發(fā)布時間：2018-05-15 21:16

  本文選題：前列腺增生癥 + 對照研究��； 參考：《第二軍醫(yī)大學》2016年碩士論文

【摘要】：研究背景:良性前列腺增生癥(benign prostatic hyperplasia,BPH)是中老年男性常見的泌尿外科疾病之一,通常表現(xiàn)為前列腺的體積增大及下尿路癥狀(lower urinary tract symptoms,LUTS)。BPH的治療方法目前主要有保守治療和手術治療兩種,但兩種治療方法均存在很多不足,急需探索更加有效、安全、方便的治療方法。針灸對于緩解下尿路癥狀有很好的療效,但缺乏嚴格的臨床研究結論,治療方法可重復性差,規(guī)范性差,標準化程度低,極大地影響了針灸方法的推廣發(fā)展。目的:探討神闕穴隔鹽灸配合溫針灸治療BPH的有效性和安全性。并通過臨床實驗設計為中醫(yī)針灸療法提供規(guī)范與標準化的治療依據(jù)。方法:采用前瞻性、隨機、對照研究,選取50歲以上良性前列腺增生癥患者作為研究對象,受試者均來自長海醫(yī)院中醫(yī)針灸門診、泌尿科門診就診患者,共觀察90例。采用神闕穴隔鹽灸配合三陰交穴溫針灸治療良性前列腺增生癥為治療組,以單純西藥(非那雄胺組、鹽酸坦洛新緩釋膠囊)組為對照。治療組每日予以針灸治療1次,每周連續(xù)治療5天,休息2天。對照組按常規(guī)劑量每日用藥。以上各組均以4周作為1個療程,3個療程后記錄各組的療效。主要測量指標:前列腺體積、最大尿流率、平均尿流率、國際前列腺癥狀評分、生活質(zhì)量評分、殘余尿量、尿常規(guī)、中醫(yī)癥候、病情輕重分級等。結果:治療組顯愈率66.67%;能明顯改善前列腺增生患者臨床癥狀,殘余尿量改善優(yōu)于西藥,前列腺體積的縮小療效與非那雄胺片相當;起效期短與鹽酸坦洛新緩釋膠囊近似;治療前后臨床主要測量指標(夜尿次數(shù)、I-PSS評分、QOL評分、Qmax、殘余尿量)差異有統(tǒng)計學意義(P0.001),治療效果優(yōu)于或等同于對照組,沒有明顯不良反應。結論:1、神闕穴隔鹽灸配合溫針灸能夠有效緩解良性BPH的臨床癥狀;2、針灸起效較快,患者夜尿次數(shù)減少,明顯改善BPH患者生活質(zhì)量;3、針灸對前列腺體積縮小療效與非那雄胺片相當;4、副作用小,是一種安全的療法。因此,本研究通過臨床對照的方法,證明隔鹽灸配合三陰交溫針灸治療具有針對良性前列腺增生的廣闊前景。
[Abstract]:Background: benign prostatic hyperplasia (BPH) is one of the most common urological diseases in middle-aged and elderly men. At present, the main treatment methods of lower urinary tract symptomsof LUTSU. BPH are conservative treatment and surgical treatment. However, there are many deficiencies in the two treatment methods, so it is urgent to explore more effective and safe treatment methods. A convenient treatment. Acupuncture and moxibustion have good effect on relieving lower urinary tract symptoms, but lack of strict clinical research conclusion, poor repeatability, poor standardization and low standardization of treatment methods, which greatly affect the popularization and development of acupuncture and moxibustion methods. Objective: to explore the efficacy and safety of shenque point salt-separated moxibustion combined with warm acupuncture in the treatment of BPH. And through the clinical experiment design to provide the standard and standardized treatment basis for the acupuncture and moxibustion therapy of traditional Chinese medicine. Methods: a prospective, randomized, controlled study was conducted in 90 patients with benign prostatic hyperplasia (BPH) over 50 years of age. The subjects were all from the clinic of acupuncture and moxibustion of traditional Chinese medicine and the outpatient department of urology of Changhai Hospital. The treatment group of benign prostatic hyperplasia was treated with shenque point salt-separated moxibustion combined with Sanyinjiao point warming acupuncture and moxibustion, and the control group was treated with only western medicine (fenasteride group, Tanluoxin hydrochloride sustained release capsule) group. The treatment group was treated with acupuncture and moxibustion once a day, 5 days a week, rest for 2 days. The control group was treated daily with routine dosage. All the above groups took 4 weeks as a course of treatment. After 3 courses of treatment, the curative effect of each group was recorded. Main outcome measures: prostate volume, maximum flow rate, mean flow rate, international prostate symptom score, quality of life score, residual urine volume, routine urethra, TCM symptoms, severity of the disease and so on. Results: in the treatment group, the apparent recovery rate was 66.67%, the clinical symptoms of the patients with prostatic hyperplasia were significantly improved, the residual urine volume was improved better than that of western medicine, the reduction effect of prostate volume was similar to that of fenasteride tablets, the short effective period was similar to that of Tanluoxin hydrochloride sustained-release capsule. Before and after treatment, there were significant differences in the main clinical measures (nocturnal urine frequency, I-PSS score, QOL score, Qmaxand residual urine volume). The therapeutic effect was better than or equal to that of the control group, and there was no obvious adverse reaction. ConclusionThe salt-separated moxibustion at Shenque point combined with warm acupuncture can effectively alleviate the clinical symptoms of benign BPH, acupuncture and moxibustion can take effect quickly, and the times of nocturnal urine of the patients are decreased. The effect of acupuncture and moxibustion on the reduction of prostate volume is equivalent to that of fenasteride tablets, and the side effect is small. It is a safe treatment. Therefore, this study proved that salt-separated moxibustion combined with Sanyinjiao warming acupuncture has a broad prospect for benign prostatic hyperplasia.
【學位授予單位】：第二軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R246.9

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