本文選題：心力衰竭 + 表里分消　； 參考：《黑龍江中醫(yī)藥大學》2017年碩士論文

【摘要】：目的通過運用表里分消法治療心源性水腫的臨床觀察,探討對于心源性水腫的最佳治療方案。方法:選取2014年12月～2015年12月就診于我院,且診斷心力衰竭患者存在心源性水腫患者60例,患者隨機分為治療組及對照組。對照組按照傳統(tǒng)強心,利尿,擴血管治療;治療組以表里分消為主,配合小劑量洋地黃類及擴血管藥物,療程為14天,觀察兩組患者治療前后中醫(yī)證候積分、水腫消退情況,心功能改善情況,尿量的增加有無以及血鉀的變化。結果:比較兩組患者在治療前性別、年齡、中醫(yī)證候積分、體重、原發(fā)病、6min步行試驗情況,血鉀均P0.05無統(tǒng)計學意義,提示二組患者具有可比性。1.兩組患者中醫(yī)證候改善比較,治療組總有效率90%,對照組總有效率70%,治療組效果優(yōu)于對照組,計算以及比較后得出P=0.018故P0.05,具有統(tǒng)計學意義;在改善水腫方面,二組患者治療前后水腫消退情況中,治療組總有效率90%,對照組總有效率76.6.治療組顯著高于對照組。心功能改善情況中治療組心功能改善情況總有效率為93%,對照組在改善心功能情況總有效率80%,治療組顯著高于對照組。2.比較兩組患者6min步行試驗中治療后,治療組中與對照組為477.33±77.18、349.00±62.38兩組進行比較P0.05,差異具有統(tǒng)計學意義。3.兩組患者治療后尿量呈增加趨勢,治療組治療前769.00±120.03ml,治療7天后尿量為1141.00±150.82ml,治療14天后,其尿量為1158.33±142.90ml進行組內比較,P值均小于0.05治療有意義,對照組治療前尿量為759.33±87.41ml,治療7天后為991.33±81.56ml治療14天后尿量為976.00±83.93ml,在治療7天前有效(P0.05),7天之后,治療無意義(P=0.57)。4.兩組患者治療期間血鉀情況,治療組治療前以及3天、7天、12天、14天相對比,P值依次為0.48、0.319、0.717、0.209,各組之間無統(tǒng)計學差異對照組治療前以及3天、7天、12天、14天相對比,P值依次為0.197、0.00、0.03、0.139,說明對照組在治療第七天時,血鉀情況明顯降低,但仍在正常范圍之內,隨尿量的減少,其血鉀在第12天又有所回升,直至到14天無明顯變化。5.兩組患者治療后證候積分相比較治療組與對照組的證候積分分別治療前后證候積分為19.33±5.99、22.83±7.51,二者進行比較,P=0.017故P0.05,具有統(tǒng)計學意義;兩組患者治療前和治療7天以及治療14天后,中醫(yī)癥狀積分主證的患者數(shù)量變化情況,均提示兩組患者中醫(yī)證候呈遞減趨勢,具有臨床效果,但治療組遞減迅速,效果較對照組更顯著。結論:對于心源性水腫患者應用表里分消法并配合西藥治療效果優(yōu)于常規(guī)西醫(yī)治療方法,本方法對于改善中醫(yī)證候,延長6分鐘步行試驗路程,改善心功能且對于鉀離子影響較小有深刻意義,故發(fā)揚傳統(tǒng)醫(yī)學優(yōu)勢,具有一定臨床研究意義。
[Abstract]:Objective to explore the best treatment for cardiogenic edema by clinical observation.Methods: from December 2014 to December 2015, 60 patients with cardiac edema were randomly divided into treatment group and control group.The control group was treated with traditional cardioversion, diuresis and vasodilatation, while the treatment group was treated with small doses of digitalis and vasodilators. The course of treatment was 14 days. The TCM syndromes and edema were observed before and after treatment in the two groups.The improvement of cardiac function, the increase of urine volume and the change of blood potassium.Results: there was no significant difference in sex, age, TCM syndrome score, body weight, 6-minute walking test of primary disease, blood potassium (P0.05) between the two groups, suggesting that the two groups have comparability. 1.The total effective rate of the treatment group was 90%, and the total effective rate of the control group was 70%. The effect of the treatment group was better than that of the control group. The calculation and comparison showed that P0. 018 and P0. 05 were statistically significant.Before and after treatment, the total effective rate of treatment group was 90 and that of control group was 76. 6%.The treatment group was significantly higher than the control group.The total effective rate of heart function improvement was 933 in the treatment group, 80 in the control group, and significantly higher in the treatment group than in the control group.After 6min walking test, the difference between the treatment group and the control group was 477.33 鹵77.18349.00 鹵62.38, the difference was statistically significant (P 0.05).The urine volume of the two groups showed an increasing trend after treatment. The urine volume of the treatment group was 769.00 鹵120.03ml before treatment and 1141.00 鹵150.82ml after 7 days treatment. After 14 days of treatment, the urine volume was 1158.33 鹵142.90ml.The urine volume of the control group was 759.33 鹵87.41 ml before treatment and 976.00 鹵83.93 ml after 14 days of treatment with 991.33 鹵81.56ml after 7 days of treatment.The status of serum potassium during the treatment of the two groups,Before treatment and 3 days after treatment, the P value of the treatment group was 0.488 鹵0.3190.170.170.209, respectively. There was no significant difference between the control group and the control group before the treatment and the control group had the value of 0.197 / 0.000.0030.030.139before the treatment and the control group was on the 7th day after treatment, and the P value was 0.1970.0.0030.030.139in the control group, and the P value was 0.1970.0.0030.030.139in the control group at the 7th day after treatment.The serum potassium level was significantly decreased, but still within normal range. With the decrease of urine volume, the serum potassium increased on the 12th day, until the 14th day there was no obvious change. 5.The syndromes integral of the treatment group and the control group were 19.33 鹵5.9ng 22.83 鹵7.51 before and after treatment, which were statistically significant before and after treatment, and were compared between the two groups before and after treatment, and the difference was significant between the two groups before treatment, 7 days after treatment and 14 days after treatment.The changes in the number of patients with main syndromes of TCM symptoms indicated that the TCM syndromes of the two groups showed a decreasing trend with clinical effect, but the treatment group decreased rapidly and the effect was more significant than that of the control group.Conclusion: for patients with cardiogenic edema, the curative effect of epidermis and western medicine combined with western medicine is better than that of routine western medicine. This method can improve the syndrome of traditional Chinese medicine and prolong the walking distance of 6 minutes.The improvement of cardiac function has profound significance for potassium ion, so it is of clinical significance to carry forward the advantages of traditional medicine.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R259

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