發(fā)布時(shí)間：2018-09-18 12:22

【摘要】：背景：目前手術(shù)治療甲狀腺疾病在臨床上較為普遍,術(shù)后一部分患者會(huì)造成暫時(shí)性或永久性的甲減,所以術(shù)后給患者服用左甲狀腺素納片(優(yōu)甲樂(lè)),這樣就會(huì)控制住甲減出現(xiàn)的癥狀和(或體征)。但是在臨床中發(fā)現(xiàn),術(shù)后患者由于心理負(fù)擔(dān)、精神壓力等等因素,出現(xiàn)的癥狀不是單純補(bǔ)充甲狀腺素所能改善的。而且甲狀腺激素治療的不良反應(yīng)較多。基于這樣的背景下,探究利用中醫(yī)藥特色,改善術(shù)后甲狀腺功能的恢復(fù),降低外源性甲狀腺素的劑量。目的：觀察優(yōu)甲樂(lè)聯(lián)合中藥溫陽(yáng)湯與單用優(yōu)甲樂(lè)治療在甲狀腺疾病術(shù)后甲減治療療效方面的差異,討論其可能的作用機(jī)理,以便于臨床推廣。資料與方法：收集了2005年01月至2014年12月,于北京中醫(yī)藥大學(xué)東直門(mén)醫(yī)院普外科確診為甲狀腺術(shù)后甲減的60例患者,隨機(jī)分為觀察組和對(duì)照組,每組30例；進(jìn)行回顧性研究分析。對(duì)照組患者采用單純西藥優(yōu)甲樂(lè)治療。而觀察組采用西藥基礎(chǔ)上加中藥溫陽(yáng)湯治療。結(jié)果：1.治療后兩組TSH、FT3、FT4比較,差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.癥狀積分比較：兩組分別進(jìn)行中醫(yī)證候前后療效比較,觀察組治療前積分10.53±2.52,治療后3.60±1.00,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.隨訪2年后服用優(yōu)甲樂(lè)的人數(shù)：對(duì)照組中8例患者多次復(fù)查甲功水平正常,不在服用優(yōu)甲樂(lè),但仍有占隨訪人數(shù)的55%還在服用。而觀察組2年后的服用優(yōu)甲樂(lè)人數(shù)只占本組總隨訪人數(shù)的25%,兩組在統(tǒng)計(jì)學(xué)意義上,存在顯著差異(P0.05)。4.優(yōu)甲樂(lè)服用過(guò)程中,穩(wěn)定劑量所需時(shí)間：觀察組的30例患者,優(yōu)甲樂(lè)劑量穩(wěn)定需要時(shí)間平均不到1個(gè)月。對(duì)照組的30例患者,服藥后穩(wěn)定優(yōu)甲樂(lè)劑量所需時(shí)間相對(duì)較長(zhǎng),波動(dòng)較大,平均需要接近2個(gè)月時(shí)間。說(shuō)明聯(lián)合溫陽(yáng)湯后能減少優(yōu)甲樂(lè)的調(diào)整時(shí)間,對(duì)術(shù)后患者的癥狀和體征及激素水平上都有穩(wěn)定作用。5.資料顯示,在甲狀腺術(shù)后的臨床證候中,以失眠,心悸,情緒低落等癥狀表現(xiàn)較為突出,下肢脛前浮腫,皮膚干燥,記憶力下降表現(xiàn)不突出。結(jié)論：用中西醫(yī)結(jié)合治療甲狀腺疾病手術(shù)后出現(xiàn)的甲減癥狀和(或)體征,其療效明顯優(yōu)于單用西藥治療。說(shuō)明了中醫(yī)藥在治療術(shù)后甲減出現(xiàn)的一系列西藥治療不明顯的癥狀上,如失眠、心悸等,提供了可行的治療方法。溫陽(yáng)湯可以縮短調(diào)整優(yōu)甲樂(lè)劑量的時(shí)間,使患者減少抽血復(fù)查的次數(shù),也減輕患者一部分經(jīng)濟(jì)費(fèi)用。隨訪2年后,觀察組服用優(yōu)甲樂(lè)的人數(shù)明顯少于對(duì)照組,也在一定程度上反應(yīng)了中西藥聯(lián)合對(duì)改善術(shù)后暫時(shí)性甲減的作用效果明顯。其機(jī)理可能與中藥聯(lián)合能夠較快促進(jìn)甲狀腺腺體分泌功能恢復(fù)正常,及通過(guò)中藥分子提高機(jī)體免疫功能有關(guān)。
[Abstract]:Background: at present, surgical treatment of thyroid diseases is common in clinic. Some patients after operation may cause temporary or permanent hypothyroidism. So patients are given levothyroxine after surgery to control symptoms and (or signs) of hypothyroidism. However, it was found that the symptoms of postoperative patients due to psychological burden, mental stress and other factors can not be improved by thyroxine supplementation alone. And thyroid hormone treatment of adverse reactions are more. Based on this background, this paper explores the application of traditional Chinese medicine to improve the recovery of thyroid function and reduce the dose of exogenous thyroxine. Objective: to observe the difference of the curative effect of Youjialao combined with Wenyang decoction and that of Youjia alone in the treatment of thyroid diseases after thyroidectomy, and discuss the possible mechanism of its action, so as to facilitate clinical popularization. Materials and methods: from January 2005 to December 2014, 60 patients diagnosed as hypothyroidism after thyroidectomy in Dongzhimen Hospital of Beijing University of traditional Chinese Medicine were randomly divided into observation group (n = 30) and control group (n = 30). To carry out retrospective study and analysis. The patients in the control group were treated with simple western medicine. The observation group was treated on the basis of western medicine and traditional Chinese medicine Wenyang decoction. The result is 1: 1. After treatment, there was no significant difference in TSH,FT3,FT4 between the two groups (P0.05). Symptom score comparison: two groups were compared before and after TCM syndrome, the observation group before treatment score 10.53 鹵2.52, after treatment 3.60 鹵1.00, the difference was statistically significant (P0.05). 3. After 2 years follow-up, 8 patients in the control group had normal thyroid function and were not taking it, but 55% of the patients were still taking it. The observation group after 2 years of taking Youjia only accounted for 25% of the total number of follow-up, the two groups in statistical significance, there was a significant difference (P0.05). 4. The time needed to stabilize the dose in the course of taking Utrechlor: in the 30 patients in the observation group, the average time to stabilize the dose was less than one month. 30 patients in the control group needed a relatively long and fluctuating time to stabilize the dosage after taking the medicine, and the average time needed was close to 2 months. The results show that the combination of Wenyang decoction can reduce the adjustment time of Youjialao, and has a stable effect on the symptoms and signs and hormone level of the patients after operation. Data showed that the symptoms of insomnia, palpitations and depression were prominent in the clinical symptoms after thyroid surgery, such as lower extremity anterior tibia swelling, dry skin, and poor memory. Conclusion: the treatment of hypothyroidism and / or signs after thyroidectomy with combination of traditional Chinese and western medicine is better than that of western medicine alone. It shows that Chinese medicine provides a feasible treatment method for a series of non-obvious symptoms of hypothyroidism, such as insomnia, palpitation and so on. Wenyang decoction can shorten the time of adjusting the dosage of Youjia Le, reduce the times of blood sampling and recheck, and also reduce the economic cost of the patients. After 2 years follow-up, the number of patients in the observation group was significantly lower than that in the control group, which also reflected to some extent the effect of the combination of Chinese and western medicine on the improvement of temporary hypothyroidism after operation. The mechanism may be related to the rapid recovery of thyroid gland secretory function and the improvement of immune function by traditional Chinese medicine.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類(lèi)號(hào)】：R653

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