發(fā)布時間：2018-05-17 07:30

  本文選題：心源性水腫 + 艾灸��； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：本課題旨在通過隨機(jī)對照試驗(yàn),將符合各項(xiàng)標(biāo)準(zhǔn)的病例按隨機(jī)分配的原則,分別納入實(shí)驗(yàn)組(分為通元組、傳統(tǒng)組)及對照組,觀察并比較三組治療第1、3、7天的體重下降幅度、中醫(yī)癥狀積分下降幅度和24小時尿量,以及治療結(jié)束后療效評價(jià)。通過比較,評估通元法艾灸治療心源性水腫的臨床療效,為防治心源性水腫提供有效可行的新方法、新思路。深入探索賴氏通元療法的臨床作用和理論內(nèi)涵,凸顯通元療法的優(yōu)越性,同時拓寬通元針法的表現(xiàn)形式。方法：所有病例均來源于廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院心內(nèi)科,通過嚴(yán)格的納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),將符合要求的病例隨機(jī)分配入對照組30例及實(shí)驗(yàn)組60例,實(shí)驗(yàn)組又分為通元組30例與傳統(tǒng)組30例。三組均同時使用內(nèi)科利尿、強(qiáng)心、擴(kuò)血管等西醫(yī)基礎(chǔ)治療,在此基礎(chǔ)上,實(shí)驗(yàn)組則分別再予通元法取穴艾灸和傳統(tǒng)法取穴艾灸治療。觀察并比較三組治療第1、3、7天的體重下降幅度、中醫(yī)癥狀積分下降幅度和24小時尿量,以及治療結(jié)束后療效評價(jià)。結(jié)果：一、一般資料方面：經(jīng)比較,三組患者的性別、年齡、原始體重、癥狀積分及疾病診斷分布無明顯差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義,具有可比性。二、療效分析：1.三組患者治療后,體重較前明顯下降,下降幅度呈不斷遞增趨勢。第1、3、7天對照組體重下降幅度分別為1.76±2.15,3.82±3.58,5.36±3.23,通元組下降幅度分別為2.83±2.09,6.97±3.88,9.82±4.08,傳統(tǒng)組下降幅度分別為2.18±2.62,4.96±3.37,7.38±4.24。三組組內(nèi)比較,均有P0.05,差異有統(tǒng)計(jì)學(xué)意義。三組同期兩兩比較,第1天三組比較P0.05,提示差異無統(tǒng)計(jì)學(xué)意義；第3天通元組與其余兩組之間比較P0.05,提示皆有差異有統(tǒng)計(jì)學(xué)意義,通元組大于傳統(tǒng)組和對照組,而傳統(tǒng)組與對照組比較P0.05,差異無統(tǒng)計(jì)學(xué)意義,提示二者差異不明顯,第三天傳統(tǒng)組與對照組的體重下降幅度基本相同;第7天三組比較P0.05,差異有統(tǒng)計(jì)學(xué)意義,提示該天體重下降幅度通元組大于傳統(tǒng)組大于對照組。2.三組患者治療后,癥狀較前明顯改善,呈漸進(jìn)式好轉(zhuǎn)。第1、3、7天對照組癥狀積分下降幅度分別為5.80±6.27,8.90±5.55,10.73±5.07,通元組癥狀在積分下降幅度分別為9.10±5.07,15.03±6.08,19.20±6.08,傳統(tǒng)組癥狀積分下降幅度分別為6.17±4.53,11.93±4.87,15.60±5.60。三組組內(nèi)三天比較,均有P0.05,差異有統(tǒng)計(jì)學(xué)意義。三組同期兩兩比較,第1天通元組與其余兩組之間比較P0.05,差異皆有統(tǒng)計(jì)學(xué)意義,提示當(dāng)天癥狀積分下降幅度通元組大于傳統(tǒng)組和對照組,而傳統(tǒng)組與對照組比較P0.05,差異無統(tǒng)計(jì)學(xué)意義,提示二者差異不明顯,說明通元組較傳統(tǒng)組能更早地改善患者的癥狀;第3天和第7天三組兩兩比較,皆有P0.05,差異有統(tǒng)計(jì)學(xué)意義,提示這兩天三組癥狀積分下降幅度通元組大于傳統(tǒng)組大于對照組。3.三組患者治療后,尿量增多,呈先增后減趨勢。第1、3、7天對照組尿量分別為1980.67±503.53,2564.33±555.34,1646.67±489.20,通元組尿量分別為2064.33±456.33,3054.30±535.42,2273.67±389.38,傳統(tǒng)組尿量分別為2022.33±477.94,2626.13±460.60,1893.33±494.65。三組組內(nèi)三天比較,均有P0.05,差異有統(tǒng)計(jì)學(xué)意義,根據(jù)均值大小,對照組和傳統(tǒng)組三天尿量比較第3天大于第1天大于第7天,而通元組三天尿量比較為第3天大于第7天大于第1天,說明通元組較傳統(tǒng)組利水消腫的作用更加持久。三組同期兩兩比較,第1天三組比較P0.05,提示差異無統(tǒng)計(jì)學(xué)意義；第3天通元組與其余兩組之間比較P0.05,提示皆有差異有統(tǒng)計(jì)學(xué)意義,通元組大于傳統(tǒng)組和對照組,而傳統(tǒng)組與對照組比較P0.05,差異無統(tǒng)計(jì)學(xué)意義,提示二者差異不明顯,該天傳統(tǒng)組與對照組的尿量基本相同；第7天三組比較P0.05,差異有統(tǒng)計(jì)學(xué)意義,提示該天尿量通元組大于傳統(tǒng)組大于對照組。4.三組患者治療后,療效不同,對照組有效率為70%,通元組有效率為100%,傳統(tǒng)組有效率為83.33%,經(jīng)秩和檢驗(yàn)分析,對照組與通元組比較,Z=-2.99,P0.05；對照組與傳統(tǒng)組比較,Z=-1.04,P0.05；通元組與傳統(tǒng)組比較,Z=-2.13,P0.05,說明通元組的臨床療效優(yōu)于對照組和傳統(tǒng)組,而對照組與傳統(tǒng)組的療效相當(dāng)。結(jié)論：整體說明,在內(nèi)科利尿、強(qiáng)心、擴(kuò)血管等西醫(yī)基礎(chǔ)治療加用艾灸措施,能更好地治療心源性水腫,快速緩解患者的臨床癥狀,促進(jìn)身體康復(fù)。而不同的取穴方法,其臨床療效亦不相同。依據(jù)賴氏通元針法理論取穴,其艾灸效果優(yōu)于傳統(tǒng)取穴法艾灸治療,通元法作用更強(qiáng),取效更快,是值得臨床推廣使之更好地服務(wù)于社會的治療方法。
[Abstract]:Objective: the purpose of this study was to observe and compare the weight decline of the three groups in the experimental group (divided into the Tongyuan group, the traditional group) and the control group according to the principle of random distribution according to the principle of randomized controlled trial, which were divided into the experimental group (divided into the Tongyuan group, the traditional group) and the control group, and the three groups were treated with the decrease of symptom score and the amount of urine of 24 hours, and the treatment after the end of treatment. To evaluate the clinical efficacy of Moxibustion in the treatment of cardiogenic edema by comparison, to provide effective and feasible new methods for the prevention and treatment of cardiogenic edema, and to explore the clinical role and theoretical connotation of Ryan's Tongyuan therapy, highlight the superiority of the Tongyuan therapy and broaden the manifestations of the Tongyuan acupuncture method. All from the Department of Cardiology, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, through strict inclusion criteria and exclusion criteria, 30 cases of the control group and 60 cases of the experimental group were randomly assigned to the control group. The experimental group was divided into the Tongyuan group and the traditional group 30 cases. The three groups all used the basic treatment of Western medicine, such as the internal Cori urine, the heart and the blood vessels, and so on. On this basis, the experimental group was given the acupuncture point moxibustion and the traditional method of Acupoint Moxibustion treatment. The weight loss of the three groups on day 1,3,7, the decrease of TCM symptom score and the 24 hour urine volume, and the evaluation of the curative effect after the end of the treatment were compared. There was no significant difference in age, original weight, symptom score and diagnosis distribution of disease (P0.05). There was no statistical significance, and was comparable. Two, the curative effect analysis: after treatment in group 1., the weight decreased significantly and the decrease was increasing. The weight loss of group 1,3,7 was 1.76 + 2.15,3.82 + 3.58,5.36 + 3.23, respectively. The decline range of the Tongyuan group was 2.83 2.09,6.97 + 3.88,9.82 + 4.08 respectively, and the decrease of the traditional group was 2.18 + 2.62,4.96 + 3.37,7.38 + 4.24. three groups, respectively, and there were P0.05, the difference was statistically significant. The three groups were compared with 22, first days and three groups were compared to P0.05, suggesting that the difference was not statistically significant; third day tuple and the rest two groups. The difference between the two and the control group was larger than the traditional group and the control group, while the traditional group and the control group were compared with the control group. The difference was not statistically significant. The difference was not significant. The difference between the two groups was not obvious. The third day group was basically the same as the control group, and the seventh day three groups compared P0.05, the difference was statistically significant. The difference was statistically significant. The average weight loss in the general group was greater than that of the control group.2. three groups, and the symptoms were improved obviously after the treatment. The symptom score of the control group was 5.80 + 6.27,8.90 + 5.55,10.73 + 5.07 respectively in the 1,3,7 day control group, and the lower amplitude of the symptoms in the general group was 9.10 + 5.07,15.03 + 6.08,19.20 + 6., respectively. 08, the decrease of the symptom score in the traditional group was 6.17 4.53,11.93 + 4.87,15.60 + 5.60. three groups in three days, and the difference was statistically significant. The three group was compared with the 22 compared with the other two groups, the difference was statistically significant between the first day tuple and the other two groups, suggesting that the decline of the symptom integral of the day was greater than that of the transmission group. The combination group and the control group, while the traditional group and the control group were compared P0.05, the difference was not statistically significant, suggesting that the difference between the two is not obvious, indicating that the Tongyuan group can improve the patient's symptoms earlier than the traditional group, and the third and seventh day three groups, 22 comparison, all have P0.05, the difference is statistically significant, suggesting that the three groups of three groups of symptom scores decrease in the general group. After the treatment of the.3. three groups in the traditional group, the urine volume increased first and then decreased. The urine volume of the control group was 1980.67 + 503.532564.33 + 555.341646.67 + 489.20 in the 1,3,7 day control group, and the urine volume in the Tongyuan group was 2064.33 + 456.333054.30 + 535.422273.67 + 389.38 respectively. The urine volume in the traditional group was 2022.33 + 477.942626.13 + 460.60,1, respectively. In the 893.33 + 494.65. three groups, there were three days compared with P0.05, the difference was statistically significant. According to the mean value, the comparison group and the traditional group three days urine volume was greater than first days greater than seventh days, while the three day urine volume in the Tongyuan group was third days larger than seventh days greater than seventh days, indicating that the function of the Tongyuan group was more lasting than the traditional group. The three groups were compared with 22 in the same period, first days and three groups were compared with P0.05, suggesting that the difference was not statistically significant. The difference between the third day group and the other two groups was statistically significant. The Tongyuan group was larger than the traditional group and the control group. The difference between the traditional group and the control group was P0.05, and the difference was not statistically significant, suggesting that the two differences were not obvious, The urine volume between the traditional group and the control group was the same as that in the control group. The difference was statistically significant between the three groups on the seventh day and the difference was statistically significant. It suggested that the urine volume group was more effective than the traditional group.4. three of the control group. The effective rate of the control group was 70%, the effective rate of the Tongyuan group was 100%, the traditional group had an effective rate of 83.33%, and the rank sum test analysis was used. Compared with the Tongyuan group, Z=-2.99, P0.05; compared with the traditional group, the control group was compared with the traditional group, Z=-1.04, P0.05; the Tongyuan group was compared with the traditional group, Z=-2.13, P0.05. The clinical effect of the Tongyuan group was better than the control group and the traditional group, while the control group had the same effect as the traditional group. Conclusion: the whole body shows the basic treatment of Western medicine, such as internal medicine diuresis, strong heart, vasodilator and so on. The treatment with moxibustion can better treat the cardiogenic edema, quickly relieve the clinical symptoms of the patients and promote the recovery of the body. The different methods of taking acupoints are different in clinical curative effect. According to the theory of Lai's Tongyuan acupuncture, the effect of moxibustion is better than the traditional point method of moxibustion treatment. The effect of the Tongyuan method is stronger and the effect is faster. It is worthy of clinical practice. It is worth clinical Promotion of better service to the society.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R259

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