【作者】 邢建军；

【导师】 段逸群；

【作者基本信息】 湖北中医药大学 ， 中西医结合临床医学， 2010， 硕士

【摘要】 目的：比较除湿胃苓汤加减方联合西药和单纯西药治疗脾虚湿蕴型亚急性湿疹的临床疗效和安全性。拟通过课题研究找到更安全、更有效的治疗湿疹的方法,在临床医疗上能够起到一定的指导作用。方法：所选54例患者均来源于武汉市第一医院皮肤科湿疹专科门诊和病房,符合湿疹诊断标准,通过中医辨证属于脾虚湿蕴证。随机分为治疗组和对照组,治疗组30例,对照组24例。两组在性别、年龄、病程、湿疹面积及严重度指数(EASI)评分上无显著性差异(P>0.05),具有可比性。治疗组口服除湿胃苓汤加减方,1剂/d,分早晚两次服,静脉注射复方甘草酸苷,每次80mg(以甘草酸苷计)加入5%葡萄糖注射液或注射用生理盐水250ml中静脉滴注,1次/d,并口服抗组胺药氯苯那敏片4 mg/次,3次/d,疗程为2w,外用本院制剂复方醋酸曲安奈德软膏或复方氧化锌搽剂。对照组静脉注射复方甘草酸苷并口服抗组胺药氯苯那敏片,用法同治疗组,外用药同治疗组。通过临床有效率、自觉症状瘙痒治疗前后的变化、有效率、不良反应的发生率、复发率方面来进行评定,进行统计学处理,观察除湿胃苓汤治疗脾虚湿蕴型亚急性湿疹的有效性、安全性。结果：1.有效率比较：治疗组痊愈16例,显效10例,好转3例,无效1例,有效率86.67%；对照组痊愈7例,显效8例,好转8例,无效1例,有效率62.50%。治疗组有效率明显高于对照组。两组有效率比较经x2检验,P<0.05,差异有统计学意义,治疗组疗效优于对照组。2.瘙痒评分比较：两组间治疗前比较P>0.05,无显著性差异；两组治疗1周后组内比较P<0.01,具有显著性差异,说明治疗组与对照组治疗前后瘙痒程度均明显减轻；治疗2周后治疗组与对照组比较P<0.05,有显著性差异,说明在瘙痒程度的改善情况方面治疗组优于对照组。3.不良反应发生率比较：治疗组发生4例,不良反应发生率13.33%,对照组发生2例,不良反应发生率8.33%,两组比较经x2检验,P>0.05,差异无统计学意义。4.复发率比较：对治疗组和对照组痊愈患者在完成治疗后进行2周的随访,治疗组16例,复发2例,复发率12.50%,对照组7例,复发2例,复发率28.57%,两组复发率比较：P>0.05,差异无统计学意义。结论：通过本课题的临床观察表明,在西医常规治疗的基础上联用除湿胃苓汤加减方治疗脾虚湿蕴型亚急性湿疹,患者的皮损状况、瘙痒程度等指标得到更好改善,临床应用证实有效、安全,值得推广应用。更多还原

【Abstract】 Objective:Comparison of clinical efficacy and safety of modification of Chushi Weiling Decoction combined with western medicine and western medicine alone cureing Spleen wet Yun subacute eczema. To be adopted by the research to find safer, more effective method of treatment of eczema, to be able to play a guiding role in the clinical. Method:54 patients were selected from Eczema Specialist Outpatient Clinics and wards, Wuhan First Hospital. All patients were met the diagnostic criteria for eczema and belonged of Spleen wet Yun card through the TCM. Patients were randomly divided into treatment group and control group, treatment group,30 cases, in the control group 24 cases. The two groups in gender, age, course of disease, eczema area and severity index (EASI) score was no significant difference (P>0.05), comparable. Treatment group:Oral modification of Chushi Weiling Decoction, day 1, divided into morning and evening to take; SNMC ived,80mg per-use (With the calculation of the amount of Glycyrrhizin), in 250ml of 5% glucose injection or Saline injection,1 time/d; chlorpheniramine oral tablets 4 mg/time,3 times/d, Topical triamcinolone acetonide acetate ointment compound and compound zinc oxide liniment.Control group:SNMC ived while chlorpheniramine oral chlorpheniramine tablets tablets, usage with the treatment group and for external use with the treatment group. Treatment for the 2w.Through effective rate, change of itching symptom before and after treatment, efficiency and the incidence of adverse reactions, relapse rate assessed for statistical analysis to observe the effectiveness, safety.Rusults:1. Effective rate:the treatment group cured 16 cases, effective in 10 cases, improvement in 3 cases, ineffective in 1 case, efficiency rate 86.67%; The control group healed in 7 cases, markedly effective in 8 cases improved in 8 cases, ineffective in 1 case, efficiency rate 62.50%. The treatment group were more efficient than that in control group significantly. Comparing the efficiency of two groups by theχ2test, P<0.05, statistically significant differences; the treatment group were more effective than the control group.2. Comparison of pruritus score:comparison of the scores between the two groups before treatment, (P>0.05),no significant difference;the comparison in the group of the each group after 1 week treatment (P<0.01),the difference was significant, noteing the itching degree of treatment group and control group reduced significantly after treatment; After 2 weeks of treatment the treatment group compared with control group(P<0.05),there was significant difference, indicating the treatment group was better than the control group in the degree of itching improvement.3. The incidence of adverse reactions:the treatment group occurred in 4 cases, the incidence of 13.33%; the control group occurred in 2 cases, the incidence of 8.33%. Comparing the two groups by theχ2test (P>0.05), the difference was not statistically significant.4. Relapse rate:Follow-up of patients cured in treatment group and control group 2 weeks after the completion of treatment. The treatment group 16 cases,2 cases of recurrence, the recurrence rate of 12.50%, control group,7 cases,2 cases of recurrence, the recurrence rate of 28.57%. Relapse rate compared between two groups:P>0.05, the difference was not statistically significant.Conclusion:Clinical observation of the subject shoued that in the treatment of Spleen wet Yun subacute eczema on the basis of conventional treatment combined with modification of Chushi Weiling Decoction, Status of patients with skin lesions, itching indicated of the degree of improvement to be better. Clinical studies proved to be effective, safe and worthy of popularization.更多还原