【作者】 陈娟；

【导师】 林俊华；

【作者基本信息】 湖北中医学院 ， 中西医结合临床， 2009， 硕士

【摘要】 目的:亚急性湿疹属于湿疹的一个阶段,多数研究认为,亚急性湿疹是急性湿疹和慢性湿疹病情转换的过渡症状。目前,湿疹在皮肤科较为常见,秋冬好发,占门诊就诊病人总数的10%-15%,也是治愈率较低的一类疾病。中医治疗根据患者的临床表现进行细致的辨证分型,根据症型的不同,使用不同的方剂针对性治疗,对患者的临床症状的改善显著,尤其具有复发率低,不良反应小等优点。虽然中医治疗远期疗效明显,但是近期显效缓慢,不利于增强患者就诊的信心和依从性;现代医学研究多将湿疹归为过敏性疾病,根据病因重点使用抗组胺药物及糖皮质激素类药物内服及外用对症治疗,近期效果明显,但治愈率低,且复发率较高。根据中西医单独治疗的利弊,结合各种文献报道及历代名老中医研究的精华,本课题根据张志礼老先生的方剂加减,自拟健脾祛湿方联合抗阻按药物咪唑斯汀缓释片治疗亚急性湿疹,系统观察其治疗脾虚湿蕴症型亚急性湿疹患者的临床疗效并探讨其机理,旨在寻找一个新的中西医结合治疗方法,增加痊愈率,降低复发机率。研究方法:将符合纳入标准的100例患者随机分入联合用药组、对照组,各观察50例。其中联合用药组给予健脾祛湿方(组方:薏仁黄柏白术炒扁豆枳壳茵陈苦参白鲜皮黄芩泽泻徐长卿。方法:每日一剂,煎水500ml,分2次口服)及咪唑斯汀缓释片(10mg,每天一次,睡前半小时口服);对照组仅给予咪唑斯汀缓释片口服。两组均连续用药28天评定疗效,对于部分痊愈的患者进行痊愈后一月和三月随访,观测二组治疗前后皮损总积分的变化,瘙痒情况以及复发率和不良反应的比较。研究结果:健脾祛湿方联合咪唑斯汀缓释片和单用咪唑斯汀缓释片均能缓解患者症状,治疗28天后总有效率分别达96%及84%,治愈率及痊愈后一月随访,三月随访结果经统计学计算得出均为p＜0.05,有明显差异,联合用药组治愈率及复发率低于对照组。对两组患者进行不良反应追踪,显示联合用药组患者有1例出现胃部不适,不良反应发生率2%。对照组患者有7例嗜睡,1例口干,1例乏力,2例胃部烧灼感、恶心、头晕、3例头疼,不良反应发生率14%,经统计学显示,p＜0.05,有差异,联合用药组不良反应发生率低于对照组.结论:健脾祛湿方联合咪唑斯汀缓释片及单用咪唑斯汀缓释片缓释片均可改善脾虚湿蕴证亚急性湿疹患者临床症状,患者治疗前后的症状积分均有所下降,但健脾祛湿方联合咪唑斯汀缓释片对脾虚湿蕴证患者临床症状的改善优于单用咪唑斯汀缓释片治疗,且副作用小于单用咪唑斯汀缓释片,治疗痊愈后1月、3月随访,联合用药组的复发率远低于对照组,故说明联合用药效果优于单一用药。更多还原

【Abstract】 Objective:Subacute eczema belongs to a subtype of eczema,most research thinks that subacute eczema is an acute eczema and chronic illness conversion between eczema symptoms.Eczema is a common disease of dermatology,the outpatient service of 10-15%total patients with low rate.Traditional medical treats with meticulous syndrome according to the clinical manifestations of patients and different shows of the proprietary with clinical symptoms improved significantly,especially low recurrence rate and small the adverse reaction.Although long-term efficacy is obvious,recent power is lowly,which is bad for the patient’s confidence and compliance. Modern medical thinks that eczema is an allergic disease and uses antihistamines and corticosteroids drugs orally and topical symptomatic treatment according to eczema cause,which is low curing rate and high relapse.According to the advantage and disadvantage of single treatment,combining various reports in the literature and the essence of the old Chinese studies,this study create an own strengthening spleen and dehumidification potion combining antihistamine Mizolastine Sustained release tablets cure subacute eczema according to the potion of ZhangZhiLi with system observation clinical curative effect in order to find an effective treatment method. Research methods:100 patients with criteria were randomized into a treatment group and a control group,each observation of 50 cases. The treatment group was given strengthening spleen and dehumidification potion(component:Chinese Pearl Barley, philodendrons,Largehead AtractylodesRhizome,stir-fried kidney、beansBitter orange、absinthe、radix sophorae flavescentis、dittany、radix scutellariae、rhizoma alismatis、radix cynanchi paniculati.Taking method:fired water 500ml,250ml po bid)and mizolastine Sustained release tablets(1 table po qd,before to sleep);Control group was given mizolastine only.Both groups continuous administration 28 days and interviewed the patients of certain healing effect after one and three months.The two groups were observed before and after the treatment of skin,integral syndrome,and the recurrence rate and adverse reaction.Research results:Using strengthening spleen and dehumidification potion combining antihistamine Mizolastine Sustained release tablets and singly use Mizolastine to improve symptoms for patients,the total effective is 96%and 84% respectively.After recovering from one and three months follow-up results were obtained by statistically calculated p＜0.05,with obvious difference between the treatment group and control group in recurrence.Chinese traditional medicine group appeared one patient stomach,and adverse reaction rate is 2%.Combined treatment group appeared two cases of patients,one somnolence dry mouth and one weakness,and adverse reaction rate 8%.The statistics shows that p＜0.05.Conclusion:strengthening spleen and dehumidification potion combining antihistamine Mizolastine Sustained release tablets and single treatment can improve the clinical symptoms of spleen syndrome subacute eczema,signs of patients before and after treatment were dropped,but strengthening spleen and dehumidification potion combining antihistamine Mizolastine Sustained release tablets for the patients to improved clinical symptoms than single with acute and less side effect than single miaowthiazoleo treatment after recovering from January,3 months of follow-up,the recurrence rate of treatment group is far less than control group according to the random interview afer one and three months,which shows that combination therapy effect is better than the single use therapy.更多还原