中医治疗慢性荨麻疹90例临床观察论文_赵云慧

哈尔滨仁济中医门诊部 黑龙江 哈尔滨 150000

摘要:目的:根据前期临床调查研究总结出的慢性荨麻疹证候规律,结合中医时间医学相关理论和心理、生活方式等相关影响因素,制定以“调和营卫”方药为主,中医时间医学干预、健康教育为辅的昼夜节律性发作的慢性荨麻疹中医综合治疗方案;并通过临床试验探讨其对改善患者临床症状,降低复发率的作用。方法:制定慢性荨麻疹中医综合治疗方案,临床研究选取慢性荨麻疹患者90例,随机分为试验组和对照组,其中试验组45例,给予中医综合治疗方案;对照组45例,给予西药治疗。治疗期4周,观察患者治疗前后主客观症状变化,并随访4周,观察两组的复发率。结果:试验组痊愈10例,显效20例,有效10例,无效5例;对照组痊愈10例,显效12例,有效8例,无效15例,治疗后两组症状均有改善,试验组优于对照组,差异有统计学意义(P<0.05)。疗程结束1月后,试验组复发2例(4.44%),对照组复发5例(11.11%),试验组复发率低于对照组,差异有统计学意义(P<0.05)。结论:以“调和营卫”方药为主,中医时间用药、健康教育为辅的中医综合治疗方案对昼夜节律性发作的慢性荨麻疹临床症状改善及降低复发率均有较好的作用,但其远期疗效及对患者生活质量的改善有待通过进一步临床观察来验证和阐明。

关键词:慢性荨麻疹;中医药 治疗 效果

Clinical observation on 90 cases of chronic urticaria treated with traditional Chinese medicine

Abstract: objective: according to the preliminary clinical study sums up the law of syndrome of chronic urticaria, combining with the relevant theory and psychological time medicine of traditional Chinese medicine, way of life and related factors of set to "reconcile the camp who" give priority to, the formulas of traditional Chinese medicine medical intervention, health education as the auxiliary time of the onset of chronic circadian rhythm sex urticaria integrated treatment of traditional Chinese medicine;And through clinical trials to explore its effect on improving patients' clinical symptoms and reducing the recurrence rate.Methods: a comprehensive treatment program of traditional Chinese medicine for chronic urticaria was developed. 90 patients with chronic urticaria were randomly divided into the experimental group and the control group in the clinical study. 45 patients in the experimental group were given a comprehensive treatment program of traditional Chinese medicine.45 patients in the control group were treated with western medicine.The patients' subjective and objective symptoms were observed before and after the treatment for 4 weeks, and the recurrence rates of the two groups were observed during the follow-up for 4 weeks.Results: in the experimental group, 10 cases were cured, 20 cases were obviously effective, 10 cases were effective and 5 cases were invalid.In the control group, 10 cases were cured, 12 cases were obviously effective, 8 cases were effective, and 15 cases were ineffective. After treatment, symptoms in both groups were improved, and the experimental group was superior to the control group, with statistically significant differences (P < 0.05).One month after the end of the treatment course, there were 2 cases of recurrence in the experimental group (4.44%), and 5 cases of recurrence in the control group (11.11%). The recurrence rate in the experimental group was lower than that in the control group, and the difference was statistically significant (P < 0.05).Conclusion: in order to "reconcile the camp who" give priority to, the formulas of TCM drugs, health education as the auxiliary time of comprehensive treatment of traditional Chinese medicine for the onset of chronic circadian rhythm sex urticaria clinical symptoms improved and reduce the recurrence rate has a good effect, but the long-term curative effect and to improve patients quality of life yet to be proved by further clinical observation and clarify.

Keywords: chronic urticaria;Therapeutic effect of traditional Chinese medicine

前言:荨麻疹是一种常见的变态反应性疾病,俗称“风疹块”,是由于皮肤、黏膜小血管反应性扩张及渗透性增加而产生的一种局限性水肿反应。慢性荨麻疹表现为皮肤反复发生风团伴剧烈瘙痒,持续6周以上[1]。因其病因与发病机制复杂,约四分之三的患者不能找到病因,故治疗上颇为棘手。该病发病率高,病程长,患者心身症状突出加之无特异性有效防治措施,常迁延不愈,给病人的工作和生活带来许多不便和负面影响,容易导致心理障碍,严重影响患者生存质量,也加重了社会经济负担。笔者从2017年6月至2018年6月在内科病房及门诊以中医辨证论治方法治疗慢性算麻疹90例,效果较满意,现总结报道如下。

1、一般资料与方法

1.1一般资料

两组共计90例,均为确诊的慢性荨麻疹患者。其中男性患者45例(50.00%),女性患者为45例(50.00%),平均年龄35岁,最大59岁,最小19岁,平均病程4月,最长9月,最短1.5月。试验组45例,男性20例,女性25例,年龄(33.73±9.824)岁,病程(3.91±1.822)月;对照组45例,男性25例,女性20例,年龄(36.97±10.540)岁,病程(4.13±2.094)月,两组在性别、年龄、病程等一般资料方面经检验差异均无统计学意义(P>0.05),具有齐同可比性。

1.2方法

根据本课题的特点,结合中医治疗慢性荨麻疹的前期临床观察及相关临床研究文献[2],每组至少需纳入病例45例,考虑到失访和脱落等因素的影响,设计纳入病例共90例,其中试验组和对照组各45例。最终本研究共收集病例90例,其中试验组45例;对照组45例。

试验组予以桂枝汤加减方为主,配合健康教育、中医时间医学干预的慢性荨麻疹中医综合治疗方案,对照组给予赛庚啶+氯雷他定+西咪替丁联合疗法。治疗期均为4周,随访4周。试验组服用桂枝汤加减方,每日一剂,每剂水煎2次,取汁300ml,分早晚二次温服,每次150ml。同时给予中医时间医学干预和健康教育治疗期间停用其它一切药物。对照组给予三联疗法,即:盐酸赛庚啶片+氯雷他定胶囊+西咪替丁片联合疗法。盐酸赛庚啶片,规格:2mg,用法:1次2mg,每日1次;氯雷他定胶囊(深圳海王药业有限公司),规格:10mg,用法:1次10mg,每日1次;西咪替丁片(天津太平洋制药),规格:200mg,用法:1次200mg,每日2次。治疗期间停用其它一切药物。疗程:试验组和对照组均连续治疗4周为一个疗程,一个疗程后观察患者临床症状及疗效,并随访4周,观察复发率,最后进行统计分析。

观察并记录患者治疗前后的瘙痒程度、风团数目、风团大小、发作持续时间。症状评分标准参考欧洲MILOR的研究[3],按0-3级标准对慢性荨麻疹患者临床症状评分,并制定相关调查表,详见表1。

2、结果

试验组治疗慢性荨麻疹45例,临床痊愈10例,显效20例,有效10例,无效5例,有效率为88.89%;而对照组治疗慢性荨麻疹45例,临床痊愈10例,显效12例,有效8例,无效15例,有效率为66.67%。经检验,二组差异有统计学意义。

3、结论

应用SPSS17.0统计程序对数据进行统计学分析,根据观察指标和数据的不同,,组内治疗前后的症状评分比较采用配对t检验,组间评分比较比较采用两组独立样本资料的t检验;计数资料采用卡方检验;等级资料采用秩和检验。均以α=0.05为检验水准。

荨麻疹(Urticaria)是一种常见的变态反应性疾病,俗称“风疹块”,是由于皮肤、黏膜小血管反应性扩张及渗透性增加而产生的一种局限性水肿反应。将慢性荨麻疹诊断标准由过去的“瘙痒性风团持续发作二月以上”修订为“持续 6 周以上,少数患者也可表现为间歇性发作,每周至少发作两次,持续至少 6

周”。该病发病率高,病程长,患者心身症状突出且无特异性有效防治措施,常迁延不愈,给病人的工作和生活带来许多不便和负面影响,容易导致心理障碍,严重影响患者生存质量,也加重了社会经济负担。近年来新疆地区荨麻疹患病率有明显增加趋势,如何有效控制病情,消除或减轻症状的同时,解除由于持续发病、严重瘙痒、长期用药导致的心理损害,维护患者心身健康,科学合理控制饮食、心理等相关诱导因素和进行健康评价,是慢性荨麻疹防治中尤为重要的问题。 本课题在慢性荨麻疹临床证候学与病机理论研究基础上,针对慢性荨麻疹“两峰值”发病特点,典型心身症状和“营卫失调”病机提出提出以调和营卫法为主,联合中医时间医学干预及健康教育手段治疗昼夜节律性发作的慢性荨麻疹的中医综合治疗方案,为临床寻求慢性荨麻疹最佳治疗方案和有效方药的筛选提供了依据。本临床研究结果显示,桂枝汤加减方联合中医时间医学干预、健康教育的中医综合治疗方案治疗昼夜节律性发作的慢性荨麻疹取得较好的临床疗效,在改善临床症状及降低复发率方面均有较好的作用,且无明显毒副作用,能针对其营卫失调之基础病机,及疾病特点、发病因素、健康危害等,抓住疾病本质,提高临床疗效。

参考文献

[1]中华医学会皮肤性病学分会.荨麻疹诊疗指南(2007版)[J].中华皮肤科杂志,2017,40(10):591-593.

[2]杨唯,石得仁.乌鲁木齐市门诊初诊24183例皮肤病统计报告[J].中国皮肤性病学杂志,2016,15(5):327-329.

[3]荨麻疹发生和环境因子[J].日本医学介绍.2015,13(10):465.

论文作者:赵云慧

论文发表刊物:《中国结合医学》2019年第03期

论文发表时间:2019/5/15

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中医治疗慢性荨麻疹90例临床观察论文_赵云慧
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