【摘要】：目的：尿路感染為泌尿外科常見(jiàn)及多發(fā)病,易復(fù)發(fā)和再感染。尤其是老年女性反復(fù)發(fā)作性尿路感染,其治療是臨床上的難點(diǎn)。本研究旨在通過(guò)隨機(jī)對(duì)照研究,觀察治療組和對(duì)照組在臨床癥狀和實(shí)驗(yàn)室檢查指標(biāo)等方面的變化,探討中醫(yī)中藥辨證治療老年女性陽(yáng)虛濕熱型反復(fù)發(fā)作性下尿路感染的臨床指導(dǎo)意義。通過(guò)研究證實(shí)扶正清熱利濕法在緩解尿路感染主要臨床癥狀、提高疾病痊愈率、降低復(fù)發(fā)率、改善機(jī)體免疫力及日常生活質(zhì)量等方面具有顯著的效果。方法：選取符合研究準(zhǔn)入標(biāo)準(zhǔn)的陽(yáng)虛濕熱型反復(fù)發(fā)作性下尿路感染老年女性患者50例,進(jìn)行隨機(jī)分組,其中對(duì)照組25例,治療組25例。對(duì)照組予以寧泌泰治療,治療組在寧泌泰基礎(chǔ)上予加味八正散治療,治療8到12周。治療結(jié)束后復(fù)查實(shí)驗(yàn)室指標(biāo)和癥狀評(píng)分,將結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析研究,觀察治療前后下尿路感染患者主要癥狀、體征和實(shí)驗(yàn)室指標(biāo)的變化,評(píng)估扶正清熱利濕法的臨床治療效果。結(jié)果：(1)、運(yùn)用扶正清熱利濕法總體有效率為96%,顯著優(yōu)于對(duì)照組,P0.05,治療后兩組患者復(fù)發(fā)率相比較,治療組明顯小于對(duì)照組,P0.05,兩者均有統(tǒng)計(jì)學(xué)意義。(2)、治療后治療組和對(duì)照組患者尿WBC、鱗狀上皮細(xì)胞相比較,治療組顯著優(yōu)于對(duì)照組,P0.05,有統(tǒng)計(jì)學(xué)意義。(3)、治療后治療組CD4、CD4/CD8均高于治療前,P0.01,差異顯著,有統(tǒng)計(jì)學(xué)意義；治療后對(duì)照組CD4、CD4/CD8較治療前無(wú)明顯變化,差異無(wú)統(tǒng)計(jì)意義,P0.05；治療前后治療組和對(duì)照組CD8變化無(wú)明顯差異,P0.05。(4)、治療組中醫(yī)癥狀積分比較,治療前后下降顯著,P0.01；對(duì)照組中醫(yī)癥狀積分比較,治療前后亦有所下降,P0.01,有統(tǒng)計(jì)學(xué)意義。治療后治療組與對(duì)照組中醫(yī)癥狀積分相比較,治療組明顯小于對(duì)照組,P0.05,存在統(tǒng)計(jì)學(xué)意義。(5)、兩組患者在治療前后血常規(guī)、肝腎功能、心電圖均未發(fā)現(xiàn)明顯異常改變。結(jié)論：(1)、扶正清熱利濕法治療老年女性反復(fù)發(fā)作性下尿路感染臨床療效確切,總有效率局。(2)、扶正清熱利濕法能顯著提高機(jī)體免疫功能及臨床痊愈率,降低下尿路感染的復(fù)發(fā)率、改善老年女性反復(fù)發(fā)作性下尿路感染的臨床癥狀,緩解下尿路刺激癥狀和脾腎陽(yáng)虛癥狀,提高患者生活質(zhì)量。(3)、清熱利濕中藥方劑替代廣譜抗生素治療尿培養(yǎng)陰性的反復(fù)發(fā)作性下尿路感染亦有明顯效果。(4)、扶正清熱利濕法使用安全,無(wú)明顯毒副作用。
[Abstract]:Objective: urinary tract infection is common and frequent in urology, easy to relapse and re-infection. In particular, the treatment of recurrent urinary tract infection in elderly women is a difficult point in clinic. The purpose of this study was to observe the changes of clinical symptoms and laboratory indexes in the treatment group and the control group through a randomized controlled study. To explore the clinical significance of TCM syndrome differentiation in the treatment of recurrent lower urinary tract infection in elderly women with yang deficiency, dampness and heat. Through the study, it was proved that the method of Fuzheng, Clearing Heat and removing dampness had remarkable effect in relieving the main clinical symptoms of urinary tract infection, increasing the cure rate of the disease, reducing the recurrence rate, improving the immunity of the body and the quality of daily life, and so on. Methods: fifty elderly women with recurrent lower urinary tract infection of Yang deficiency and damp-heat type were randomly divided into two groups: control group (n = 25) and treatment group (n = 25). The control group was treated with Ningmytai, and the treatment group was treated with Jiawei Bazheng Powder on the basis of Ningmetai for 8 to 12 weeks. After the treatment, the laboratory indexes and symptom scores were reviewed, and the results were analyzed statistically. The changes of the main symptoms, signs and laboratory indexes of the patients with lower urinary tract infection before and after treatment were observed. To evaluate the clinical effect of Fuzheng Qingre and dampness therapy. Results: (1) the total effective rate of Fuzheng, Qingre and dampness was 96, which was significantly better than that of the control group (P0.05). After treatment, the recurrence rate of the two groups was higher than that of the control group. The treatment group was significantly smaller than the control group (P 0.05), both of which had statistical significance. (2) after treatment, the urinary WBC, squamous epithelial cells were compared between the treatment group and the control group. The CD4,CD4/CD8 in the treatment group was significantly higher than that in the pre-treatment group (P 0.01), the difference was significant (P 0.05), the CD4,CD4/CD8 in the control group was not significantly different from that in the control group (P 0.05), and there was no significant difference between the two groups (P 0.05). There was no significant difference in the changes of CD8 between the treatment group and the control group before and after treatment (P0.05. (4). The scores of TCM symptoms in the treatment group decreased significantly before and after treatment, and the scores of TCM symptoms in the control group were also decreased before and after treatment (P 0.01), with statistical significance. After treatment, the scores of TCM symptoms in the treatment group and the control group were significantly lower than that in the control group (P 0.05). (5) there were no obvious abnormal changes in blood routine, liver and kidney function and electrocardiogram before and after treatment in the two groups. Conclusion: (1) the clinical effect of Fuzheng, Clearing Heat and removing dampness in treating elderly women with recurrent lower urinary tract infection is definite, and the total effective rate can be obtained. (2) the method of Fuzheng, Clearing Heat and removing dampness can significantly improve the immune function of the body and the clinical recovery rate, and reduce the recurrence rate of lower urinary tract infection. To improve the clinical symptoms of recurrent paroxysmal lower urinary tract infection in elderly women, to alleviate the symptoms of irritation of lower urinary tract and deficiency of spleen and kidney yang, Improve the quality of life of patients. (3) the treatment of repeated episodes of lower urinary tract infection with negative urine culture also has obvious effect. (4) it is safe to use the method of tonifying heat and removing dampness without obvious side effects.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R277.5

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