中医外治治疗糖尿病足溃疡的临床研究

【作者】 王长璐；

【导师】 杨博华；

【作者基本信息】 北京中医药大学 ， 中医外科学， 2008， 硕士

【摘要】 目的以中医外治法辩证治疗疮疡的思想为指导,根据糖尿病足溃疡创面的具体情况辨证分期治疗,与西药组作对照,通过观察对糖尿病足溃疡创面的治疗作用,初步阐述其作用机理及中医辩证外治对促进糖尿病足溃疡愈合的结果。方法采用随机分组对照法。将符合入选标准的糖尿病足溃疡患者60例分为西药组(依沙丫啶)30例,中药组30例。控制血糖,抗感染,改善循环及并发症的处理方法一致,局部治疗先根据创面具体情况辨证分型,进行分别进行常规换药,西药组使用依沙丫啶,中药组气虚血瘀证使用祛腐生肌膏、湿热蕴结证使用溃疡油,疗程为28天。对比两组患者患足创面的变化情况,并在治疗前、后测量患足创面周围的经皮氧分压、创面分泌物的酸碱度、治疗前后查血液C-反应蛋白、血浆内皮素值。结果:结果显示:中药组有效率86.2%,显愈率65.5%,其中气虚血瘀证有效率73.3%,显愈率46.7%,湿热蕴结证有效率100%,显愈率85.7%;西药组有效率60.7%,显愈率39.3%,其中气虚血瘀证有效率27.3%,显愈率9.1%,湿热蕴结证有效率82.4%,显愈率58.8%。中药组总有效率优于西药组(P﹤0.05),中药组湿热蕴结证的有效率优于气虚血瘀证(P﹤0.05),西药组湿热蕴结证的有效率明显高于气虚血瘀证(P﹤0.01),中药组气虚血瘀证有效率优于西药组气虚血瘀证。检测结果显示:PH值治疗前后比较:西药组气虚血瘀证明显改善(P﹤0.05),其余各组均有非常明显改善(P﹤0.01),治疗前各组无明显差别,治疗后中药气虚血瘀证组明显优于西药气虚血瘀证组(P﹤0.01),其余各组比较无明显差异;经皮氧分压治疗前后比较:西药组气虚血瘀证无明显差异(P﹥0.05),各组均有非常显著差异(P﹤0.01),治疗前比较:两组气虚血瘀证与湿热蕴结证均有非常明显差异(P﹤0.01),治疗后比较:中药组与西药组无明显差异,其余各组均有非常明显差异(P﹤0.01)。结论中医辩证外治糖尿病足溃疡,对促进创面的愈合,改善疼痛症状明显优于西药。应用中医辩证外治糖尿病足溃疡在改善局部微循环、溃疡面环境方面,有良好的作用。中医外治根据创面的具体情况进行辨证分期,药物直达病所,加快了创面的愈合,发挥了中医辨证论治的优势。更多还原

【Abstract】 Objective To External TCM treatment Sores dialectical thinking as a guide, in accordance with diabetic foot ulcers face into the specific circumstances of Qi blood stasis, hot and humid Wenjie cards were given cured rot S hengji extract, local oil dressing ulcer treatment, and in accordance with sand Centre(LEI Vonore) for the control group, and by observing its diabetic foot ulcer treatment, initially on its mechanism.Methods A randomized control law. The selected standards will be consistent with diabetic foot ulcer patients divided into two groups of 60 cases (depending on the sand Centre) 30 cases (13 cases Qi blood stasis, hot and humid Wenjie card 17 cases), the Chinese group of 30 patients (Qi blood stasis - Qu fu Shengji Plaster, 16 cases of hot and humid Wenjie card - 14 cases of ulcer oil). Conventional dressing separately, on a course of treatment. Contrast two groups of patients suffering from changes in the foot wound, and before and after treatment with adequate measurement sore weeks percutaneous oxygen, pH wound exudates, check blood before and after treatment of C-reactive protein, plasma endothelin levels.Results:The results showed that:①Clinical efficacy, the efficiency of traditional Chinese medicine group, 86.2%, 65.5% of the more significant, Qi blood stasis efficient 73.3%, significantly the rate of 46.7%, hot and humid Wenjie permit effective rate of 100%, which was the rate of 85.7%; WM group efficiency 60.7%, 39.3% of the more significant, Qi blood stasis efficient 27.3%, significantly the rate of 9.1 per cent, hot and humid Wenjie permit efficient 82.4%, significantly the rate of 58.8%. The total efficiency of traditional Chinese medicine is better than medicine group (P <0.05), the Chinese Medicines Board Hygrothermal Wenjie permit efficient than Qi blood stasis (P <0.05), the WM group Hygrothermal Wenjie permit efficient blood was significantly higher than that Qi Stasis Card (P <0.01), the Chinese Medicines Board Qi blood stasis efficient than WM group Qi blood stasis.②Wound PH value and percutaneous oxygen, PH value compared before and after treatment: Western medicine group Qi blood stasis improved significantly (P <0.05), the other groups are very significantly improved (P <0.01), the treatment There was no significant difference between treatment after Chinese Qi blood stasis was better than Western medicine Qi blood stasis group (P <0.01) and the rest of the group there was no significant difference; percutaneous oxygen before and after treatment comparison: western medicine group Qi blood stasis Permit no significant difference (P> 0.05), each group there was a significant difference (p <0.01), before treatment: two blood stasis and Qi Wen Jie cards are very hot and humid significant difference (p<0.01). , and after treatment: traditional Chinese medicine and western medicine group was no significant difference between the other groups are very significant difference (p<0.01).Conclusion Chinese medicine governance diabetic foot ulcers TCM Differential Treatment is the guiding ideology, according to the specific circumstances of the wound Differentiation stage, the use of different drugs for treatment of partial dressing to the drug directly to the wound, drug Direct disease has good Qu rot Shengji, acidification wound, improve microcirculation, and promote the growth of granulation tissue effects, thereby speeding up the healing of wounds. Play to the advantages of the TCM Differential Treatment.更多还原