本文選題：急性痛風(fēng)性關(guān)節(jié)炎 + 濕熱蘊結(jié)　； 參考：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:本研究主要觀察壯醫(yī)藥線點灸治療壯醫(yī)辯證分型中濕熱蘊結(jié)型和瘀熱阻滯型兩種證型的急性痛風(fēng)性關(guān)節(jié)炎患者的臨床療效和安全性,通過各組臨床療效、關(guān)節(jié)腫痛評分以及血尿酸情況行對比研究,評價壯醫(yī)藥線點灸治療急性痛風(fēng)性關(guān)節(jié)炎的臨床療效,以提高壯醫(yī)藥治療水平,為建立一個有效的壯醫(yī)療法臨床療效評價體系,使壯醫(yī)藥臨床標(biāo)準(zhǔn)化、療效評價標(biāo)準(zhǔn)化提供新的內(nèi)容及思路。方法:本研究參照2004版中國壯醫(yī)內(nèi)科學(xué)的診斷標(biāo)準(zhǔn)及美國風(fēng)濕病協(xié)會診斷標(biāo)準(zhǔn),選取2014年3月至2015年10月本院針灸科、腎內(nèi)科、內(nèi)分泌等門診及住院部符合診斷標(biāo)準(zhǔn)的急性痛風(fēng)性關(guān)節(jié)炎患者90例,按照就診順序采用隨機表法將患者隨機分為3組,治療組A(濕熱蘊結(jié)型)和治療組B組(瘀熱阻滯型)兩組在口服西藥的基礎(chǔ)上,根據(jù)壯醫(yī)理論“寒手熱背腫在梅”的取穴原則采用壯醫(yī)藥線點灸療法在“梅花穴”及腎俞、足三里進行點灸,且治療A組配以一些清熱祛濕理氣通絡(luò)的穴位(大椎、曲池、外關(guān)、合谷、太沖、陽陵泉、豐隆穴、陰陵泉穴,均取雙側(cè)),治療組B組配以一些清熱活血祛瘀通絡(luò)的穴位(大椎、曲池、外關(guān)、合谷、太沖、血海、膈俞、三陰交,均取雙側(cè))。兩組治療每穴1壯,每日3次,每次間隔10分鐘,2周為1療程;對照組服用秋水仙堿(西雙版納藥業(yè)有限責(zé)任公司生產(chǎn))與別嘌醇片(廣東彼迪藥業(yè)有限公司生產(chǎn))治療。記錄3組患者治療前、治療后關(guān)節(jié)腫痛積分與血尿酸變化以及不良反應(yīng)等情況,通過統(tǒng)計學(xué)分析對3組治療前后做組內(nèi)對比與組間對比,評價各組療效與安全性。結(jié)果:經(jīng)兩個療程治療后,90例患者無脫落病例,均納入研究。(1)臨床療效數(shù)據(jù)顯示,兩組治療組與對照組比較P0.05,治療A組與治療B組比較P0.05;(2)三組治療前后關(guān)節(jié)腫痛積分與血尿酸數(shù)據(jù)顯示,同組治療前后比較,P0.01;治療后各組比較,治療A、B兩組與對照組比較,P0.01;治療A組與治療B組比較,P0.05。(3)對照組30例中,出現(xiàn)上述不良反應(yīng)者10例,占33.3%;治療A組30例中,12例出現(xiàn)局部皮疹皮膚瘙癢和(或)胃腸道反應(yīng)癥狀的不良反應(yīng),占40.0%,治療B組出現(xiàn)12例局部皮疹水泡皮膚瘙癢和(或)胃腸道反應(yīng),占40.0%,兩組治療組不良反應(yīng)發(fā)生率與對照組相當(dāng)(P0.05),而兩組不同壯醫(yī)證型的治療組之間相比較,不良反應(yīng)發(fā)生率也無明顯差異(P0.05)。結(jié)論:(1)兩個西藥基礎(chǔ)上的壯醫(yī)藥線點灸治療組和西藥對照組治療急性痛風(fēng)性關(guān)節(jié)炎均取得優(yōu)異療效,但壯醫(yī)療法效果要好于單純西藥,而不同證型壯醫(yī)藥線點灸治療的兩組療效相比無明顯差異;(2)三組療法均能降低血尿酸,減輕關(guān)節(jié)腫痛癥狀的效果,但壯醫(yī)療法降低血尿酸水平和改善關(guān)節(jié)腫痛癥狀效果要好于單純西藥,而基于西藥基礎(chǔ)上的壯醫(yī)藥線點灸治療的兩組療效相比無明顯差異;(3)安全性評價結(jié)論方面,治療組與單純西藥治療安全性相當(dāng),而壯醫(yī)藥線點灸的主要不良反應(yīng)是局部皮疹水泡皮膚瘙癢,其安全可能比西藥高。
[Abstract]:Objective: To observe the clinical efficacy and safety of two syndrome types of acute gouty arthritis in the dialectical typing of Zhuang medicine in the dialectical typing of Zhuang medicine, and to evaluate the clinical efficacy of each group, the score of joint swelling and pain and the condition of blood uric acid, and evaluate the treatment of acute pain with Moxibustion of Zhuang medicine line point. The clinical curative effect of wind arthritis in order to improve the treatment level of Zhuang medicine, to establish an effective evaluation system of clinical curative effect of Zhuang medicine therapy, to make the clinical standardization of Zhuang medicine, and to standardize the evaluation of curative effect. Method: This study refers to the 2004 edition of Chinese Zhuang Medical diagnosis standard and the diagnosis standard of the American Rheumatism Association. 90 cases of acute gouty arthritis in the Department of acupuncture and moxibustion, Nephrology, endocrinology, endocrinology, endocrinology and inpatient department were selected from March 2014 to October 2015. The patients were randomly divided into 3 groups according to the order of medical treatment, the treatment group A (damp heat accumulation) and the group B of the treatment group (blood stasis heat block type) in the group of two groups in the oral Western Medicine On the basis of the theory, according to the theory of Zhuang medicine, the principle of "cold hand heat back swelling in plum" is adopted by Zhuang medicine line point moxibustion therapy in "Mei Hua point" and Shenshu and Zusanli point moxibustion, and the treatment group A with some acupoints (dzhui, Quchi, Wai Guan, Hegu, Tai Chong, Yang Mausoleum, Feng long point, Yin Ling spring point, both sides), and treatment group B The two groups were treated with 1 Zhuang each of the two groups, 3 times a day, 10 minutes each time, 2 weeks as 1 courses, and the control group took the colchicine (Xishuangbanna Pharmaceutical Co., Ltd.) and Allopurinol Tablets (Guangdong medicine industry) Treatment. Records of 3 groups of patients before treatment, after the treatment of joint swelling and pain score and blood uric acid changes and adverse reactions, through statistical analysis of the 3 groups before and after the comparison and comparison between groups to evaluate the efficacy and safety of each group. Results: after two courses of treatment, 90 patients without shedding cases, all included in the research (1) the clinical curative effect data showed that the two groups were compared with the control group P0.05, the treatment group A and the B group were compared P0.05; (2) the joint swelling pain score and the blood uric acid data before and after treatment were compared, P0.01; the treatment groups were compared, the treatment A, B two groups were compared with the control group, P0.01; the treatment A group compared with the B group, P0.05., P0.05.. (3) of the 30 cases in the control group, 10 cases of these adverse reactions were found, accounting for 33.3%. Of the 30 cases in the A group, 12 cases had local rash skin pruritus and / or gastrointestinal reaction symptoms, accounting for 40%. In the treatment group, 12 cases of local rash blister skin pruritus and / or gastrointestinal reaction were 40%. The incidence of adverse reactions in the two groups was 40%. The incidence of adverse reactions in the two group and the two groups was associated with the incidence of adverse reactions. The group was equivalent to (P0.05), but there was no significant difference in the incidence of adverse reactions between the two groups. Conclusion: (1) the treatment group of Zhuang medicine line point moxibustion and the western medicine control group were better than the western medicine, but the effect of Zhuang medicine therapy was better than that of the western medicine, but the effect of Zhuang medicine therapy was better than that of the pure western medicine, but the effect of Zhuang medicine therapy was better than that of the pure western medicine. There is no significant difference in the curative effect between the two groups of different syndromes of Zhuang medicine line point moxibustion treatment. (2) the three groups can reduce the blood uric acid and reduce the effect of joint swelling and pain symptoms, but the effect of Zhuang Medical method to reduce the level of blood uric acid and improve the symptoms of joint swelling and pain is better than the pure western medicine, and the two groups based on Western Medicine on Zhuang medicine line point moxibustion treatment. There was no obvious difference in effect. (3) the safety evaluation conclusion, the treatment group and the pure western medicine treatment safety is equivalent, and the main adverse reaction of the Zhuang medicine line moxibustion is the local rash blister skin itching, its safety may be higher than the western medicine.

【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R29

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