本文選題：特發(fā)性肺間質(zhì)纖維化 + 陽(yáng)虛��； 參考：《云南中醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本研究旨在通過(guò)基于象思維的“天龍竭”分期辨治方案觀察特發(fā)性肺間質(zhì)纖維化患者的綜合療效。為“天龍竭”方案的運(yùn)用提供臨床證據(jù);發(fā)掘云南民族醫(yī)藥資源中防治IPF行之有效的方法和手段。方法:運(yùn)用“天龍竭”分期辨治方案,將收集的34例病例進(jìn)行分期分組治療,由同組高年資中醫(yī)醫(yī)師執(zhí)行,根據(jù)中醫(yī)四診合參收集證候,結(jié)合病程、實(shí)驗(yàn)室指標(biāo)、肺功能及影像學(xué)檢查分為早期肺痹組、晚期肺痿組,兩組患者均采用“天龍竭”分期辨治方案干預(yù),予門(mén)診中藥口服,對(duì)全體患者治療前后的高分辨CT(HRCT)、肺功能(通氣和彌散功能),IPF中醫(yī)證侯積分表,圣喬治呼吸問(wèn)卷(SGRQ)及呼吸困難評(píng)分表(m MRC)進(jìn)行療效綜合評(píng)估。結(jié)果:本研究最終納入34例患者,肺痹組17例,男性12例,女性5例,平均年齡為62.76±11.22歲,病程1.71±1.07年;肺痿組17例,男性10例,女性7例,平均年齡為68.88±9.59歲,病程2.59±1.62年,基本情況無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。治療前后總體患者肺功能(TLC、VC、DLco)指標(biāo)無(wú)統(tǒng)計(jì)學(xué)差異;肺痹組患者治療后TLC及VC較前改善,DLco無(wú)統(tǒng)計(jì)學(xué)差異;肺痿組患者治療前后TLC、VC、DLco無(wú)統(tǒng)計(jì)學(xué)差異。治療后患者高分辨率CT總體檢查結(jié)果有效2例,穩(wěn)定26例,無(wú)效6例。肺痹組治療后有效2例,穩(wěn)定15例,肺痿組治療后穩(wěn)定11例,無(wú)效6例,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療后兩組患者中醫(yī)證候評(píng)分中主癥、次癥、或見(jiàn)癥及總分均較治療前有明顯降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療后兩組患者圣喬治評(píng)分較治療前有顯著改善,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。兩組患者治療后的m MRC評(píng)分較治療前有顯著緩解,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。肺痹組患者治療前后肝腎功無(wú)統(tǒng)計(jì)學(xué)差異,肺痿組患者治療前后AST、尿素氮無(wú)統(tǒng)計(jì)學(xué)差異,ALT較治療前升高,肌酐較治療前降低,上述指標(biāo)均在正常值范圍。結(jié)論:綜合所有資料得出,基于象思維的“天龍竭”分期辨治方案治療特發(fā)性肺間質(zhì)纖維化能明顯改善患者的癥狀、體征,提高其生活質(zhì)量,對(duì)其肺功能及高分辨率CT有穩(wěn)定性作用,治療無(wú)肝腎功能損傷。
[Abstract]:Objective: This study aims to observe the comprehensive curative effect of the patients with idiopathic pulmonary fibrosis based on the "tiandragon" staging based on image thinking. To provide clinical evidence for the application of the "Tianlong exhaustion" scheme, and to explore the effective methods and means for the prevention and treatment of IPF in the national medical resources of Yunnan. The plan, 34 cases of the collected cases were divided into groups, which were carried out by the same group of high year traditional Chinese medicine doctors. According to the four diagnosis of Chinese medicine, according to the four diagnosis of TCM syndrome, combined with the course of disease, laboratory index, lung function and imaging examination, it was divided into early lung arthralgia group and advanced lung flaccid group. The two groups were treated with "Tianlong exhaustion" stage differentiation and treatment plan intervention, to outpatient medicine Oral high resolution CT (HRCT), pulmonary function (ventilation and diffusion function), IPF syndrome score table, St Georges Respiratory Questionnaire (SGRQ) and dyspnea score (m MRC) were evaluated. Results: the results were included in 34 patients, 17 cases in the pulmonary arthralgia group, 12 male and 5 female, with an average age of 62.76 11.. 22 years old, the course of disease was 1.71 + 1.07 years, lung flaccid group 17 cases, male 10 cases, 7 cases of female, the average age was 68.88 + 9.59 years, the course of disease was 2.59 + 1.62 years, the basic situation was not statistically different (P0.05). The pulmonary function (TLC, VC, DLco) before and after treatment was not statistically different; the TLC and VC in the pulmonary arthralgia group were improved after treatment, and there was no statistical difference in DLco; the lung flaccid had no statistical difference. There was no statistical difference between TLC, VC and DLco before and after treatment. The total results of high resolution CT after treatment were effective in 2 cases, stable in 26 cases and ineffective in 6 cases. 2 cases were effective after treatment in the pulmonary arthralgia group, 15 cases were stable, 11 cases were stable after the treatment of the lung flaccid group and 6 cases were invalid (P0.05). The TCM syndrome of two groups after treatment was evaluated after treatment. The main symptoms, secondary symptoms, or symptoms and total scores were significantly lower than before the treatment (P0.05). After treatment, the two groups of patients in the two groups were significantly improved than before treatment, the difference was statistically significant (P0.001). The two groups of patients after the treatment of M MRC scores were significantly relieved before treatment, the difference was statistically significant (P0.001). There was no statistical difference between the liver and kidney work before and after treatment in the arthralgia group. There was no statistical difference between the AST and the urea nitrogen in the patients before and after the treatment. The ALT was higher than that before the treatment, and the creatinine was lower than that before the treatment. All the above indexes were in the normal range. Conclusion: the comprehensive data obtained, based on the "tiandragon" stage differentiation and treatment scheme based on the image thinking to treat the idiopathic pulmonary interstitial Fibrosis can significantly improve the symptoms and signs of patients, improve their quality of life, and have a stabilizing effect on lung function and high-resolution CT.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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本文編號(hào)：2031721