【作者】 刘立群；

【导师】 李丽霞；

【作者基本信息】 广州中医药大学 ， 中医学， 2012， 硕士

【摘要】 研究目的：本课题将通过不同干预措施,观察火针与西药在治疗带状疱疹急性期的临床疗效及免疫指标CD4、CD8差异。从而验证火针在治疗带状疱疹急性期的临床疗效。为临床治疗带状疱疹提供一种有效、安全的治疗手段。研究方法：1.本研究采用前瞻性随机对照试验的研究方法,收集2011年1月至2012年4月广州市中医院针灸科住院部带状疱疹患者。2.将符合纳入标准的受试者60例分为治疗组与对照组两组,其中火针治疗组30例,西药对照组30例。3.治疗方法：(1)火针治疗组：穴位选取病变皮损局部阿是穴、与皮损局部相对应的患侧夹脊穴(病变相应神经节段及上下各一节段)及双侧的支沟穴和后溪穴。患者取卧位,在已选阿是穴上用艾尔碘消毒,点燃酒精灯,左手持酒精灯,右手持中粗火针在酒精灯的外焰加热针体,直至将针尖烧至红白后,迅速准确地刺入疱疹中央约0.2-0.3cm,根据疱疹数量的多少,先刺早发的疱疹,每次选择3-5个,每个疱疹针刺2次,术毕挤出疱液,按压约30秒钟,涂上一层万花油。取患侧的夹脊穴,在穴位上涂上一层薄薄的万花油,用细火针浅刺约0.1cm。取双侧的后溪穴及支沟穴,在穴位上涂上一层薄薄的万花油,用细火针浅刺约0.1cm。每日1次,10次为1个疗程,共计1个疗程。(2)西药对照组：服用药物盐酸伐昔洛韦300mg/次,2次/日；维生素B1：口服：10mg,3次/日。4.治疗结束后观察两组疱疹评分,疼痛评分,血清中免疫指标CD4、CD8水平变化,后遗神经痛的发生率及安全性评价等指标。研究结果：1.一般资料：共完成病例60例,分为治疗组30例,对照组30例,两组在年龄构成及性别构成均无统计学差异(P>0.05),两组具有可比性。2.治疗效果：火针组治愈20例,好转10例,无效0例,有效率100%；西药组治愈7例,好转22例,无效1例,有效率96.7%。(P<0.05)说明火针疗效优于西药。3.疱疹评分：在治疗措施干预前两组的疱疹评分无统计学差异(P>0.05),两组资料具有可比性。治疗组与对照组治疗后的疱疹评分进行比较(P<0.05)。说明火针在促进疱疹结痂、愈合、脱痂方面,火针疗效更优。4.VAS评分：在治疗措施干预前两组的疼痛评分无统计学差异(P>0.05),两组具有可比性。火针组与西药组疼痛评分治疗后比较(P<0.05),有统计学意义。说明火针在减轻带状疱疹急性期疼痛方面优于西药。5.CD4和CD8：治疗前两组的CD4、CD8及CD4/CD8水平差别无统计学差异(P>0.05),两组具有可比性。火针组与西药组治疗后CD4、CD8及CD4/CD8比较(P<0.05),有统计学意义。说明火针在改善免疫方面优于西药。6.后遗神经痛的发生率：两组经过治疗后,后遗神经痛的发生率相比较,有统计学意义(P<0.05)。结论：火针在治疗带状疱疹急性期中,对于缩短疱疹的结痂时间,减轻急性期疼痛,减少后遗神经痛的发生上,较西药的疗效更为明显、确切、安全且副作用小。更多还原

【Abstract】 Objective:The task through different interventions methods to observe the differences between fire needle and western medicine in the treatment of herpes zoster acute phase of clinical efficacy and immune index of CD4, CD8. Verify the efficacy in the treatment of herpes zoster acute phase with the fire needle. Provide an effective and safe treatment for the clinical treatment of herpes zoster.Methods:The prospective randomized controlled study collected60patients from the Acupuncture Department of Guangzhou Hospital of Traditional Chinese Medicine during January2011to April2012. The patients were randomly divided into treatment group and comparison group. Which were divided into fire needle therapy group (30cases) and the comparison group (30cases). There are14cases of male,16cases of female. Aged18-69, the average age of the group is44.33years old. In the western medicine group, there are12cases of male,18cases of female. Aged18-70, average43.63years.Methods of operation:1. Fire needle treatment group:(1)Acupuncture points selected lesions local ashi points, the local lesions corresponding to the ipsilateral Jiaji points (lesion corresponding nerve segment and up and down the one above) and Zhigou points (SJ6) and Houxi points (SI3).(2) Fire the needles in the outer flame heating above alcohol lamp. Then pick the fair needle into the center of the piercing herpes quickly and accurately about0.2-0.3cm. According to the number of the herpes, select3-5points of the early onset of herpes. And press out of the blister fluid about30seconds. Then pick the fire needles into Houxi Points and Zhigou points in this way. The treatment above should be arranged once a day,10times as a course of treatment.2. Western medicine:Famciclovir:300mg per time,2times per day and vitaminBl:10mg per time,3times per day. Observed the herpes score, the skin lesions subsided and the pain score, pain relief, time, pain relief, and serum immune parameters of CD4and CD8levels, the incidence of postherpetic neuralgia and safety evaluation of indicators after the treatment.Results:1. General information:Completed60ases divided into treatment group30cases and control group30cases. The two groups in age composition and sex were not statistically different (P>0.05), two groups were comparable.2Effect after treatment:20cases were cured,10cases improved,0cases are invalid, the efficiency is100%. In western medicine group,7cases were cured,22cases improved,1cases are invalid, the efficiency is96.7%.(P<0.05) fire-needle therapy efficacy is superior to Western medicine.3. Herpes score:Two groups before intervention measures in the treatment of herpes zoster scores showed no significant difference (P>0.05). The treatment group and the control group after treatment of herpes score for comparison (P<0.05). Description of acupuncture in promoting simplex crusted, healing, fire-needle therapy efficacy is superior to Western medicine.4. VAS score:Two groups before intervention measures in the treatment of pain scores showed no significant difference (P>0.05), the two groups were comparable. Acupuncture group and Western medicine group pain score after treatment (P<0.05), with statistical significance. Description of fire-needle in alleviating acute herpes zoster is superior to Western medicine.5. CD4and CD8before treatment in two groups:CD4, CD8and CD4/CD81evel difference is no statistical difference (P>0.05), the two groups were comparable. Fire needle group and Western medicine group after treatment with CD4, CD8and CD4/CD8(P<0.05), with statistical significance. Description of fire-needle in improving immune is superior to Western medicine.6. The incidence of post herpetic neuralgia:two groups after treatment, the incidence of post herpetic neuralgia compared, statistically significant (P<0.05).Conelusion:Fire needle in the acute treatment of herpes zoster midterm shortening herpes scab time to alleviate the acute pain, reduce the incidence of post herpetic neuralgia, compared with the efficacy of western medicine is more obvious, the precise, safe and side effects.更多还原