本文選題：溫腎健脾方 + 肝硬化　； 參考：《湖北中醫(yī)藥大學》2016年碩士論文

【摘要】：目的:研究應用常規(guī)西醫(yī)綜合療法聯(lián)用溫腎健脾中藥方治療肝硬化腹水的臨床療效及評價其安全性。方法:本實驗遵從研究中制訂的納入及排除標準,選取滿足條件的78例肝硬化腹水病人,進行隨機數(shù)字分組,分為對照組和治療組,各為39例。對照組單純予以常規(guī)西醫(yī)綜合療法:(1)一般治療:休息及飲食療法等;(2)病因治療:如抗肝纖維化、降低門脈壓、針對原發(fā)病等;(3)藥物治療:護肝降酶退黃、利尿、輸血漿及人血白蛋白等對癥支持療法。治療組在對照組治療基礎上聯(lián)用溫腎健脾類中藥湯劑。療程均為6周。觀察并記錄病人在療程前后主要癥狀及其積分、體征、肝功能及凝血功能指標、24h尿量及腹水消退情況及實驗結(jié)束后2個月內(nèi)腹水復發(fā)情況等,用統(tǒng)計學進行臨床功效歸納分析,并同時觀察記錄病人T、P、HR、BP,血液分析、腎功能、二便常規(guī)、心電圖及藥物不良反應等,評價藥物的安全性。結(jié)果:⑴臨床療效比較:用藥6周后治療組顯效15例、有效21例,總有效率為92.3%;對照組顯效8例、有效20例,總有效率為71.8%;治療組總有效率優(yōu)于對照組,P(27)0.05,有統(tǒng)計學差異;⑵中醫(yī)癥狀療效比較:治療組總有效率與顯效率分別為94.9%、56.4%,對照組總有效率與顯效率分別為74.4%、33.3%,兩組相比較P0.05,具有統(tǒng)計學差異;⑶中醫(yī)癥狀總積分比較:(1)同一組別在治療前后的組內(nèi)比較:6周療程后中醫(yī)癥狀總積分較治療前明顯下降,P0.05,有顯著性差異,治療后優(yōu)于治療前;(2)治療組與對照組在治療后比較:6周療程結(jié)束后治療組中醫(yī)癥狀總積分較對照組下降更明顯,P0.05,有著性性差異,治療組優(yōu)于對照組;⑷中醫(yī)各主要癥狀積分比較:(1)同一組別在藥物治療前后各主要癥狀積分的組內(nèi)比較:腹脹、水腫、倦怠乏力、食欲不振、惡心嘔吐、便溏、脅肋疼痛、口干口苦、黃疸等癥狀積分均較治療前下降,P0.05,有統(tǒng)計學差別,治療后優(yōu)于治療前;(2)治療組與對照組在6周療程結(jié)束后各主要癥狀積分比較:腹脹、水腫、倦怠乏力、食欲不振、黃疸癥狀積分治療組較對照組下降更明顯,P0.05,證實統(tǒng)計學有顯著差別,治療組優(yōu)于對照前,但6周療程結(jié)束后治療組與對照組惡心嘔吐、便溏、脅肋疼痛及口干口苦癥狀積分無明顯差異,P0.05,無統(tǒng)計學意義。⑸肝功能主要指標的比較:(1)同一組別在治療前后的組內(nèi)比較:治療后ALT、AST、ALB、TBIL、CHE、TBA均較治療前明顯好轉(zhuǎn),P0.05,有統(tǒng)計學意義,治療后優(yōu)于治療前;(2)6周療程后治療組與對照組比較:治療組ALT、AST、TBIL、CHE、TBA均較對照組明顯好轉(zhuǎn),P0.05,具有統(tǒng)計學意義,但兩組在ALB改善方面無明顯差別,P0.05,無統(tǒng)計學意義;⑹凝血功能的比較:(1)同一組別在治療前后的組內(nèi)比較:治療后凝血功能較治療前明顯好轉(zhuǎn),P0.05,具有統(tǒng)計學差異;(2)6周療程結(jié)束后治療組與對照組的組間比較:治療組凝血功能較對照組改善更明顯,P0.05,具有顯著性差異;⑺腹圍及24h尿量的比較:(1)同一組別在治療前后的組內(nèi)比較:P0.05,具有統(tǒng)計學意義,治療后優(yōu)于治療前;(2)療程結(jié)束后治療組與對照組的組間比較;P0.05,有統(tǒng)計學意義,提示治療組在改善患者腹圍及增加24h尿量方面優(yōu)于對照組;⑻試驗結(jié)束后2月內(nèi)腹水復發(fā)情況比較:在療程結(jié)束后2月內(nèi),治療組有3例患者腹水復發(fā),對照組有11例患者腹水復發(fā),治療組在2月內(nèi)腹水復發(fā)率低于對照組,P0.05,有統(tǒng)計學意義。結(jié)論:常規(guī)西醫(yī)綜合療法基礎上聯(lián)用溫腎健脾中藥方治療肝硬化腹水,可顯著改善病人的臨床癥狀、體征、相關(guān)實驗室指標及復發(fā)率,有利于腹水消退,臨床效果顯著,且在實驗過程中未出現(xiàn)明顯的毒副作用,藥物使用安全,值得進一步臨床實驗研究及推廣應用。
[Abstract]:Objective: To study the clinical efficacy and safety of traditional Chinese medicine combined with traditional western medicine combined with warm kidney and spleen invigorating traditional Chinese medicine in the treatment of cirrhotic ascites. Methods: the inclusion and exclusion criteria formulated in this study were made in this experiment, and 78 patients with cirrhosis ascites were selected and divided into control group and treatment group, each was 39. The control group only received conventional western medicine comprehensive therapy: (1) general treatment: rest and dietetic therapy, and (2) etiological treatment, such as anti liver fibrosis, lower portal pressure, primary disease and so on; (3) drug treatment: liver protection, depressing yellowing, diuresis, transfusion of plasma and Human Albumin, and other symptomatic support therapy. The treatment group was treated in the control group on the basis of treatment based on the temperature. The treatment of kidney invigorating Chinese herbs decoction was 6 weeks. The main symptoms, signs, signs, liver function and coagulation function, 24h urine volume and ascites regression and the recurrence of ascites within 2 months after the experiment were observed and recorded. The clinical efficacy was analyzed by statistics, and the patients' T, P, HR, B were observed at the same time. P, blood analysis, renal function, two stool routine, electrocardiogram and drug adverse reactions, and so on to evaluate the safety of drugs. Results: (1) comparison of clinical efficacy: after 6 weeks of medication, 15 cases were markedly effective in the treatment group, 21 cases were effective, the total effective rate was 92.3%, 8 cases in the control group, 20 effective, and the total effective rate was 71.8%; the total effective rate of the treatment group was better than the control group, and the total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group. The total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate of the treatment group was better than the control group, and the total effective rate was better than the control group, and the total effective rate was better than the control group, and the total effective rate of the treatment group was Comparison of Chinese traditional Chinese medicine symptoms: (2) comparison of the curative effect of traditional Chinese medicine: the total efficiency and effective efficiency of the treatment group were 94.9%, 56.4% respectively, the total effective rate and the significant efficiency of the control group were 74.4%, 33.3%, and the two groups were compared P0.05, with statistical difference; (1) the comparison of the same group in the group before and after the treatment: after 6 weeks of treatment, the symptoms of traditional Chinese medicine were total Scores were significantly lower than before treatment, P0.05, significant difference, after treatment before treatment; (2) compared with the control group after treatment: after 6 weeks of treatment, the total score of TCM symptoms in the treatment group decreased more significantly than the control group, P0.05, there were significant differences, the treatment group was better than the control group; (1) the same of the main symptoms of traditional Chinese medicine: (1) the same one Group comparison of the main symptom scores before and after the treatment: abdominal distention, edema, burnout, anorexia, nausea and vomiting, loose stool pain, dry mouth pain, jaundice, and jaundice symptom scores were lower than before treatment, P0.05, after treatment better than before treatment; (2) treatment group and control group after 6 weeks of treatment after the end of the main course. Symptom scores were compared: abdominal distention, edema, tired lassitude, anorexia, and jaundice symptom integral treatment group decreased more obviously than the control group, P0.05, confirmed statistically significant difference, the treatment group was better than the control group, but after 6 weeks of treatment, the treatment group and the control group had no significant difference in nausea and vomiting, stool pain and stomatostomy symptoms, P0.05 The comparison of main liver function indexes: (1) the comparison of the same group before and after treatment: after treatment, ALT, AST, ALB, TBIL, CHE, TBA were obviously better than before treatment, P0.05, statistically significant, better than before treatment; (2) the treatment group after 6 weeks treatment was compared with the control group: the treatment group was ALT, AST, TBIL, CHE, TBA were compared with the control group Obviously improved, P0.05, with statistical significance, but there was no significant difference between the two groups in the improvement of ALB, P0.05, no statistical significance. (1) compared with the same group before and after treatment: after treatment, coagulation function was significantly better than before treatment, P0.05, with statistical difference; (2) the treatment group and the control group after the end of 6 weeks of treatment. Compared with the control group, the coagulation function in the treatment group was more obvious than the control group, with a significant difference in P0.05. The comparison of abdominal circumference and 24h urine volume: (1) the comparison of the same group in the group before and after treatment: P0.05, with statistical significance, better than before the treatment; (2) the comparison between the treatment group and the control group after the end of the treatment; P0.05, with statistical meaning The treatment group was better than the control group in improving the patient's abdominal circumference and increasing the 24h urine volume. After the end of the trial, the recurrence of ascites in the treatment group after the end of February was compared: in the treatment group, there were 3 cases of ascites recurrence in the treatment group and 11 cases of ascites recurrence in the control group. The recurrence rate of ascites in the treatment group was lower in the treatment group than the control group in February, P0.05, with statistical meaning. Conclusion: the treatment of cirrhotic ascites with traditional Chinese medicine on the basis of conventional western medicine combined with traditional Chinese medicine can significantly improve the clinical symptoms, signs, related laboratory indexes and recurrence rate, which is beneficial to the elimination of ascites, the clinical effect is significant, and there is no obvious toxic and side effects in the process of experiment, and the safety of drug use is worthy of further study. Clinical experimental research and application.

【學位授予單位】：湖北中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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