【作者】 王波；

【导师】 罗翌；

【作者基本信息】 广州中医药大学 ， 中医学， 2008， 硕士

【摘要】 研究目的:急性上呼吸道感染是临床中最常见的一种感染性疾病,据统计,约有70～80%由病毒引起,细菌感染约占20～30%。据广东省中医院急诊科统计,以发热为主要原因就诊的病人占急诊科门诊总数的40%左右。急性上呼吸道感染对大多数人发热只引起发热、疲倦、头痛等不适,但对于免疫力下降的老人或小儿,病毒性上呼吸道感染可能还会引起严重后果,所以有效治疗急性病毒性上呼吸道感染具有重要的临床意义。在治疗上,目前尽管病毒唑,阿西洛韦等抗病毒药物对病毒性急性上呼吸道感染有一定疗效,但特异性较差,尚有某些毒副作用,限制了此类药物在临床上的应用。据现代药理和临床研究,许多清热解毒中药在体外和体内均具有较强的抗病毒作用,其抗病毒疗效肯定,毒副作用小。但目前中药的应用以汤剂为主,服药量大,煎取不方便,针剂又由于工艺等原因,易发生过敏或输液反应,限制了其在临床的广泛应用等,均不能满足患者的需要。针灸疗法是我国传统医学宝库的重要组成部分,在治疗许多急性病症上有快速取效的特点。但传统针刺具有强烈的酸、麻、胀、痛等不适感,大多数人不易接收;有时针刺某些穴位有一定的危险性等,因此限制了传统针灸在临床中的应用,不能广泛推广。新近发展起来的薄氏腹针疗法以其安全、无痛、高效、快捷等优点逐渐受到临床医生的重视。近20余年的临床研究表明,腹针治疗许多急性疾病通常能迅速取效,因此在急诊科的应用价值较大,值得推广。本课题旨在观察薄氏腹针疗法对急性上呼吸道感染发热的退热及其他伴随症状的效应来分析其临床疗效,以推广中医特色技术疗法在急诊的应用,为临床上治疗急性上呼吸道感染提供新途径。本研究从观察薄氏腹针疗法治疗急性上呼吸道感染发热中医辨证属风热犯表,暑湿袭表的临床疗效,确定治疗上呼吸道感染的规范腹针处方。研究方法:采用随机对照的方法,将符合诊断纳入标准的病例按接受治疗的先后分为腹针组和西药组,观察对比腹针治疗外感发热中医辨证属风热犯表,暑湿袭表证的临床疗效,并进行临床安全性评价。研究结果:两组开始退热时间均小于30min,在45min内两组退热速度相当。在第2h时腹针组有3人可完全退热,而西药组有10人,两组比较差异有统计学意义(P＜0.05),提示在此段时间内西药治疗较腹针治疗退热快;在第3h时,腹针组有12例完全退热,西药组有18例完全退热,两组比较差异无统计学意义(P＞0.05),提示治疗2h后两组退热例数开始趋于一致;在3.5h时,腹针组完全退热14例,西药组完全退热21例,两组比较差异无统计学意义(P＞0.05),提示在3.5h内两组完全退热疗效相当。腹针组和西药组退热总有效率分别为80%及92.5%,两组比较差异均无统计学意义(P＞0.05),提示两组总体退热疗效相当;但是在症状改善方面,针刺组治疗前后平均得分差值为11.53+13.37,明显高于西药组8.03±2.59,两组比较,差异有统计学意义(P＜0.05),提示腹针疗法疗对改善症状较好,优于西药治疗。结论:1.腹针疗法对急性上呼吸道感染发热除具有良好的退热效果外,还可以明显改善咽痛、头痛、肢体酸痛等上呼吸道感染症状,综合疗效明显优于西药组;2.腹针针刺操作简便、取穴方便、安全无痛、疗效快捷等作用,值得在急诊中广泛推广。更多还原

【Abstract】 Objective:Acute upper respiratory tract infection is the most common clinical infective disease,and about 70%-80%of it is caused by virus infection,with a proportion of about 40%of the entire outpatients in emergency clinic.Fever, tiredness,headache and other syndromes of the upper respiratory infection influences the daily work and even the life severely.Virus infection usually has a bad effect to the older and children.So the effective therapy on upper respiratory infection has significant clinical meanings.The anti-viral medicines to upper respiratory tract infection such as Amantadine and Ribavirin have their defects like low specificity and many side effects,so the clinical application of these drugs is limited.Modern pharmacology and clinic study datum indicated that traditional Chinese Medicine has an affirmative curative effect on anti-viral field and with fewer side effects. But most of the outpatient in the emergency department got a high temperature, which is in an acute condition and needs to handle promptly.However,the full process of frying makings and drug effect of the Traditional Chinese Medicine takes a long time.Acupuncture treatment therapy is the important component of the traditional medical treasure-house of our country,and has a remarkable and prompt curative effect in treating various kinds of diseases.Acupuncture therapy,especially abdominal acupuncture therapy developed recently is causing attention to the clinician because of its virtues such as easy to operate,with no pain,nice curative effect and safety,so it gradually has an extensively study and clinical application.The clinical research of more than nearly 20 years indicates the abdominal acupuncture therapy fetches curative effect rapidly in treating many acute diseases in clinical practice, so it has a great application value in emergency and is good for popularization. This subject aimed at discussing its clinical curative effect through observing abdomen acupuncture therapy in treating fever and other syndromes caused by acute upper respiratory tract infection.And observe the clinic therapeutic effect of abdominal acupuncture therapy in the treatment of upper respiratory tract infection differentiated of fengrefanbiao syndrome and shushixibiao syndrome,and to confirm the canonical prescription of abdominal acupuncture to acute upper respiratory tract infection.Methods:Using the randomization comparison method to divide the patients who are diagnosed as acute upper respiratory infection into two groups which named abdominal acupuncture therapy（treat group）and western medicine（comparison group）,and observing the results of treatment effect on the patients who are diagnosed as fengrefanbiao syndrome and shushixibiao syndrome in TCM,And evaluating the safety of the abdominal acupuncture therapy.Results:The defervesce time of abdominal acupuncture group and western medicine group are both below 30min;there are 3 patients in acupuncture group and 10 in western medicine group can defervesce to normal on the 2^ndhour with a prominent statistics meanings between them（P＜0.05）,indicating the defervesce rate is faster in western medicine group in the first 2 hours,and there are 12 patients in acupuncture group and 18 in western medicine group can defervesce to the normal level on the 3^rdhour;and there are 14 patients in acupuncture group and 21 in western medicine group can defervesce to the normal level within the observational time（3.5h）but both of the comparisons has no statistics meanings（P＞0.05）;indicating the defervesce rate is equal to each other after the 2^ndhour.The total effective ratio is 80%in acupuncture group and 92.5%in western medicine group and there is no statistics meaning between them,indicating the whole curative effect is equal between the two groups,but in the symptoms,alleviating aspect,the scoring distance fore-and-aft the treatment is 11.53±3.37 in abdominal acupuncture group which is obviously higher than that of western group with a statistics meaning （P＜0.05）,indicating the curative effect of abdominal acupuncture therapy is superior to that of western medicine in the syndrome alleviating aspect. Conclusions:1.Clinical study indicates not only abdominal acupuncture therapy has favorable curative effects on antipyretic aspect but also meliorate the syndromes caused by acute upper respiratory tract infection such as chilly,sore throat,headache,body ache etc.And the comprehend effect of abdominal acupuncture therapy is superior to the western medicine group.2.The abdominal acupuncture therapy is worth popularizing in the emergency department because of its simple manipulation,painlessness, safety and prompt curative effect.更多还原