目的在医学伦理学指导下以同理心干预为对策观察自制中药通痹膏外敷治疗膝骨性关节炎的临床疗效，并探讨其作用机制，为临床护理提供新的思路和方法。方法将该院骨科2014年1月至2015年4月收治的402例膝骨性关节炎伴关节积液患者按入院先后顺序随机分为对照组和联合治疗组，每组201例。对照组采用关节腔抽液、口服盐酸氨基葡萄糖胶囊治疗及常规护理，联合治疗组在此基础上进行关节腔抽液冲洗，外敷中药通痹膏结合同理心干预治疗。采用视觉模拟评分（VAS）、膝骨性关节炎严重指数（KOSI）作为临床观察指标进行疗效评价，分别测定治疗前后膝关节腔积液透明质酸（HA）和白介素-1β亚型（IL-1β）水平，并借此评价伦理学指导下以同理心干预结合通痹膏治疗膝骨性关节炎的疗效。结果治疗4周后联合治疗组VAS[（2.21±0.09）分]、KOSI[（15.21±2.32）分]评分明显好转，HA[（4.39±0.45）mg/L]、总有效率[96.52%（194/201）]明显升高、IL-1β[（28.31±2.44）μg/mL]降低，与对照组[分别为（3.90±0.24）、（25.56±3.29）分，（1.99±0.33）mg/L，88.56%（178/201），（33.50±3.17）μg/mL]比较，差异均有统计学意义（P<0.05）。结论伦理学指导下以同理心干预结合外敷通痹膏治疗膝骨性关节炎疗效显著。作用机制可能是通痹膏吸收后可增加关节腔内HA 合成、抑制IL-1β分泌，结合同理心干预更能提高患者战胜疾病的信心而具有良好的治疗作用。%Objective To observe the clinical efficacy of the empathy intervention as the strategy under the guidance of medical ethics combined with external application of self-made Tongbi Ointment for treating knee osteoarthritis ,and to investigate its mechanism to provide new thinking and method for clinical nursing. Methods 402 patients with knee osteoarthritis compli-cating with hydrarthrosis in our hospital from January 2014 to April 2015 year were randomly divided into the control group and the combined treatment group according to the admission order ,201 cases in each group. The control group used the articular cav-ity drainage,oral Glucosamine Hydrochloride Capsules and routine nursing care,while on this basis the combined treatment group was performed the articular cavity drainage and flushing ,external application of Chinese medicine Tongbi Ointment combined with the empathy intervention therapy. The visual analogue scale(VAS) and index for severity of osteoarthritis(ISOA) were adopted as the clinical observation indicators for evaluating the curative effect. The levels of hyaluronic acid (HA) and interleukin-1 beta subtype(IL-1 beta) of knee articular cavity effusion were measured before and after treatment. Furthermore the curative effect was evaluated by these indexes. Results The VAS and ISOA scores after 4-week treatment in the combined treatment group were sig-nificantly improved[(2.21±0.09) points and(15.21±2.32) points],the HA level and the total effective rate were significantly in-creased[(4.39±0.45)mg/L,96.52%(194/201)],and IL-1βwas decreased[(28.31±2.44)μg/mL],which in the control group were (3.90±0.24)points,(25.56±3.29)points,(1.99±0.33)mg/L,88.56%(178/201) and (33.50±3.17)μg/mL respectively,the differ-ences were statistically significant(P<0.05). Conclusion Implementing the empathy intervention under the guidance of ethics combined with external application of Tongbi Ointment has significant effect for treating knee osteoarthritis and its mechanism may be that the absorption of Tongbi Ointment may increase the HA synthesis in articular cavity ,inhibit the IL-1 beta secretion, which combining with the empathy intervention can increase the patient′s more confidence to overcome the disease ,thus plays a good therapeutic effect.
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