【作者】 唐成；

【导师】 马勇； 张传名；

【作者基本信息】 扬州大学 ， 中医硕士（专业学位）， 2023， 硕士

【摘要】 目的:本研究旨在观察扶阳宣痹汤治疗退行性腰椎管狭窄症(寒湿痹阻型)的临床疗效,评价扶阳宣痹汤对该病患者主要症状的改善情况及对血清炎症因子水平的影响,进一步验证扶阳宣痹汤的有效性与科学性。方法:选取60名寒湿痹阻型退行性腰椎管狭窄症患者为观察对象,将其随机分组为研究组和对照组,每组30例,研究组口服扶阳宣痹汤4周,对照组口服美洛昔康片和甲钴胺片4周。分别在治疗前、治疗2周、4周后对观察对象进行VAS评分记录,在治疗前、治疗4周后对观察对象进行跛行距离评价、中医证候评分、生活质量评分和血清炎症因子指标(IL-1β、hs-CRP、ESR)进行记录,在停药1月后进行VAS评分随访,比较两组在各时间节点的各项观察指标变化情况。结果:两组患者一般资料、各项观察指标在治疗前均无显著性差异。①研究组有效率为89.29%,对照组有效率为66.67%,两组疗效差异具有统计学意义。②VAS评分方面,治疗2周、4周后VAS评分与治疗前相比均有改善,差异具有统计学意义。在治疗2周后,对照组VAS评分显著优于研究组,差异具有统计学意义;治疗4周后,两组VAS评分比较无明显差别,不具有统计学意义。在停药1月后,对照组VAS评分较前有所升高,差异具有统计学意义,研究组VAS评分较前无明显改变,差异无统计学意义;③跛行距离方面,治疗前组间跛行距离比较差异具有显著性。经过4周治疗观察,两组跛行距离与治疗前相比均有明显改善,研究组跛行距离为(637.65±217.25)米,对照组跛行距离为(518.39±180.28)米,研究组跛行距离显著优于对照组,差异具有统计学意义。④单一证候方面,研究组在寒凉感、无力感和重着感的改善情况方面显著优于对照组,具有显著性差异,改善麻木感方面也优于对照组,差异具有统计学意义。⑤SF-36评分方面,两组患者在治疗4周后的SF-36各项评分均高于治疗前,具有显著性差异;研究组的躯体疼痛评分与对照组比较无明显差别,不具有统计学意义,其余SF-36各项评分均明显高于对照组,差异具有统计学意义。⑥血清炎症因子指标方面,两组治疗后血清IL-1β、hs-CRP和ESR水平与治疗前相比均有下降,差异具有统计学意义;两组治疗后各炎症因子水平相当,差异无统计学意义。结论:扶阳宣痹汤能够明显缓解患者间歇性跛行症状,改善寒凉感、麻木感等症状,在抗炎、止痛方面疗效有所改善,但并不显著,整体而言该方治疗有效提高了患者生活质量,疗效持续且平稳,值得在临床进行推广。更多还原

【Abstract】 Objective:The purpose of this study is to observe the clinical efficacy of Fuyang Xuanbi Decoction in the treatment of degenerative lumbar spinal stenosis(cold dampness obstruction type),evaluate the improvement of main symptoms of patients with this disease and the impact of Fuyang Xuanbi Decoction on serum inflammatory factor levels,and further verify the effectiveness and scientific nature of Fuyang Xuanbi Decoction.Methods:Sixty patients with degenerative lumbar spinal stenosis were selected as observation objects,and they were randomly divided into control group and research group,with 30 cases in each group,the control group took oral meloxicam tablets and methylcobalamin tablets for 4 weeks,and the research group took oral Fuyang Xuanbi Decoction for 4 weeks.Before treatment and 4 weeks after treatment,claudication distance evaluation,TCM syndrome scores,quality of life scores,and serum inflammatory factor levels were recorded for the observation subjects.VAS scores were followed up 1 month after drug withdrawal to compare the changes in various scores and serum inflammatory factor(IL-1β、hs-CRP、ESR)levels of the two groups at each time point.Results:There was no significant difference between the two groups before treatment in general information and observation indexes.① The effective rate of the study group was 89.29%,and the effective rate of the control group was 66.67%,and the difference in efficacy between the two groups was statistically significant.②In terms of VAS score,the VAS score after 2 weeks and 4 weeks of treatment was improved compared with before treatment,and the difference was statistically significant.After 2 weeks of treatment,the control group had significantly better VAS scores than the study group,and after 4 weeks of treatment,there was no significant difference in VAS scores between the two groups.After 1 month of discontinuation,the VAS score of the control group was significantly higher than before,and the difference was statistically significant,while the VAS score of the study group did not change significantly compared with the previous one,and the difference was not statistically significant;③ In terms of claudication distance,there was no significant difference in claudication distance between groups before treatment.After 4 weeks of treatment,the limping distance in both groups was significantly improved compared with before treatment.The limping distance in the study group was(637.65±217.25)meters,and the limping distance in the control group was(518.39±180.28)meters.The limping distance in the study group was significantly better than that in the control group,and the difference was statistically significant.④In terms of single syndrome,the study group was significantly better than the control group in the improvement of coldness,weakness and heaviness,and there were significant differences,and the improvement of numbness was also better than that of the control group,and the difference was statistically significant.⑤ In terms of SF-36 scores,the SF-36 scores of the two groups after 4 weeks of treatment were higher than those before treatment,which was significantly different.There was no significant difference in the somatic pain scores in the study group compared with the control group,which was not statistically significant,and the rest of the SF-36 scores were significantly higher than those in the control group,and the difference was statistically significant.⑥In terms of serum inflammatory factors,serum IL-1β,hs-CRP and ESR levels decreased after treatment in the two groups compared with before treatment,and the differences were statistically significant.The levels of inflammatory factors in the two groups were comparable after treatment,and the difference was not statistically significant.Conclusion:Fuyang Xuanbi Decoction can significantly relieve the symptoms of intermittent claudication in patients,improve the coldness,numbness and other symptoms,and improve the efficacy in anti-inflammatory and analgesic aspects,but it is not significant,on the whole,the treatment effectively improves the quality of life of patients,the efficacy is continuous and stable,and it is worth promoting in clinical practice.更多还原