【作者】 孙琪；

【导师】 邵瑛；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2019， 硕士

【摘要】 目的:通过观察3-10岁常年性中-重度变应性鼻炎患儿推拿传统组(第二版小儿推拿学鼻炎基本方)、推拿创新组(邵瑛教授通元儿推创新方)、和对照组(孟鲁司特钠西药组)在经过治疗3个月后总鼻症状积分(TNSS)、视觉模拟评分量表(VAS)的对比。验证邵瑛教授通元儿推创新方对小儿变应性鼻炎的有效性及实用性,形成临床推拿治疗小儿变应性鼻炎的新的防治技术。方法:筛选98例符合研究设计要求的小儿变应性鼻炎的病例,将病例按随机化原则分为推拿传统组、推拿创新组、西药组。推拿传统组、推拿创新组小儿进行相应的推拿干预,隔天1次,1周3次,1个月1疗程,共3个月。西药组小儿给与一定剂量的孟鲁司特钠,每天1次,1个月1疗程,共3个月。观察两组小儿干预3个月的总鼻症状积分(TNSS)、视觉模拟评分量表(VAS)。比较三组间的差异,通过统计分析,得出结论。结果:研究共纳入98例,推拿传统组中有3例自行退出,最终完成30例;推拿创新组有2例主动退出最终完成30例;西药组有1例服药过敏退出,2例自行服用他要最终完30例。治疗前三组患儿的年龄构成、性别、发病前主症、次症、体征积分等一般资料无统计学差异,具有可比性。(1)临床有效率方面:经过治疗,三组均有较高的有效率,推拿传统组总有效率90%,显效率为40%;推拿创新组总有效率96.66%,显效率为46.66%;西药组总有效率90%,显效率为33.33%,三组有效率无明显差异。提示小儿推拿传统组、小儿推拿创新组、西药组均能有效改善小儿变应性鼻炎。(2)总鼻症状积分方面:分别对推拿传统组、推拿创新组、西药组患儿治疗前后主要症状积分、体征积分、VAS评分进行比较,均有统计学意义(P<0.05),提示三组治疗均有疗效;对三组症状、体征总分治疗前后差值进行比较,有统计学意义(P<0.05),且推拿创新组在改善患儿鼻塞方面优于推拿传统组,推拿创新组在改善喷嚏、鼻痒、鼻甲方面优于西药组,推拿传统组和西药组比较,无统计学意义(P>0.05),提示两者疗效上无差异。(3)VAS评分方面:三组治疗后VAS评分F=3.09,P=0.05,无统计学意义,说明三组治疗效果无差异。推拿传统组于推拿创新组相比P<0.05,有统计学意义,说明推拿创新组效果优于推拿传统组;西药组与推拿创新组相比P<0.05,有统计学意义,推拿创新组效果优于西药组;推拿传统组于西药组相比无统计学意义,提示两组治疗效果无显著性差异。结论:推拿传统组、推拿创新组、西药组对小儿变应性鼻炎的症状(喷嚏、鼻涕、鼻痒、鼻塞)体征(鼻甲、鼻粘膜)均有缓解作用,但推拿创新组治疗效果最好,有效率达96.66%,推拿传统组和西药组治疗效果无差异,有效率达90%。推拿创新组在改善患儿鼻塞方面优于推拿传统组,推拿创新组在改善喷嚏、鼻痒、鼻甲方面优于西药组,推拿传统组和西药组比较无差异。表明:推拿创新组效果最好,值得在临床上推广。更多还原

【Abstract】 ObjectiveThe total nasal symptom score(TNSS)and visual analogue scale(VAS)of 3-10 year-old children with perennial moderate-severe allergic rhinitis were compared between the traditional tuina group(the second edition of the basic formula for pediatric tuina rhinitis),the innovative tuina group(Professor Shao Ying Tongyuan’s innovative tuina method)and the control group(the montelukast sodium western medicine group)after 3 months of treatment.To verify the effectiveness and practicability of Professor Shao Ying Tongyuan’s innovative tuina method for allergic rhinitis in children,and to form a new prevention and treatment technology of Clinical Tuina for allergic rhinitis in children.MethodsNinety-eight cases of allergic rhinitis in children were selected and randomized into traditional tuina group,innovative tuina group and Western medicine group.Children in the traditional group and innovative group were given corresponding tuina intervention once every other day,three times a week and one month as a course of treatment for 3 months.The children in the western medicine group were given a certain dose of montelukast sodium once a day for one month as a course of treatment for three months.The total nasal symptom score(TNSS)and visual analogue scale(VAS)were observed in the two groups after 3 months of intervention.Compare the differences among the three groups,and draw conclusions through statistical analysis.ResultNinety-eight cases were included in the study.Three of them quit by themselves in the traditional tuina group and finished 30 cases in the final;two of them quit voluntarily and finished 30 cases in the innovative tuina group;one of them quit with allergy to drugs in the western medicine group and two of them took other drugs by themselves,and finally 30 cases were finished.Before treatment,there werw no significant differences in age composition,sex,main symptoms,secondary symptoms and signs scores among the three groups,and there was comparability.Clinical efficiency:After treatment,the three groups have higher efficiency,the total effective rate of traditional tuina group is 90%,the marked efficiency is 40%;the total effective rate of innovative tuina group is 96.66%,the marked efficiency is 46.66%;the total effective rate of Western medicine group is 90%,the marked efficiency is 33.33%,and there is no significant differences among the three groups.It is suggested that traditional tuina group,innovative tuina group and oral montelukast sodium chewable tablet group can effectively improve allergic rhinitis in children.Total nasal symptoms score(traditional tuina group,innovative tuina group,western medicine group):compared with traditional tuina group,innovative tuina group and Western medicine group before and after treatment,the main symptoms score,signs score and VAS score were statistically significant(P<0.05),suggesting that all three groups have curative effect;the difference of the total scores of symptoms and signs between before and after treatment in the three groups was statistically significant(P<0.05),and Shao’s innovative group were better than the basic group in improving nasal obstruction,and Shao,s innovative group was better than the western medicine group in improving sneezing,nasal itching and turbinate.There were no significant differences between the basic group and the western medicine group(P>0.05),suggesting that there were no significant differences in the curative effect between the two groups.VAS score:VAS score F=3.09,P=0.05 after treatment in the three groups,there was no statistical significance,indicating that there were no differences in the treatment effect of the three groups.Compared with the traditional tuina group,the traditional tuina group had statistical significance(P<0.05),indicating that the effect of the innovative tuina group was better than that of the traditional tuina group;compared with the innovative tuina group,the western medicine group had statistical significance(P<0.05),and the innovative massage group had better effect than the western medicine grouP;the traditional tuina group had no statistical significance compared with the western medicine group,suggesting that there were no significant differences in the therapeutic effect between the two groups.ConclusionTraditional tuina group,innovative tuina group and Western medicine group all alleviated the symptoms(sneezing,runny nose,itchy nose,nasal obstruction)and signs(concha,nasal mucosa)of allergic rhinitis in children,but the innovative tuina group had the best therapeutic effect,the effective rate was 96.66%.There were no differences between traditional massage group and Western medicine group,the effective rate was 90%.The innovative tuina group was superior to the traditional tuina group in improving nasal obstruction,while the innovative tuina group was superior to the western medicine group in improving sneezing,nasal itching and turbinate.There was no difference between the traditional tuina group and the western medicine group.The results showed that the effect of tuina innovation group was the best,and it was worth popularizing in clinic.更多还原