【摘要】：1目的通過觀察名方-膈下逐瘀湯治療氣滯血瘀型盆腔炎性疾病后遺癥(Sequelae of PID)患者治療前后的中醫(yī)證候、癥狀、體征的改變,患者血清炎性細胞因子IL-1、IL-8、IL-10、TNF-α表達水平的變化及患者焦慮、抑郁改善情況,分析總結(jié)膈下逐瘀湯治療盆腔炎性后遺癥的臨床綜合療效及治療機制。2方法選取2014年11月~2015年11月就診于安徽中醫(yī)藥大學第一附屬醫(yī)院婦科門診及住院的氣滯血瘀型的盆腔炎性疾病后遺癥患者80例,其中年齡:20歲~29歲28人,30歲~34歲28人,35歲~45歲24人。病程6個月至1年21人,1年以上3年以下16人,3至5年23人。按患者就診時間1比1的比例隨機分組。分為治療組(服用膈下逐瘀湯聯(lián)合野菊花通絡灌腸顆粒保留灌腸)和對照組(服用西藥聯(lián)合超短波理療)各40例。分別記錄兩組患者治療前后的中醫(yī)證候、臨床癥狀、局部體征的相應變化,分析臨床綜合療效;同時記錄治療前后兩組患者不良心理情緒變化、治療前后患者炎性細胞因子IL-1、IL-8、IL-10、TNF-α表達水平變化情況。綜合評價兩組盆腔炎性疾病后遺癥患者治療效果;3結(jié)果治療后結(jié)果顯示:在綜合療效方面,治療組和對照組的總有效率分別達到:85.0%和82.5%,治療組優(yōu)于對照組。經(jīng)統(tǒng)計學分析,差異具統(tǒng)計學意義(P0.01);在中醫(yī)證候療效方面,治療組和對照組的總有效率分別為95%和90%,治療組優(yōu)于對照組。經(jīng)統(tǒng)計學分析,治療組療效有統(tǒng)計學意義(P0.01),對照組的療效同樣具有顯著性差異(P0.05);治療后兩組病例中醫(yī)證候積分方面,治療組和對照組在治療前中醫(yī)癥候總積分無明顯差別(P0.05),治療后對照組的中醫(yī)證候分要高于治療組(P0.05),對照組患者治療后中醫(yī)癥候積分均較前有所降低,治療組治療后的整體得分都較治療前有顯著下降(P0.01)。治療組優(yōu)于對照組(p0.05)。在患者焦慮、抑郁評分方面,治療前組間差異不顯著,治療后兩組的抑郁、焦慮水平均顯著下降(p0.05),其中治療組的下降程度要大于對照組。在炎細胞因子IL-1、IL-8 IL-10、TNF-a方面,治療組治療后,細胞因子水平優(yōu)于對照組(p0.05)。治療后IL-1、IL-8顯著低于治療前(P0.05),IL-10顯著高于治療前(P0.05),TNF-a療前后無顯著統(tǒng)計學差異(P0.05)。治療過程中均未發(fā)現(xiàn)明顯不良反應。4結(jié)論膈下逐瘀湯治療氣滯血瘀型盆腔炎性疾病后遺癥的療效確切,能改善盆腔炎性疾病后遺癥患者的臨床癥狀、局部體征、中醫(yī)癥候,能調(diào)節(jié)炎細胞因子的表達水平,從而改善患者的不良心理狀態(tài)。
[Abstract]:Objective to observe the changes of TCM syndromes, symptoms and signs of (Sequelae of PID) patients with Qi stagnation and Blood stasis Type pelvic inflammatory Disease sequelae before and after treatment. Changes of serum inflammatory cytokine IL-1,IL-8,IL-10,TNF- 偽 expression and improvement of anxiety and depression in patients, Analysis and summary of clinical comprehensive curative effect and treatment mechanism of Gexiazhuyu decoction in treating pelvic inflammatory sequelae methods from November 2014 to November 2015, Qi-stagnation blood was selected from gynecological outpatient and inpatient of the first affiliated Hospital of Anhui University of traditional Chinese Medicine. 80 cases of pelvic inflammatory disease sequelae of blood stasis type, Among them, age 20, age 29, age 28, age 30, age 34, age 28, age 35, age 45, age 24. The course of disease ranged from 6 months to 21 cases, and from 1 year to 3 years, from 3 to 5 years. The patients were randomly divided into two groups according to the ratio of 1: 1. The patients were divided into treatment group (treated with Gexia Zhuyu decoction combined with wild chrysanthemum Tongluo enema granule retention enema) and control group (taking western medicine combined with ultrashort wave physiotherapy). Record the corresponding changes of TCM syndromes, clinical symptoms and local signs before and after treatment, analyze the comprehensive clinical efficacy, and record the changes of bad psychological emotions of the two groups before and after treatment. Changes of inflammatory cytokine IL-1,IL-8,IL-10,TNF- 偽 expression before and after treatment. Comprehensive evaluation of the two groups of pelvic inflammatory disease sequelae treatment results after treatment results: in the comprehensive curative effect, the total effective rate of the treatment group and the control group reached 85.0% and 82.5% respectively, the treatment group is better than the control group. The total effective rate of treatment group and control group were 95% and 90% respectively, the treatment group was superior to the control group. After statistical analysis, the curative effect of the treatment group has statistical significance (P0.01), the control group also has significant difference (P0.05); after the treatment of two groups of cases of TCM syndromes integral, There was no significant difference between the treatment group and the control group in the total score of TCM symptoms before treatment (P0.05). After treatment, the TCM syndrome score of the control group was higher than that of the treatment group (P0.05), and the TCM symptom score of the control group was lower than that of the former. The overall score of treatment group was significantly lower than that before treatment (P0.01). The treatment group was superior to the control group (p0.05). There was no significant difference in the scores of anxiety and depression between the two groups before treatment. After treatment, the depression and anxiety level of the two groups decreased significantly (p0.05), and the degree of depression in the treatment group was greater than that in the control group. The level of cytokines in the treatment group was better than that in the control group (p0.05). After treatment, IL-1,IL-8 was significantly lower than that before treatment (P0.05) and IL-10 was significantly higher than that before treatment (P0.05). There was no significant difference before and after treatment (P0.05). Conclusion Gexia Zhuyu decoction is effective in treating the sequelae of pelvic inflammatory disease of qi stagnation and blood stasis type, and can improve the clinical symptoms, local signs and TCM symptoms of patients with pelvic inflammatory disease. Can regulate the expression level of inflammatory cytokines, thereby improving the poor psychological state of patients.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R271.9

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