本文選題：神經(jīng)根型頸椎病 + 風(fēng)寒濕型�。� 參考：《成都中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：通過桂枝加葛根湯加味結(jié)合頸椎牽引、中頻脈沖與布洛芬緩釋膠囊口服配合頸椎牽引、中頻脈沖治療風(fēng)寒濕型神經(jīng)根型頸椎病的療效的對比研究,探討桂枝加葛根湯加味治療風(fēng)寒濕型神經(jīng)根型頸椎病的臨床療效及作用機(jī)制。方法：將2015年9月至2016年1月就診于我院骨科的60例風(fēng)寒濕型神經(jīng)根型頸椎病的研究對象；運(yùn)用信封隨機(jī)分組法,將病患分為治療組和對照組,各30例。治療組予桂枝加葛根湯加味,一日一劑,配合每天頸椎牽引、中頻脈沖一次,各20分鐘；對照組予布洛芬,一日兩次,配合每天頸椎牽引、中頻脈沖一次,各20分鐘；2周為一個(gè)療程,共2個(gè)療程。兩組治療前、后分別用目測類比評分(VAS)、田中靖久評分評估受試者的癥狀體征及隨訪3個(gè)月的田中靖久評分；并用SPSS19.0對數(shù)據(jù)統(tǒng)計(jì)處理。結(jié)果：(1)兩組的總體療效對比：P0.05,對比無統(tǒng)計(jì)學(xué)差異：表明兩組的總體療效無明顯差別；但桂枝加葛根湯加味組的臨床控制率(20%)和顯效率(43.3%)均高于對照組的10.3%和34.5%。(2)兩組治療后VAS評分對比：P0.05,對比有統(tǒng)計(jì)學(xué)差異：說明桂枝加葛根湯加味組對緩解疼痛的效果要好于對照組。兩組治療后田中靖久癥狀體征功能評分對比：PO.05,對比無統(tǒng)計(jì)學(xué)差異；說明兩組在治療后田中靖久癥狀體征功能評分的改善差別不顯著；但桂枝加葛根湯加味對改善癥狀體征功能還是要略微好于布洛芬。(3)兩組1、2個(gè)月后復(fù)發(fā)例數(shù)對比：P0.05,對比無統(tǒng)計(jì)學(xué)差異；說明兩組1、2個(gè)月后復(fù)發(fā)例數(shù)沒有顯著的差別。 3個(gè)月后復(fù)發(fā)例數(shù)對比：P0.05,對比有明顯差異；說明布洛芬組3個(gè)月后復(fù)發(fā)例數(shù)比治療組明顯增加。由表可看出,對照組的復(fù)發(fā)例數(shù)隨著時(shí)間的推移,增長幅度越大；說明布洛芬組的遠(yuǎn)期療效比桂枝加葛根湯加味組差。結(jié)論：(1)桂枝加葛根湯加昧方可以治療風(fēng)寒濕型神經(jīng)根型頸椎病,總體療效與布洛芬緩釋膠囊對照組沒有明顯差別；但遠(yuǎn)期療效較好,且復(fù)發(fā)例數(shù)較少；說明中醫(yī)辨證治療更具優(yōu)勢。(2)本方的藥理作用機(jī)制可能為：①緩解肌肉痙攣,改善微循環(huán),消除炎癥反應(yīng)和神經(jīng)根水腫；②鎮(zhèn)痛消炎,保護(hù)神經(jīng)細(xì)胞和調(diào)節(jié)骨代謝；③抑制免疫反應(yīng)；針對“根性痛”三個(gè)主要病理。
[Abstract]:Objective: to compare the curative effect of Guizhi plus Gegen decoction combined with cervical traction, medium frequency pulse and ibuprofen sustained release capsule combined with cervical traction and middle frequency pulse in the treatment of rheumatic and wet nerve root cervical spondylosis. To explore the clinical efficacy and mechanism of Guizhi plus Gegen decoction in the treatment of cervical spondylosis of nerve root type of wind-cold and dampness type. Methods: from September 2015 to January 2016, 60 patients with rheumatic, cold and wet nerve root type cervical spondylosis were randomly divided into treatment group and control group with 30 cases each. The treatment group was treated with Guizhi plus Gegen decoction, one dose per day, combined with cervical traction every day, and the control group was given ibuprofen twice a day, once a day, 20 minutes each, and the control group was given ibuprofen once a day. 2 weeks as a course of treatment, a total of 2 courses of treatment. Before and after treatment, visual analogue scores were used to evaluate the symptoms and signs of the subjects and the follow-up data were analyzed by SPSS 19.0. Results there was no significant difference in the total curative effect between the two groups: (1) there was no significant difference in the total curative effect between the two groups. However, the clinical control rate of Guizhi plus Gegen decoction group (20) and the effective rate (43.3%) were higher than those of the control group (10.3% and 34.55.0%). The VAS score of the two groups after treatment was compared with that of the control group (P 0.05). The comparison showed that there was a significant difference between Guizhi group and Gegen decoction group in relieving pain. The effect was better than that in the control group. There was no significant difference in the scores of symptoms and signs between the two groups after treatment, indicating that there was no significant difference in the scores of symptoms and signs between the two groups after treatment. But Guizhi plus Gegen decoction could improve the function of symptoms and signs slightly better than that of ibuprofen group 1, and the number of recurrence cases 2 months later had no statistical difference, indicating that there was no significant difference in the number of recurrence cases between the two groups after 1 and 2 months. The number of recurrence cases in ibuprofen group after 3 months was significantly higher than that in treatment group. It can be seen from the table that the number of recurrence cases in the control group increases more with time, which indicates that the long-term effect of ibuprofen group is worse than that of Guizhi plus Gegen decoction group. Conclusion (1) Guizhi plus Gegen decoction can treat cervical spondylopathy of nerve root type of wind-cold and dampness type, the overall curative effect is not significantly different from that of ibuprofen sustained release capsule control group, but the long-term effect is better, and the number of recurrence cases is less. It is suggested that the pharmacological mechanism of traditional Chinese medicine (TCM) is to relieve muscle spasm, improve microcirculation, eliminate inflammatory reaction and nerve root edema, analgesia and anti-inflammation, protect nerve cells and regulate bone metabolism. 3 inhibition of immune response and three major pathologies of "root pain".
【學(xué)位授予單位】：成都中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R274.9

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