【摘要】：目的本課題采用隨機對照的設(shè)計方案,通過對帕金森病(PD)患者治療前后癥狀、體征改善情況的臨床觀察,比較西藥的使用情況,客觀評價芍甘定顫湯輔助治療帕金森病的療效,為治療帕金森尋找一條中西醫(yī)結(jié)合的有效途徑。方法收集符合PD診斷、納入及排除標(biāo)準(zhǔn)的患者72名,隨機分為觀察組和對照組。對照組只給予西藥普拉克索治療,初始劑量為每次0.125 mg,每日3次；病情進展者,聯(lián)合口服多巴絲肼片,初始劑量每次62.5mg,每日2次；觀察組在上述西藥治療的基礎(chǔ)上加用芍甘定顫湯。兩組療程均為3個月。分別在治療前和治療3個月后對兩組PD患者進行各項UPDRS量表、中醫(yī)癥候量化分級表評分,并記錄兩組PD患者西藥應(yīng)用的種類和劑量。結(jié)果1.中西醫(yī)結(jié)合治療PD對UPDRS的影響治療前觀察組和對照組的UPDRS各部分及總分評分比較均無顯著差異(P0.05),說明兩組具有可比性；觀察組與對照組治療前后UPDRS總分比較差異明顯(P0.05),且兩組治療后UPDRS總分的比較,觀察組18.4706±6.3065分和對照組20.8286±5.4691分,比較有統(tǒng)計學(xué)差異(P0.05),說明兩組在治療后的UPDRS總分均明顯改善,且對照組的改善更加明顯：在UPDRS各部分積分的比較中,觀察組治療后UPDRS中的第Ⅱ、Ⅲ部分與對照組相比有統(tǒng)計學(xué)差異(P0.05),而在第Ⅰ、Ⅳ部分的比較中,差異不明顯(P0.05),說明觀察組在日常生活活動、運動功能部分評分的療效更明顯；由治療前后UPDRS積分的變化計算其有效率,觀察組有效率(85.29%)明顯高于對照組(77.14%)。2.中西醫(yī)結(jié)合治療PD對中醫(yī)癥候量表的影響治療前兩組患者中醫(yī)癥候量表評分無統(tǒng)計學(xué)差異(P0.05),說明兩組治療前在中醫(yī)癥候方面均衡可比；兩組治療前后中醫(yī)癥候量表的總分均有明顯差異(P0.05),說明兩組在改善中醫(yī)癥候量表積分方面均有明顯療效；兩組中醫(yī)癥候量表積分療效差異有統(tǒng)計學(xué)意義(P0.05),且觀察組總有效率(88.24%)高于對照組(74.29%),表明觀察組療效優(yōu)于對照組。治療后兩組在手部動作遲緩、步態(tài)、顫振、面容、言語、生活自理力方面與治療前相比均降低,且有統(tǒng)計學(xué)差異(P0.05),而觀察組在肢體拘痙方面的療效同樣明顯改善(P0.05),說明觀察組在緩解PD患者肢體拘痙方面的效果好于對照組。3.中西醫(yī)結(jié)合治療PD對西藥使用情況的影響兩組患者經(jīng)治療3月后,普拉克索維持量比較,觀察組的劑量明顯小于對照組的劑量(P0.05),說明普拉克索與芍甘定顫湯聯(lián)合應(yīng)用治療PD,只需較小維持劑量就能獲得滿意療效。兩組因病情進展加用多巴絲肼的情況比較,對照組加用多巴絲肼者的比例為15:35,,觀察組加用多巴絲肼者的比例為4:34,兩組比例比較具有統(tǒng)計學(xué)意義(P0.05),且多巴絲肼的使用劑量比較,觀察組的用量明顯較少(P0.05),說明聯(lián)合應(yīng)用芍甘定顫湯治療PD,更能有效延遲PD病情的進展,降低加用多巴絲肼的幾率,減少多巴絲肼的增加量。結(jié)論1.芍甘定顫湯聯(lián)合西藥治療PD能有效改善患者的UPDRS評分、中醫(yī)癥候量化分級表評分。2.在西藥治療基礎(chǔ)上加用芍甘定顫湯治療早期PD的臨床效果優(yōu)于單用西藥治療的效果。3.西藥與芍甘定顫湯聯(lián)合應(yīng)用治療PD,只需較小維持劑量就能獲得滿意療效；且能延遲PD病情的進展,降低多種西藥聯(lián)合應(yīng)用的幾率。
[Abstract]:Objective to adopt a randomized controlled design, through the clinical observation of the symptoms and signs of Parkinson's disease (PD) patients before and after treatment, compare the use of Western medicine, objectively evaluate the efficacy of Paeonia Gump Decoction in the treatment of Parkinson's disease, and to find an effective way to find a combination of Chinese and Western medicine for the treatment of Parkinson. A total of 72 patients were divided into the observation group and the control group. The control group was treated with western medicine pramexso, the initial dose was 0.125 mg each time, 3 times a day; the patients with the disease progressed, combined with the oral dose of 62.5mg, and 2 times a day for each time; the observation group was added to the western medicine on the basis of the treatment. The two groups were treated for 3 months. Before and after 3 months of treatment, two groups of PD patients were given various UPDRS scales, TCM syndrome grading scale scores, and the types and doses of Western medicine in two groups of PD patients were recorded. Results 1. the effect of combination of traditional Chinese and Western Medicine on UPDRS in the observation group and the control group of UPDRS before treatment. There was no significant difference in the score and total score (P0.05), indicating the comparability of the two groups. The total scores of UPDRS in the observation group and the control group were significantly different (P0.05), and the comparison of the total scores of the two groups after treatment was 18.4706 + 6.3065 and 20.8286 + 5.4691 in the control group (P0.05), indicating that the two groups were in the two groups. The total score of UPDRS after treatment was obviously improved, and the improvement of the control group was more obvious: in the comparison of the integral parts of the UPDRS, the second and third part of UPDRS in the observation group had a statistically significant difference compared with the control group (P0.05), while in the comparison of the first and fourth parts, the difference was not obvious (P0.05), indicating that the observation group was in daily life activities. The effect of the functional part score was more obvious; the efficiency of the UPDRS integral before and after the treatment was calculated, the effective rate of the observation group (85.29%) was significantly higher than that of the control group (77.14%). The effect of the combination of Chinese and Western Medicine on the TCM Syndrome Scale was not statistically significant (P0.05) in the two groups of patients before the treatment (P0.05), indicating that the two groups were before the treatment. The total score of TCM syndrome was significantly different in the two groups before and after treatment (P0.05), indicating that the two groups had obvious curative effect in improving the score of TCM Syndrome Scale, and the difference of the integral effect of the two groups of TCM syndrome scales was statistically significant (P0.05), and the total effective rate of the observation group (88.24%) was higher than that of the control group (74.2 9%), the observation group was better than the control group. After treatment, the two groups were lower in hand movement, gait, flutter, facial expression, speech, and self-care ability compared with before treatment, and there were statistical differences (P0.05), but the effect of the observation group in the limb spasmodic was also significantly improved (P0.05), indicating that the observation group was relieving the spasmodic side of the limbs of PD patients. The effect is better than the effect of the combination of.3. and Western Medicine on the use of Western medicine in the treatment of PD. Two groups of patients were compared with the maintenance of pramc after March. The dose of the observation group was significantly smaller than that of the control group (P0.05). Two groups were compared with dododozide in the two groups. The proportion of the control group added with dodozide was 15:35, and the proportion of dodozide in the observation group was 4:34 and the proportion of the two groups was statistically significant (P0.05), and the dosage of dodozide was compared, and the dosage of the observed group was significantly less (P0.05), indicating the combination of Paeonia Paeonia. The treatment of PD can effectively delay the progression of PD, reduce the probability of adding the use of the use of the use of the PD, and reduce the increase in the dose of the hydrazine. Conclusion 1. Paeonia Gan Ding tremor soup combined with western medicine can effectively improve the patient's UPDRS score, and the TCM Syndrome Quantification Scale score.2. is added to the early PD on the basis of the western medicine treatment. The effect of clinical effect is better than that of Western medicine alone..3. western medicine combined with peony Gump tremor soup is combined with the treatment of PD. Only a small amount of maintenance dose can be used to obtain satisfactory curative effect, and it can delay the progress of PD and reduce the probability of combination of various western medicine.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7

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