【作者】 黄启嘉；

【导师】 金宏柱；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 目的：本课题研究通过系统文献回顾,并进行分析归纳,通过临床研究,进行小儿推拿结合神阙灸对儿童过敏性鼻炎的临床观察,为儿童过敏性鼻炎治疗提供一个行之有效的治疗方案。方法：于2010年3月-2010年12月在台湾嘉光耳鼻喉科诊所筛选符合纳入标准的儿童病例90例。经患者父母及儿童知情同意后,随机分为治疗组、对照1组、对照2组,每组为30例。最后完成病例85例,治疗组28例,对照1组27例,对照2组30例,共计脱落5例。诊断标准按照1997年中华医学会耳鼻咽喉科学分会海口制定的《变应性鼻炎诊断及评定标准》和1995年《中华人民共和国中医药行业标准·中医病证诊断疗效标准》进行。治疗组：对受试儿童进行小儿推拿加神阙灸治疗。小儿推拿1次/2天,神阙灸1次/天,以6天为一个疗程,共计治疗4周。对照1组：行小儿推拿治疗1次/2天,以6天为一个疗程,共计治疗4周。对照2组：口服盐酸左西替利嗪片。1次/天,每次1片(5mg),睡前服用,7天为1疗程,治疗4疗程。观察指标：观察患儿症状分级、体征分级、疗效观察、血清总IgE和安全性检测指标观察结果：(1)治疗4周后,治疗组与对照1、2组疗效无显著差异性。疗程结束3个月后,治疗组疗效优于对照1、2组。(2)三组在治疗4周后,均可明显改善患者喷嚏症状,治疗组优于对照1组,和对照2组无显著性差异。治疗结束后3月,治疗组、对照1组和治疗前相比仍明显改善了患者喷嚏症状,而对照2组疗效不显著,治疗组和对照1组均优于对照2组,治疗组优于对照1组。(3)三组在治疗4周后,均可明显改善患者流涕症状。治疗结束后3月,治疗组、对照1组和治疗前相比明显改善了患者流涕症状,而对照2组和治疗前相比疗效不显著,治疗组和对照1组均优于对照2组,治疗组优于对照1组。(4)治疗4周后,治疗组和对照1组均可明显改善鼻堵症状,而对照2组改善不明显。治疗3个月以后,治疗组和对照1组均优于治疗前,对照2组改善不明显,治疗组优于对照1组。(5)治疗4周后,三组均可明显改善患者鼻痒症状。治疗3个月以后,治疗组和对照1组优于对照2组,治疗组和对照1组优于治疗前,对照2组无改善。(6)三组在症状积分上,治疗4周后,均优于治疗前。治疗结束3月后,治疗组和对照1组均优于治疗前；治疗组和对照1组均优于对照2组；治疗组优于对照1组。(7)治疗4周后,三组在体征等级改善上均优于治疗前。治疗结束后3个月,治疗组优于对照1、2组,对照1组优于对照2组,治疗组和对照1组优于治疗前。(8)治疗4周后,三组均优于治疗前。治疗结束后3月,治疗组优于对照1、2组,对照1组优于对照2组,治疗组和对照1组均优于治疗前。(9)三组在治疗4周后,血清总IgE较治疗前均有改善,治疗组优于对照1、2组,对照1组和对照2组无显著性差异。结论：(1)传统中医方法在改善症状的同时,注重辨证论治从患儿补益脾肺,固护正气,调理患儿体质,扶正祛邪,从而取得疗效。(2)针灸推拿等传统中医非药物治疗方法对小儿过敏性鼻炎具有良好的近期和远期疗效,疗效保持时间长,也可推测针灸推拿对小儿过敏性鼻炎的治疗机制和西药的疗效机制有不同之处。(3)传统针灸推拿方法对患儿免疫机制影响的途径可能有不同之处,作用机制可能是多途径的,这有待进一步研究。其疗效与对患儿的免疫机制产生影响密切相关。更多还原

【Abstract】 Objective:The aim of this study was to review and analyse the effectiveness of integrated therapy of traditional pediatric massage and moxibustion on the’Shenque’ acupuncture point, in treatment of pediatric allergic rhinitis, so as to provide an efficient treatment plan for children with allergic rhinitis.Methods:With the consent from the patients and their parents, a total of 90 pediatric cases who visited and received treatments between March to Decenber 2010 at the Jia Guang Otolaryngological Specialist Clinic were recruited for study. Selection of patients were based on the diagnostic criteria for Atopic Rhinitis set by "Chinese Medical Association of Otolaryngology" in Haikou,1997 as well as "Standards of Professional Practice" and "Standards of Medical Diagnosis and Therapy of Diseases" set by the Traditional Chinese Medical Association, People’s Republic of China, in 1995. Patients were divided into 3 groups, namely, Treatment Group, Control GroupⅠand Control GroupⅡ, based on random selection; with thirty patients in each group. The final patient count was 85, with 28 patients remaining in the treatment group,27 patients in control groupⅠand 30 patients in control group II; with a total dropout count of 5.Patients in the Treatment Group were treated with traditional pediatric massage and moxibustion on the Shenque acupuncture point. Pediatric massage was conducted on alternate days while moxibustion was given on a daily basis for a total of four weeks with 6 days to a treatment course. Patients in the Control GroupⅠreceived traditional pediatric massage on alternate days for a total of four weeks, with 6 days to a treatment course. Patients in Control GroupⅡwere given one tablet of oral Levo-Cetirizine pills, qhs for a total of four weeks with 7 days to a treatment course.Observation parameters:grading was done in accordance to symptoms、body types、reactions to treatment total serum IgE count and laboratory safety and consistency measurements.Results:(1) There was no significant difference in the effect of treatment among Treatment Group, Control GroupⅠandⅡimmediately after 4 weeks of treatment. However, three months after completion of treatment program, the effect of treatment in Treatment Group was superior to that in Control GroupⅠandⅡ.(2) Marked improvement in patients with symptom of sneezing was noted in all 3 groups immediately after 4 weeks of treatment. Results in the Treatment Group were superior to that in Control GroupⅠbut showed no significant difference from the results in Control GroupⅡ. Three months after completion of treatment program, significant improvement persisted in Experimental Group and Control GroupⅠbut no significant improvement in symptom of sneezing was noted in Control GroupⅡas compared to condition prior to treatment. Therefore, the results of treatment in Treatment Group and Control GroupⅠwere superior to that in Control GroupⅡand the results in Treatment Group were superior to that in Control GroupⅠ.(3) Marked improvement in the symptom of running nose was noted in all three groups immediately after 4 weeks of treatment. Three months after completion of treatment program, significant improvement persisted in Treatment Group and Control GroupⅠbut no significant improvement in symptom of sneezing was noted in Control GroupⅡas compared to condition prior to treatment. Therefore, the results of treatment in Treatment Group and Control GroupⅠwere superior to that in Control GroupⅡand the results in Treatment Group were superior to that in Control GroupⅠ.(4) Marked improvement in the symptom of nasal obstruction was noted in Treatment Group and Control GroupⅠwhile no significant difference in symptom was noted in GroupⅡimmediately after 4 weeks of treatment. Three months after completion of treatment program, significant improvement was noted in Treatment Group and Control GroupⅠbut no significant improvement in symptom was noted in Control GroupⅡ, while results in Experimental Group were superior to Control GroupⅠ.(5) Marked improvement in the symptom of nasal pruritis was noted in all three groups immediately after 4 weeks of treatment. Three months after completion of treatment program, results in the Treatment Group and Control GroupⅠwere superior to that in Control groupⅡ. Marked improvement in symptom was noted in Treatment Group and Control GroupⅠbut no significant improvement was noted in Control GroupⅡ.(6) Statistically, all three groups showed improvement in symptoms immediately after 4 weeks of treatment. Three months after completion of treatment program, improvement in symptoms was noted in Treatment Group and Control GroupⅠwhen compared to that before treatment; results in both Treatment Group and Control GroupⅠwere superior to that in Control GroupⅡ; results in Treatment Group were superior to that in Control GroupⅠ.(7) Improvement in body shape was noted in all three groups immediately after 4 weeks of treatment. Three months after completion of treatment program, results in Treatment Group were superior to that in Control GroupⅠ、Ⅱ:results in Control GroupⅠwere superior to Control GroupⅡand improvement was noted in Treatment Group and Control GroupⅠwhen compared to the conditions prior to treatment.(8) Marked improvements were noted in all three groups immediately after 4 weeks of treatment. Three months after completion of treatment program, results in Treatment Group were superior to that in Control GroupⅠandⅡ; results in Control GroupⅠwere superior to Control GroupⅡand improvement was noted in Treatment Group and Control GroupⅠas compared conditions prior to treatment.(9) Stabilization of serum IgE levels was noted in all three groups immediately after 4 weeks of treatment; results in Treatment Group were superior to Control GroupⅠandⅡwhile no significant difference was noted in the results in Control GroupⅠandⅡ.Conclusion:(1) The therapeutic effects of Traditional Chinese Medicine are achieved by emphasizing differential diagnosis, tonifying systemic deficiency, regulation of Qi, strengthening of physical constitution while at the same time achieving an improvement in symptoms. (2) Non-pharmaceutical Traditional Chinese Medical treatments such as Acupuncture and Moxibustion produce good short and long term effect on allergic rhinitis in children and the effects are long lasting. Therefore, it is to be speculated that the mechanism of therapy of Acupuncture and Moxibustion in treatment of allergic rhinitis in children is different from that found in Western Medicine. (3) There may be different mechanisms in which the traditional methods of acupuncture, moxibustion and massage influence the immune system in a pediatric patient and further studies are required. It can be concluded that the curative effects of the traditional methods are closely related to their influences over the immune system in the pediatric patient.更多还原