2.中醫(yī)證候總評(píng)分(1)組內(nèi)比較對(duì)治療組受試人員在治療前、第9次治療后、療程結(jié)束時(shí)進(jìn)行中醫(yī)證候總評(píng)分,其均值分別為9.04±1.43、4.68±1.42、1.84±2.15,各時(shí)點(diǎn)分別與治療前進(jìn)行比較,P值均小于0.05,故可知該差異具有統(tǒng)計(jì)學(xué)意義。對(duì)對(duì)照組受試人員在治療前、第9次治療后、療程結(jié)束時(shí)進(jìn)行中醫(yī)證候總評(píng)分,其均值分別為8.98±1.49、5.94±1.54、3.72±2.22,各時(shí)點(diǎn)分別與治療前進(jìn)行比較,P值均小于0.05,故可知該差異具有統(tǒng)計(jì)學(xué)意義。(2)組間比較對(duì)治療組與對(duì)照組受試人員的中醫(yī)證候總評(píng)分進(jìn)行獨(dú)立樣本t檢驗(yàn),統(tǒng)計(jì)結(jié)果提示治療組與對(duì)照組在第9次治療后、治療結(jié)束時(shí)的癥候評(píng)分組間比較所得P值均小于0.05,具有統(tǒng)計(jì)學(xué)意義。3.喘息性支氣管炎生存質(zhì)量量表評(píng)分(1)組內(nèi)比較對(duì)治療組受試人員在治療前、療程結(jié)束時(shí)進(jìn)行生存質(zhì)量量表評(píng)分,其均值分別為105.04±22.76、204.82±20.03,治療前與治療結(jié)束時(shí)進(jìn)行比較,P值小于0.05,故可知差異具有統(tǒng)計(jì)學(xué)意義。對(duì)對(duì)照組受試人員在治療前、療程結(jié)束時(shí)進(jìn)行生存質(zhì)量量表評(píng)分,其均值分別為113.70±21.26、158.26±21.21,治療前與治療結(jié)束時(shí)進(jìn)行比較,P值小于0.05,故可知該差異具有統(tǒng)計(jì)學(xué)意義。(2)組間比較對(duì)治療組與對(duì)照組受試人員的生存質(zhì)量量表評(píng)分進(jìn)行獨(dú)立樣本t檢驗(yàn),統(tǒng)計(jì)結(jié)果提示治療組與對(duì)照組在治療結(jié)束時(shí)的癥候評(píng)分組間比較所得P值小于0.05,故可知該差異具有統(tǒng)計(jì)學(xué)意義。4.有效率經(jīng)統(tǒng)計(jì)檢驗(yàn),完成療程的合格受試者治療組與對(duì)照組均為50例,治療組的總有效率較高,為92%,而對(duì)照組的總有效率為74%。兩組療效的比較屬于2個(gè)獨(dú)立樣本的等級(jí)資料比較,應(yīng)用秩和檢驗(yàn)檢測得出P=0.0000.05,故可知治療組與對(duì)照組的療效比較有顯著性差異。結(jié)論：綜上所述,天灸療法對(duì)于改善慢性喘息性支氣管炎急性發(fā)作期的臨床癥狀有較好的療效,同時(shí)能夠顯著提高患者的生存質(zhì)量,值得臨床推廣。
[Abstract]:Objective: in this paper, the patients who were diagnosed as acute attack of chronic asthmatic bronchitis (asthma: wind cold and lung type) were selected as the subjects of the acute attack of chronic asthmatic bronchitis in the hospital of the people's Hospital of Xinjiang. In recent years, the prevalence rate of chronic asthmatic bronchitis in China is increasing, which may be due to the accelerated aging of the population and the increase of air pollution, which seriously affects people's daily work and life quality. Xiao Haizi reclamation area is one of the three reclamation areas of the three division of the southern Xinjiang corps, which belongs to the arid desert climate, the temperature difference between day and night is large and the sandstorm is frequent. The chronic asthmatic bronchitis has become one of the common diseases because of the perennial wind sand and cold air. Therefore, a more effective method is used to treat this disease, thus improving the disease. The curative effect is of great significance, and the day moxibustion therapy is simple and easy to treat. There is no obvious toxic and side effects. Methods: 100 cases of observation cases collected in this clinical study were all derived from the outpatient in the medical department of the people's Hospital of Xinjiang. 100 cases of chronic asthmatic bronchitis were randomly assigned to the treatment group (day moxibustion group) and the control group (placebo group). The two groups of basic treatments were the same as Theophylline Sustained Release Capsules (xechuan Ding), each time 0.1g, morning and evening. Take 1 times and take 5 weeks without interruption. The treatment group: use the day moxibustion therapy on basic treatment. Drug composition: the day moxibustion ointment contains drugs such as yercaso, white mustard, asarum, and cabbage; the preparation method is provided by the pharmacy department of tuxunk City People's hospital. 80 mesh size sifting powder and evenly mixed into the powder for use; acupoint composition: (1) bilateral lung Yu, Wei Yu, Zhi room, Shan Zhong; (2) bilateral wind gate, spleen Yu, pogastric Yu, Tian Tun; (3) bilateral asthma, Shenshu, Xinshu and Zhong Wan. Alternate selection of three groups of acupoints. The medicinal powder is evenly blended into the ointment (the weight ratio of the powder and ginger juice is set to 3:4), and the ointment is cut into every 1cm x 1cm x 1cm size drug block, then the patient is taken to take the seat, and the drug block is placed in the center of the air permeable rubber cloth of about 5cm * 5cm with tweezers, and the rubber cloth is accurately attached to the acupoint, and the subjects can be tearing themselves after 2 hours' sticker enough. In the control group, a placebo patch was added to the basic treatment. Drug composition: a placebo (mainly composed of day moxibustion powder, red yeast red pigment powder, chestnut shell brown powder, buckwheat powder, 1:1:3:6) preparation methods: the general market buckwheat powder bought from the general market, chestnut shell brown powder, red yeast red pigment powder and day moxibustion powder powder, four A mixture of powder and powder is used to make a bulk agent. Acupoint composition: the same as the treatment group. Operation method: diluted a small amount of ginger juice with water (the proportion of ginger juice and water at 1:10), and evenly blend the placebo powder into the appearance of the day moxibustion ointment, the texture more similar to the ointment, and cut into each 1cm x 1cm x 1cm size drug block, followed by The patient took the seat, placed the drug block in the center of the air permeable rubber cloth of about 5cm x 5cm with tweezers, and put the rubber cloth to the acupoint accurately. The subjects were told that the subjects could tear themselves down after 2 hours of sticker. The two groups of subjects were treated 3 times a week for 5 weeks, that is, 15 times, each time was 2 hours, each time interval of treatment should be equal to 148 hours, each time interval of treatment interval of more than 148 hours, The treatment completed more than 12 times (including 12 times) as the completion of treatment. Before the treatment, after ninth treatment, the total score of TCM syndrome in two groups of patients and the integral changes of Asthmatic bronchitis quality of life questionnaire, AQLQ were evaluated at the end of the course of treatment, and two groups of clinical effects were evaluated at the end of the course of treatment. The calculation was efficient and recorded the adverse events of the study at any time. Statistical method: after the observation was finished, the data were processed and analyzed objectively by the SPSS19.0 statistical software package. The measurement data of the two observation group were compared with the t test of paired design data and the t test of the independent sample. Two observation. The count data of the group were compared with the chi square test of 2 * 2 table data. The rank sum test was used to compare the grade data. Results: the 1. baseline data were statistically tested. There were no significant differences between the two groups in ethnic distribution, sex distribution, age composition and course distribution (P value was 0.086,0.248,0.103,0.064); before treatment, The total score of TCM syndrome in the two groups and the total score of the quality of life scale of asthmatic bronchitis were homogeneity (P value was 0.838,0.052). It is clear that the difference of the data between the two groups before treatment is P0.05, suggesting that the baseline data between the two groups are comparable to the.2. syndrome. In the total score (1), the total score of TCM syndrome was compared to the treatment group before the treatment, and the average value of the TCM syndrome was 9.04 + 1.43,4.68 + 1.42,1.84 + 2.15 at the end of the course of treatment. The value of the total score was 9.04 + 1.42,1.84 + 2.15 respectively. The value of P was less than 0.05, so the difference was statistically significant. Before treatment, after ninth times of treatment, the total score of TCM syndromes was carried out at the end of the course of treatment, the mean value was 8.98 + 1.49,5.94 + 1.54,3.72 + 2.22 respectively, each time point was compared with that before treatment, and the value of P was less than 0.05. (2) the total score of TCM syndrome in the treatment group and the control group was compared. Independent sample t test, the results showed that the treatment group and the control group after ninth times of treatment, the symptom score between the end of the treatment group P values were less than 0.05, statistically significant.3. asthmatic bronchitis quality of life scale score (1) in the group compared to the treatment group before the treatment, the end of the course of survival at the end of the quality of life. The mean value of the scale was 105.04 + 22.76204.82 + 20.03 respectively. Compared with the end of treatment, the value of P was less than 0.05, so the difference was statistically significant. Before the treatment of the control group, the quality of life scale was scored at the end of the course of treatment, the average value was 113.70 + 21.26158.26 + 21.21, before and after treatment. At the end of the treatment, the P value was less than 0.05, so the difference was statistically significant. (2) the group was compared with the independent sample t test for the quality of life scale of the treatment group and the control group. The statistical results suggested that the value of P between the treatment group and the control group at the end of the treatment group was less than 0.05, so it was known that the difference between the treatment group and the control group was less than 0.05. The difference has statistical significance.4. effective rate through statistical test, complete course of qualified subjects in the treatment group and the control group are 50 cases, the total effective rate of the treatment group is higher, 92%, and the total effective rate of the control group is 74%. two group comparison of the 2 independent samples of the grade data comparison, using the rank sum test to get P=0.0000.05 Therefore, it can be seen that the curative effect of the treatment group and the control group has a significant difference. Conclusion: in summary, the day moxibustion therapy can improve the clinical symptoms of the acute attack of chronic asthmatic bronchitis, and can significantly improve the quality of life of the patients, and it is worthy of clinical promotion.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.1

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