發(fā)布時(shí)間：2018-06-12 03:15

  本文選題：病機(jī) + 多發(fā)性硬化急性期　； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：研究目的1.比較中醫(yī)外治穴位貼敷療法合基礎(chǔ)治療方案與單純基礎(chǔ)治療方案對(duì)多發(fā)性硬化急性期的臨床療效,評(píng)價(jià)穴位貼敷法對(duì)多發(fā)性硬化急性期的療效作用。2.創(chuàng)新性的提出基于多發(fā)性硬化急性期中醫(yī)病機(jī)認(rèn)識(shí)基礎(chǔ)上的督脈穴位貼敷理論,探討以控制病機(jī)發(fā)展的外治方法與分經(jīng)論治方法的切合點(diǎn)。研究方法本研究是北京市中醫(yī)藥科技項(xiàng)目《基于病機(jī)的多發(fā)性硬化急性期督脈貼敷法的臨床評(píng)價(jià)》的主要研究?jī)?nèi)容。以多發(fā)性硬化急性期患者為研究對(duì)象,按照隨機(jī)數(shù)字表法隨機(jī)納入患者50例,其中治療組25例,對(duì)照組25例。參照"痿證(多發(fā)性硬化)中醫(yī)診療方案"的辨證論治方案作為基礎(chǔ)治療方案進(jìn)行研究設(shè)計(jì),治療組采用基礎(chǔ)治療方案結(jié)合穴位貼敷的外治法,對(duì)照組采用基礎(chǔ)治療方案。依據(jù)多發(fā)性硬化腎虛為本,濕熱為標(biāo)的中醫(yī)病機(jī)理論,穴位貼敷法分別采用清利濕濁和補(bǔ)腎溫陽(yáng)兩種治法,方藥分別采用《理瀹駢文》所載行水膏和扶陽(yáng)益火膏加減。行水膏貼敷于大椎、陶道、身柱穴,扶陽(yáng)益火膏貼敷于兩側(cè)腎俞、命門、腰陽(yáng)關(guān)、兩足底涌泉穴。每日貼敷1次,每次4～6小時(shí),共貼敷28天。分別于穴位貼敷用藥當(dāng)天、第14天、第28天3個(gè)時(shí)點(diǎn)進(jìn)行臨床評(píng)估。采用NIHSS評(píng)分、EDSS評(píng)分及Barthel指數(shù)及臨床常見癥狀評(píng)分對(duì)多發(fā)性硬化急性期患者的神經(jīng)功能、生活質(zhì)量的改善情況進(jìn)行療效評(píng)估。研究結(jié)果1.基本資料:本研究共納入53例患者,脫落3例(因家住外地不能如期隨訪),最終納入統(tǒng)計(jì)分析共50例,其中治療組25例,對(duì)照組25例。治療組平均年齡40.76± 10.787,女性19例,男性6例;對(duì)照組平均年齡38.56± 11.132,女性19例,男性9例。兩組女性38例,男性12例,女:男=3.2:1。治療組和對(duì)照組入組當(dāng)天在性別、年齡、民族、文化程度及職業(yè)等人口學(xué)資料比較中均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。治療組和對(duì)照組的在發(fā)病前感染史、吸煙史、飲酒史、糖尿病、中風(fēng)、高脂血癥等病史資料及證型、體質(zhì)等中醫(yī)基本資料均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),具有可比性。2.NIHSS評(píng)分變化結(jié)果:治療組入組當(dāng)天評(píng)分4.0(3.0),入組第28天評(píng)分3.4(4.0),下降1.0(2.5),差異具有統(tǒng)計(jì)學(xué)意義(P0.01);對(duì)照組入組當(dāng)天評(píng)分3.0(4.0),入組28天評(píng)分3.0(2.0),下降1.0(2.0),差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)治療組與對(duì)照組入組14天、28天NIHSS總分比較無(wú)顯著性差異。治療組入組14天、入組28天與入組當(dāng)天,對(duì)照組入組28天與入組當(dāng)天進(jìn)行兩兩比較,結(jié)果均存在顯著性差異。3.EDSS評(píng)分變化結(jié)果:治療組入組當(dāng)天評(píng)分(11.08±4.564),入組28天評(píng)分(5.24±3.407),下降(5.840±3.793),差異具有統(tǒng)計(jì)學(xué)意義(P0.01);對(duì)照組入組當(dāng)天評(píng)分(11.80±5.008),入組 28 天評(píng)分(6.76±3.407),下降(5.040±3.780),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。治療組與對(duì)照組入組14天比較存在顯著性差異,入組28天比較無(wú)顯著性差異。治療組入組28天、入組14天分別與入組當(dāng)天,對(duì)照組入組28天與入組當(dāng)天比較,差異均存在統(tǒng)計(jì)學(xué)意義。4.Barthel指數(shù)評(píng)分變化結(jié)果:治療組入組當(dāng)天評(píng)分80.0(25.0),入組第28天評(píng)分90.0(17.5),上升10(17.5),差異具有統(tǒng)計(jì)學(xué)意義(P0.01);對(duì)照組入組當(dāng)天評(píng)分80.0(32.5),入組第28天評(píng)分85(27.5),上升5.0(15.0),差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。治療組與對(duì)照組入組第14天與入組當(dāng)天Barthel指數(shù)評(píng)分差值比較具有統(tǒng)計(jì)學(xué)差異。治療組入組14天、入組28天分別與入組當(dāng)天、對(duì)照組入組28天與入組當(dāng)天比較,差異均具有統(tǒng)計(jì)學(xué)意義。5.常見臨床癥狀改善情況:治療組肢體無(wú)力、視力障礙、二便障礙、感覺異常、語(yǔ)言不清、共濟(jì)失調(diào)、肢體疼痛、頭暈治療前后均存在差異,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。對(duì)照組肢體無(wú)力、二便障礙、感覺異常、共濟(jì)失調(diào)、頭暈差異具有統(tǒng)計(jì)學(xué)意義(P0.05);視力障礙、語(yǔ)言不清、肢體疼痛治療前后無(wú)顯著性差異(P0.05)。治療組與對(duì)照組入組第28天組間臨床癥狀評(píng)分比較,肢體無(wú)力、視力障礙及感覺異常三組臨床癥狀治療前后療效存在差異,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。6.臨床療效分析:治療組25例,顯效17例(68%),有效6例(24%),無(wú)效2例(8%),總有效率92%。對(duì)照組25例,顯效9例(36%),有效12例(48%),無(wú)效4例(16%),總有效率84%。差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。研究結(jié)論1.在多發(fā)性硬化急性期內(nèi)科治療基礎(chǔ)上,結(jié)合基于病機(jī)的中醫(yī)外治穴位貼敷法可明顯改善患者急性期神經(jīng)功能缺損程度,改善臨床癥狀,提高生活質(zhì)量,為多發(fā)性硬化急性期臨床治療提供了新的方法和思路。2.基于多發(fā)性硬化急性期中醫(yī)病機(jī)理論,創(chuàng)新性的提出內(nèi)科辨證論治與外科分經(jīng)(督脈)論治結(jié)合,應(yīng)用了中醫(yī)元素,發(fā)揮了中醫(yī)治療難治病的特色。3.穴位貼敷法療效確切,操作簡(jiǎn)單,降低多發(fā)性硬化治療成本,患者依從性較高,有利于在基層臨床推廣應(yīng)用。
[Abstract]:Objective 1. to compare the clinical effect of traditional Chinese medicine acupoint application therapy combined with basic therapy and simple basic therapy on acute stage of multiple sclerosis, and to evaluate the effect of Acupoint Application on acute phase of multiple sclerosis (.2.) and to bring forward the innovation of the meridian point based on the understanding of the acute phase of multiple sclerosis in the acute phase of multiple sclerosis. The research method is the main research content of the clinical evaluation of the acute phase of multiple sclerosis based on the pathogenesis of the disease machine based acute phase of multiple sclerosis in Beijing. The digital table method was randomly included in 50 patients, including 25 cases in the treatment group and 25 cases in the control group. Referring to the syndrome differentiation and treatment scheme of "multiple sclerosis" (multiple sclerosis), the treatment group was designed as the basic treatment scheme. The treatment group adopted the basic treatment scheme combined with the external treatment of acupoint application, and the control group adopted the basic treatment scheme. According to the multiple characteristics. To harden the kidney deficiency and damp heat as the traditional Chinese medicine theory, the acupoint application method of the acupoint application was used respectively in the two methods of clearing wet turbid and tonifying the kidney and warming Yang respectively. The prescription was applied to the Zhui, Tao, body column, and Fu Yang Yi Huo ointment on both sides of the Shenshu, the life gate, the waist Yang Guan and the two foot. Yongquan point was applied 1 times a day for 4~6 hours each time for 28 days. The clinical evaluation was performed on the day of acupoint application, fourteenth days and twenty-eighth days at 3 points. The NIHSS score, the EDSS score, the Barthel index and the clinical common symptom score were applied to the improvement of the nerve function and quality of life of the patients with multiple sclerosis. 1. basic data: a total of 53 patients were included in the study, and 3 cases were dropped out (due to home stay in the field), and 50 cases were finally included in the statistical analysis, including 25 cases in the treatment group and 25 in the control group. The average age of the treatment group was 40.76 + 10.787, the female 19 cases were 6 cases, the average age of the control group was 38.56 + 11.132, the female 19 cases, the male 9 cases. Two groups of women 38 cases, male 12 cases, female: male =3.2:1. treatment group and control group on the day of sex, age, nationality, education and occupation and other demographic data are not statistically significant (P0.05). The treatment group and the control group in the history of pre onset infection, smoking history, drinking history, diabetes, stroke, hyperlipidemia and other medical history data and syndrome type, The basic data of traditional Chinese medicine had no statistical difference (P0.05), and the results of comparable.2.NIHSS score were 4 (3), 3.4 (4) and 1 (2.5) in the twenty-eighth days of entry group, and the difference was statistically significant (P0.01); the score of the control group was 3 (4), and the group was scored 28 days, 3 (2), declined 1 (2), and the difference has a difference. There was statistical significance (P0.05). There was no significant difference between the treatment group and the control group for 14 days and 28 days, and there was no significant difference in the total score of the 28 days. The treatment group entered the group 14 days, the group entered the group 28 days and the day of entry, the control group entered the group 28 days and the day of entry of 22, the results were significantly different.3.EDSS score changes: the treatment group was scored (11.08 + 4.5) on the day of entry. 64), the score of 28 days in the group (5.24 + 3.407), decreased (5.840 + 3.793), and the difference was statistically significant (P0.01). The score of the control group was (11.80 + 5.008), and the score of the group was 28 days (6.76 + 3.407), and the difference was statistically significant (P0.01). The difference was significant between the treatment group and the control group. There was no significant difference. The treatment group entered the group for 28 days, 14 days in the group and the day of entry, the control group was compared with the group for 28 days, the difference was statistically significant.4.Barthel index score change results: the treatment group was 80 (25), twenty-eighth days score 90 (17.5), 10 (17.5), the difference was statistically significant (P0.01); The score of the control group was 80 (32.5), the score of the group was 85 (27.5) and 5 (15), and the difference was statistically significant (P0.01). The difference between the treatment group and the control group at fourteenth days and the day of entry was statistically significant. The treatment group entered the group for 14 days, and the group entered the group 28 days respectively, and the control group entered the group 28 days and the control group entered the group on the day 28 days. On the day of entry, the difference was statistically significant in the improvement of common clinical symptoms of.5.: there were differences in the treatment group, such as limb weakness, visual impairment, two stool disorder, abnormal sensation, malfunction, ataxia, limb pain, and dizziness. The difference was statistically significant (P0.05). The control group was weak in limbs, two stool disorder, and abnormal sensation. The difference of ataxia and dizziness was statistically significant (P0.05); there was no significant difference between the treatment group and the control group (P0.05). The clinical symptom scores of the twenty-eighth days between the treatment group and the control group were compared, and there were differences in the clinical symptoms before and after the treatment of the limb weakness, the visual impairment and the sensation abnormality. Statistical significance (P0.05).6. clinical efficacy analysis: 25 cases in the treatment group, effective 17 cases (68%), effective 6 cases (24%), invalid 2 cases (8%), total effective 92%. control group 25 cases, significant effect 9 cases (36%), effective 12 (48%), invalid 4 cases (16%), the total effective 84%. difference has statistical significance (P0.05). Conclusion of the study conclusion in the acute stage of multiple sclerosis medical treatment basis The combination of TCM External Treatment acupoint application based on disease machine can obviously improve the degree of nerve function defect in acute phase of patients, improve the clinical symptoms and improve the quality of life. It provides a new method and thought for the clinical treatment of acute stage of multiple sclerosis,.2. based on the theory of TCM Syndrome in acute stage of multiple sclerosis, and innovatively put forward the dialectical theory of internal medicine. The combination of treatment and surgical treatment (Du Meridian) has applied the elements of traditional Chinese medicine. The.3. acupoint application is effective, easy to operate, to reduce the cost of the treatment of multiple sclerosis, and the compliance of the patients is high, which is beneficial to the application of the clinic.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.6

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