目的：观察甲氨蝶呤联合强的松治疗类风湿关节炎( RA )的效果和并发症，并探讨护理策略。方法选取2012年1月至2013年10月收治的RA患者100例，随机分为观察组和对照组，各50例。对照组应用甲氨蝶呤治疗，观察组应用甲氨蝶呤联合强的松治疗。观察两组患者的疗效，治疗后平均红细胞沉降率（ESR）、C蛋白反应（CRP）、类风湿因子（RF），平均晨僵、握力及不良反应。结果观察组显效率为44.00%，明显高于对照组的34.00%( P﹤0.05)；观察组无效率为4.00%，明显低于对照组的12.00%( P﹤0.05)；观察组治疗后晨僵（2.21±0.08）h，明显低于对照组的（2.57±0.10）h ( P﹤0.05)；观察组治疗后握力为（12.85±0.41）kPa，高于对照组的（10.69±0.58）kPa ( P﹤0.05)；观察组治疗后平均ESR，CRP，RF滴度分别为（24.36±0.93）mm/h，（11.22±0.48）mg/L，11.53±0.40，均明显低于对照组治疗后的（28.71±1.48）mm/h，（13.15±0.50）mg/L，14.07±0.68( P﹤0.05)。两组主要不良反应发生率比较，无统计学差异。结论甲氨蝶呤联合强的松治疗RA疗效显著，患者的症状和主要指标均有明显改善，合理的护理措施亦有助于患者病情的缓解。%Objective To observe the effect and complications of methotrexate combined with prednisone in treating rheumatoid arthritis ( RA ) and to discuss the nursing strategy. Methods 100 cases of RA treated in our hospital from January 2012 to October 2013 were selected and randomly divided into the observation group and the control group, 50 cases in each group. The control group used the methotrexate therapy, while the observation group adopted the therapy of methotrexate combined with prednisone. The curative effects after treatment, average ESR, CRP, RF, average morning stiffness, griping power and adverse reactions were observed in the two groups. Results The significantly effective rate of the observation group was 44. 00%, which was higher than 34. 00% in the contorl group ( P﹤0. 05 );the ineffective rate of the observation group was 4. 00%, which was lower than 12. 00% of the control group ( P﹤0. 05 );the morning stiff-ness after treatment in the observation group was ( 2. 21 ± 0. 08 ) h, which was lower than ( 2. 57 ± 0. 10 ) h in the control group ( P﹤0. 05 );the gripping power of the observation group was ( 12. 85 ± 0. 41 ) kPa, which was higher than ( 10. 69 ± 0. 58 ) kPa of the control group ( P﹤0. 05 );the average ESR, CRP and RF of the observation group were ( 24. 36 ± 0. 93 ) mm/h, ( 11. 22 ± 0. 48 ) mg/L and 11. 53 ± 0. 40 respectively, which were lower than ( 28. 71 ± 1. 48 ) mm/h, ( 13. 15 ± 0. 50 ) mg/L and 14. 07 ± 0. 68 of the control group ( P﹤ 0. 05 ) . The major adverse reactions between the two groups had no statistically significant difference. Conclusion Methotrexate combined with pred-nisone for treating RA has significantly clinical effect and obviously improve the patient's symptoms and the main indicators. The ratio-nal nursing under this basis also conduces to alleviate the patient's condition.
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