【摘要】：目的:客觀地評(píng)價(jià)隔姜灸聯(lián)合溫陽逐水膏穴位貼敷療法治療肝硬化腹水的臨床療效及安全性,明確其治療優(yōu)勢(shì),并初步探討其作用機(jī)理,為該療法的臨床應(yīng)用提供有效依據(jù),且為進(jìn)一步探索新的安全有效的中醫(yī)外治法提供有益參考。方法:選擇符合本研究納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的60例肝硬化腹水患者作為研究對(duì)象,按照患者入組的先后順序及隨機(jī)數(shù)字表原則,以相等的比例將入選患者隨機(jī)分為兩組,即治療組和對(duì)照組各30例。兩組患者分別給予不同的治療措施,對(duì)照組采用肝硬化腹水的西醫(yī)基礎(chǔ)治療聯(lián)合中藥參附仙桂顆�？诜�;治療組在對(duì)照組治療方案基礎(chǔ)上加用隔姜灸聯(lián)合溫陽逐水膏穴位貼敷,兩組均治療2個(gè)療程,10日為1個(gè)療程,隨訪3個(gè)月。觀察兩組治療前后中醫(yī)證候、腹圍、體重、24h尿量、B超探測(cè)下腹水深度、肝功能(TBIL、ALT、AST、ALB)、腎功能(血尿素氮BUN、血肌酐Cr)、電解質(zhì)(血清鉀K~+、鈉Na~+)等指標(biāo)的變化及不良反應(yīng)的發(fā)生情況,并觀察兩組的總體臨床療效及中醫(yī)證候療效,比較兩組有無統(tǒng)計(jì)學(xué)差異。在研究過程中,治療組脫落1例,對(duì)照組脫落2例,故實(shí)際入組人數(shù)為治療組29例,對(duì)照組28例。結(jié)果:1.治療組和對(duì)照組的總有效率分別為93.10%和71.43%。兩組總有效率比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05),表明治療組療效明顯優(yōu)于對(duì)照組。2.兩組患者治療后癥狀積分較治療前均有明顯下降,且治療組較對(duì)照組下降更為顯著,兩組患者治療前后癥狀積分變化比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);另外,兩組患者中醫(yī)證候療效比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。3.兩組患者治療后腹圍、體重較治療前均有明顯下降,24h尿量較治療前均有明顯增加,且治療組較對(duì)照組變化幅度更高,兩組患者治療前后腹圍、體重、24h尿量差值分別進(jìn)行比較,差異均具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組患者治療后肝功能主要指標(biāo)較治療前均有改善,且治療組較對(duì)照組改善更為明顯,經(jīng)統(tǒng)計(jì)分析,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.兩組患者治療后B超探測(cè)下腹水暗區(qū)最大深度較治療前均有明顯減小,且治療組較對(duì)照組減小更為明顯,兩組患者治療前后腹水深度變化比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者治療后腹水分級(jí)較治療前均有改善,且治療組較對(duì)照組改善程度更大,經(jīng)比較具有顯著性差異(P0.05)。結(jié)論:本研究結(jié)果顯示兩組在治療肝硬化腹水方面均有效,但合用隔姜灸聯(lián)合溫陽逐水膏穴位貼敷治療組的療效較常規(guī)中西藥治療的對(duì)照組更顯著,能較大程度地改善患者的癥狀、體征,并能明顯減小腹圍、減輕體重、增加24h尿量、減少腹水量、改善腹水等級(jí),有效地促進(jìn)腹水消退,且在治療過程中及治療后未發(fā)生明顯的不良反應(yīng),安全性較高。說明隔姜灸聯(lián)合溫陽逐水膏穴位貼敷治療脾腎陽虛型肝硬化腹水的療效肯定,值得臨床推廣應(yīng)用。
[Abstract]:Objective: to evaluate objectively the clinical efficacy and safety of ginger-separated moxibustion combined with Wenyangzhushui ointment acupoint application in the treatment of ascites due to liver cirrhosis, to clarify its therapeutic advantages, and to explore its mechanism of action so as to provide an effective basis for the clinical application of the therapy. And to further explore new safe and effective external treatment of Chinese medicine to provide a useful reference. Methods: sixty cirrhotic ascites patients who met the criteria of inclusion and exclusion of the study were randomly divided into two groups according to the order of admission and the principle of random number table. There were 30 cases in the treatment group and 30 cases in the control group. Two groups of patients were given different treatment measures, the control group with liver cirrhosis ascites treated with western medicine combined with Chinese medicine Shenfu Xiangui granule oral; The treatment group was treated with ginger-separated moxibustion combined with Wenyang Zhushui ointment on the basis of the control group. The two groups were treated for 2 courses, 10 days as a course of treatment, followed up for 3 months. The TCM syndromes, abdominal circumference, body weight, 24h urine volume, depth of lower ascites, liver function (TBIL,ALT,AST,ALB), renal function (blood urea nitrogen, BUN, serum creatinine Cr), electrolyte) were observed before and after treatment in both groups. The changes of sodium Na~ and the occurrence of adverse reactions were observed. The overall clinical efficacy and TCM syndromes of the two groups were observed and there was no statistical difference between the two groups. In the course of the study, there were 1 case in the treatment group and 2 cases in the control group, so the actual number of the patients in the treatment group was 29 cases and that in the control group was 28 cases. The result is 1: 1. The total effective rates of treatment group and control group were 93.10% and 71.43%, respectively. The total effective rate of the two groups was significantly higher than that of the control group (P0.05), indicating that the curative effect of the treatment group was significantly better than that of the control group. 2. The symptom scores of the two groups after treatment were significantly lower than before treatment, and the treatment group was more significant than the control group, the difference between the two groups before and after treatment was statistically significant (P0.05). In addition, the two groups of patients with traditional Chinese medicine syndrome efficacy difference was statistically significant (P0.05). After treatment, the abdominal circumference, body weight and 24h urine volume of the two groups were significantly decreased, and the changes of the treatment group were higher than those of the control group, the abdominal circumference and body weight of the two groups were higher than those of the control group before and after treatment. 24 hours urine volume difference were compared, the differences were statistically significant (P0.05). The main indexes of liver function in the two groups were improved after treatment, and the improvement in the treatment group was more obvious than that in the control group. The difference was statistically significant (P0.05). After treatment, the maximum depth of the underlying ascites dark area detected by B-ultrasound in the two groups was significantly decreased compared with that before treatment, and the decrease in the treatment group was more obvious than that in the control group. There was significant difference in the changes of ascites depth between the two groups before and after treatment (P0.05). The ascites grade of the two groups were improved after treatment, and the degree of improvement in the treatment group was greater than that in the control group, the difference was significant (P0.05). Conclusion: the results of this study show that both groups are effective in the treatment of ascites due to cirrhosis, but the curative effect of the treatment group combined with ginger separated moxibustion combined with Wenyangzhushui ointment at acupoint is more significant than that of the control group treated with traditional Chinese and western medicine. It can improve the symptoms and signs of the patients, reduce the abdominal circumference, reduce the weight, increase the urine volume for 24 hours, reduce the quantity of ascites, improve the grade of ascites, and promote ascites to recede effectively. There was no obvious adverse reaction during and after treatment, and the safety was high. The results showed that the curative effect of ginger separated moxibustion combined with Wenyang Zhushui ointment on ascites of liver cirrhosis due to deficiency of spleen and kidney yang was definite and worth popularizing in clinic.
【學(xué)位授予單位】：河南中醫(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)】：R246.1

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