本文選題：芪實(shí)顆粒 + 盆底肌訓(xùn)練��； 參考：《中國(guó)中醫(yī)科學(xué)院》2016年博士論文

【摘要】：1研究目的1.1通過(guò)對(duì)中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁療效的系統(tǒng)評(píng)價(jià),為臨床實(shí)踐提供循證醫(yī)學(xué)證據(jù)；1.2觀察芪實(shí)顆粒治療女性壓力性尿失禁的ICI-Q-SF評(píng)分變化及尿墊試驗(yàn)變化,評(píng)價(jià)其療效：觀察芪實(shí)顆粒聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁的ICI-Q-SF評(píng)分及I-QOL評(píng)分變化,24小時(shí)尿失禁頻次評(píng)價(jià)其療效。為中醫(yī)藥治療女性壓力性尿失禁提供臨床依據(jù)；1.3研究芪實(shí)顆粒聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁的癥狀時(shí)點(diǎn)緩解規(guī)律。2試驗(yàn)方法2.1檢索中文數(shù)據(jù)庫(kù)包括相關(guān)期刊論文(CNKI)、維普中文科技期刊全文數(shù)據(jù)庫(kù)(VIP)、萬(wàn)方全文數(shù)據(jù)庫(kù)、中國(guó)生物醫(yī)學(xué)文獻(xiàn)數(shù)據(jù)庫(kù)(CBM)；外文數(shù)據(jù)庫(kù)包括PubMed等。所有檢索時(shí)間為各數(shù)據(jù)庫(kù)建庫(kù)時(shí)間至2016年1月。文獻(xiàn)檢索語(yǔ)言為中英文。手工檢索相關(guān)雜志、會(huì)議的中英文文獻(xiàn),用谷歌(Google)等搜索引擎在互聯(lián)網(wǎng)上查找相關(guān)文獻(xiàn)并追查已檢出文獻(xiàn)的參考文獻(xiàn),查找灰色文獻(xiàn),所查文獻(xiàn)包括期刊、會(huì)議文章匯編及研究生論文。系統(tǒng)評(píng)價(jià)中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁的療效。2.2選擇中國(guó)中醫(yī)科學(xué)院西苑醫(yī)院泌尿外科門(mén)診輕中度壓力性尿失禁(SUI)患者70例,按隨機(jī)數(shù)字表法將患者隨機(jī)分為兩組,治療組、對(duì)照組各35例。治療組采用芪實(shí)顆粒；對(duì)照組采用盆底肌訓(xùn)練療法。觀察兩組患者ICI-Q-SF評(píng)分、尿失禁量的變化和臨床療效比較,均連續(xù)治療4周后統(tǒng)計(jì)療效。2.3納入西苑醫(yī)院泌尿外科的成年女性輕中度SUI患者,共62例。進(jìn)行平行對(duì)照、隨機(jī)、雙盲臨床試驗(yàn)。治療組選用芪實(shí)顆粒聯(lián)合盆底肌功能訓(xùn)練治療；對(duì)照組選用安慰劑聯(lián)合盆底肌功能訓(xùn)練治療。連續(xù)服藥56天,每?jī)芍茉L(fǎng)視一次。通過(guò)ICI-Q-SF評(píng)分、I-QOL評(píng)分、24小時(shí)排尿日記的尿失禁頻率記錄進(jìn)行療效評(píng)估。3結(jié)果3.1中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁的meta分析結(jié)果中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁有效：中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁優(yōu)于單純使用盆底肌訓(xùn)練治療。由于納入的文獻(xiàn)質(zhì)量偏低,本研究得出結(jié)論的應(yīng)用需要謹(jǐn)慎。尿失禁的病位以脾、腎為主,臨床應(yīng)用補(bǔ)脾益腎的中藥聯(lián)合盆底肌訓(xùn)練對(duì)于壓力性尿失禁的預(yù)防和治療有一定的療效。但是由于目前研究的患者數(shù)量少,質(zhì)量偏低,各家對(duì)結(jié)局的判定指標(biāo)不統(tǒng)一等問(wèn)題,不能完全說(shuō)明中醫(yī)藥對(duì)治療女性壓力性尿失禁有一定的療效,還需要大量的隨機(jī)樣本研究,統(tǒng)一的量化評(píng)定標(biāo)準(zhǔn)來(lái)進(jìn)一步評(píng)價(jià)。3.1.1文獻(xiàn)的一般情況從納入文獻(xiàn)的基本情況來(lái)看,文獻(xiàn)發(fā)表的數(shù)量相對(duì)較少,文獻(xiàn)的真實(shí)性和可信度較高,但目前文獻(xiàn)的基金支持少,且多為單中心研究。3.1.2隨機(jī)化、分配方案、盲法本系統(tǒng)評(píng)價(jià)納入的4篇研究文獻(xiàn)僅提及為隨機(jī)分組,未顯示分組方法,不能判定隨機(jī)分組的正確性,隨機(jī)化的整體質(zhì)量不高。都未描述是否實(shí)施分配方案的隱匿,因此存在選擇偏移的可能性大。均未描述盲法的具體應(yīng)用,使用盲法率低,從質(zhì)量評(píng)價(jià)標(biāo)準(zhǔn)來(lái)看,不可避免存在偏倚。3.1.3退出、失訪(fǎng)、不良反應(yīng)病例記錄4篇研究文獻(xiàn)均未提及隨訪(fǎng)時(shí)間的標(biāo)準(zhǔn),均未描述退出與失訪(fǎng)病例,從研究結(jié)果看無(wú)退出與失訪(fǎng)病例。均未描述嚴(yán)重不良事件,無(wú)法判斷使用藥物的安全性。3.1.4療效判定指標(biāo)、統(tǒng)計(jì)學(xué)方法療效觀測(cè)指標(biāo)不統(tǒng)一,影響療效的判定和結(jié)論的分析,整體研究缺少中醫(yī)特色。本研究4篇文章中未說(shuō)明具體統(tǒng)計(jì)學(xué)方法,從報(bào)道提供的資料看4篇文獻(xiàn)的統(tǒng)計(jì)方法正確,有具體的統(tǒng)計(jì)量和P值。3.2芪實(shí)顆粒及盆底肌訓(xùn)練對(duì)女性壓力性尿失禁影響的臨床觀察結(jié)果3.2.1兩組治療后ICI-Q-SF評(píng)分與尿失禁量比較治療后2周兩組ICI-Q-SF評(píng)分與尿失禁量均較同組治療前明顯改善(P0.01)；治療后4周與同組治療后2周比較,治療組差異有統(tǒng)計(jì)學(xué)意義(P0.01),對(duì)照組則無(wú)明顯變化(P0.05)。治療組治療后2周、4周與對(duì)照組同時(shí)間段比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05、P0.01)3.2.2臨床療效比較治療后治療組總有效率為67.7%,對(duì)照組為37.0%,兩組總有效率比較,差異有顯著性意義(P0.01)。3.3芪實(shí)顆粒聯(lián)合盆底肌訓(xùn)練對(duì)Ⅰ-Ⅲ度女性壓力性尿失禁ICI-Q-SF及I-QOL評(píng)分影響的臨床觀察結(jié)果3.3.1試驗(yàn)組和對(duì)照組ICI-Q-SF評(píng)分比較組內(nèi)比較,試驗(yàn)組ICI-Q-SF分?jǐn)?shù)從治療后2周起,均與前一次訪(fǎng)視時(shí)有減少,減少的分值具有統(tǒng)計(jì)學(xué)意義(2周時(shí)P值0.005,4周、6周、8周P值均0.0001)。對(duì)照組ICI-Q-SF分?jǐn)?shù)在療后2周時(shí)與基線(xiàn)相比,療效變化無(wú)統(tǒng)計(jì)學(xué)意義,從療后4周起與前一次訪(fǎng)視相比,分?jǐn)?shù)有所減少,減少值有統(tǒng)計(jì)學(xué)意義(P值均0.0001)試驗(yàn)組和對(duì)照組的ICI-Q-SF基線(xiàn)值比較,P值為0.6825,二者無(wú)統(tǒng)計(jì)學(xué)意義：自服藥2周,直至4周后,試驗(yàn)組和對(duì)照組的ICI-Q-SF值比較均無(wú)統(tǒng)計(jì)學(xué)意義(P值分別為0.2625和0.1063)；但當(dāng)服藥至6周P值為0.0095,8周P值為0.0003,兩組比較差異顯著。3.3.2試驗(yàn)組和對(duì)照組I-QOL評(píng)分比較組內(nèi)比較,試驗(yàn)組QOL分?jǐn)?shù)從療后2周起,均與前一次訪(fǎng)視時(shí)有增加,增加的分值具有統(tǒng)計(jì)學(xué)意義(2周時(shí)P值0.05,4周、6周、8周P值均0.0001)。對(duì)照組QOL分?jǐn)?shù)在療后2周時(shí)與基線(xiàn)相比,療效變化無(wú)統(tǒng)計(jì)學(xué)意義,從療后4周起與前一次訪(fǎng)視相比增加量有統(tǒng)計(jì)學(xué)意義(P值均0.0001)。試驗(yàn)組和對(duì)照組的I-QOL基線(xiàn)值比較,P值為0.687,二者無(wú)統(tǒng)計(jì)學(xué)意義；服藥2周試驗(yàn)組和對(duì)照組的ICI-Q-SF值比較無(wú)統(tǒng)計(jì)學(xué)意義,P值為0.905；但當(dāng)服藥至4周、6周及8周后,P值為0.0317、0.0003、0.0001,統(tǒng)計(jì)學(xué)差異顯著。3.3.3試驗(yàn)組和對(duì)照組24h尿失禁頻次比較組內(nèi)比較,試驗(yàn)組尿失禁頻次從療后2周起,均與前一次訪(fǎng)視時(shí)有減少,減少的頻次數(shù)具有統(tǒng)計(jì)學(xué)意義(2周、4周P值0.0005,6周、8周P值0.0001)。對(duì)照組尿失禁頻次在療后2周時(shí)與基線(xiàn)相比,變化無(wú)統(tǒng)計(jì)學(xué)意義,從療后4周起與前一次訪(fǎng)視相比,減少的尿失禁頻次有統(tǒng)計(jì)學(xué)意義(P值均0.0001)。試驗(yàn)組和對(duì)照組的尿失禁頻次基線(xiàn)值比較,P值為0.498,二者無(wú)統(tǒng)計(jì)學(xué)意義；服藥2周、4周后試驗(yàn)組和對(duì)照組的尿失禁頻次比較無(wú)統(tǒng)計(jì)學(xué)意義,P值為0.0938和0.078；但當(dāng)服藥至6周及8周后,P值為0.0071、0.0002,統(tǒng)計(jì)學(xué)差異顯著。3.3.4治療前后漏尿情況分析試驗(yàn)組在咳嗽或打噴嚏時(shí)漏尿和在活動(dòng)或體育運(yùn)動(dòng)時(shí)漏尿兩項(xiàng)的好轉(zhuǎn)率大于對(duì)照組。4結(jié)論4.1 meta分析結(jié)果顯示中醫(yī)藥聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁有效；4.2單純運(yùn)用芪實(shí)顆粒治療女性輕中度壓力性尿失禁療效優(yōu)于盆底肌訓(xùn)練組；4.3芪實(shí)顆粒聯(lián)合盆底肌訓(xùn)練可以改善輕中度女性壓力性尿失禁的ICI-Q-SF評(píng)分、I-QOL評(píng)分及24小時(shí)尿失禁頻次；且療效優(yōu)于盆底肌訓(xùn)練對(duì)照組；4.4芪實(shí)顆粒聯(lián)合盆底肌訓(xùn)練治療女性壓力性尿失禁有明顯的癥狀時(shí)點(diǎn)緩解規(guī)律。
[Abstract]:Objective 1.1 To provide evidence for evidence - based medicine in clinical practice through systematic evaluation of the curative effect of Chinese medicine combined with pelvic floor muscle training on female stress urinary incontinence ;
1.2 To observe the change of ICI - Q - SF score and the change of urinary pad test in female stress urinary incontinence , and evaluate its curative effect by observing the changes of the ICI - Q - SF score and I - QOL score in female stress urinary incontinence .
1.3 To study the rule of point relief in the treatment of female stress urinary incontinence by the combination of Qi - solid granule and pelvic floor muscle training . The test method 2.1 retrieves Chinese database including Chinese journal full - text database ( CNKI ) , full - text database ( VIP ) of Vip Chinese sci - tech periodicals , full - text database of Wanfang , Chinese Biomedical Literature Database ( CBM ) ;
The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . The literature search language is Chinese and English . According to the Chinese and English literature of the conference , the author searches the relevant literature on the Internet and looks up the literature references . The system evaluates the curative effect of Chinese medicine combined with pelvic floor muscle training on female stress urinary incontinence .
In the control group , pelvic floor muscle training was used to observe the effects of ICI - Q - SF score , urinary incontinence and clinical curative effect in two groups .
In the control group , the therapeutic effect of traditional Chinese medicine combined with pelvic floor muscle training on the prevention and treatment of female stress urinary incontinence was discussed . The results showed that the clinical application of traditional Chinese medicine combined with pelvic floor muscle training was superior to the treatment of female stress urinary incontinence .
Compared with the control group , the total effective rate was 67.7 % in the treatment group and 37.0 % in the control group . Compared with the control group , the total effective rate was 67.7 % in the treatment group and 37.0 % in the control group .
Compared with baseline , the QOL scores of the control group were significantly different from baseline ( P < 0.05 , 4 weeks , 6 weeks , 8 weeks P < 0.0001 ) . Compared with baseline , the scores of QOL in the control group were statistically significant ( P < 0 . 0001 ) .
The ICI - Q - SF values of the two week test group and the control group were not statistically significant , and the P value was 0.905 ;
Compared with baseline at 2 weeks after treatment , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) . Compared with baseline in the control group , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) . Compared with baseline in the control group , the frequency of urinary incontinence decreased significantly ( P < 0.0001 ) .
The frequency of urinary incontinence in the test group and the control group was not statistically significant after 2 weeks , 0 . 0938 and 0.078 , respectively .
The results showed that the combined pelvic floor muscle training in the treatment of female stress urinary incontinence was effective in the treatment of female stress urinary incontinence .
4.2 The curative effect of treating female with mild and moderate pressure urinary incontinence was better than that of pelvic floor muscle training group .
4 . The ICI - Q - SF score , I - QOL score and 24 - hour urinary incontinence frequency of female stress urinary incontinence in women with mild and moderate pressure were improved by the combination of Qi - solid granule and pelvic floor muscle .
and the curative effect is superior to that of the pelvic floor muscle training control group ;
4.4 Qi - solid granule combined with pelvic floor muscle training in the treatment of female stress urinary incontinence has obvious symptom time point relief rule .

【學(xué)位授予單位】：中國(guó)中醫(yī)科學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R711.59

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮鳳英;宋睿;;生物反饋-電刺激+盆底肌肉鍛煉治療女性尿失禁的療效觀察[J];中國(guó)社區(qū)醫(yī)師;2015年01期

2 李春茹;;探討壓力性尿失禁的解剖學(xué)改變與治療[J];中外醫(yī)學(xué)研究;2011年12期

3 盛少琴;李東輝;;中西醫(yī)結(jié)合治療老年女性壓力性尿失禁療效觀察[J];浙江中西醫(yī)結(jié)合雜志;2011年03期

4 陳軍;葛醫(yī);;補(bǔ)中益氣湯加味配合理療治療女性壓力性尿失禁80例療效觀察[J];中國(guó)醫(yī)藥指南;2010年18期

5 羅少波;賈金銘;馬衛(wèi)國(guó);董佳晨;焦擁政;;益精方治療少弱精癥207例[J];陜西中醫(yī);2010年04期

6 周倩;張寶平;張平;;中藥內(nèi)服外用治療女性壓力性尿失禁105例[J];河北中醫(yī);2010年03期

7 胡長(zhǎng)效;朱靜;;中藥桑螵蛸的研究進(jìn)展[J];農(nóng)業(yè)與技術(shù);2007年05期

8 李美紅;楊雪瓊;萬(wàn)直劍;楊亞濱;李t，

本文編號(hào)：1828608