目的 探讨芒硝外敷治疗活动性类风湿关节炎(RA)伴腓肠肌肿胀的临床疗效及其对护理工作的指导意义.方法 选取2014—2016年在西南医科大学附属医院风湿免疫科确诊且接受住院治疗的活动性RA伴腓肠肌肿胀患者60例,采用随机数字表法分为A、B、C 3组,每组20例.A组患者采用芒硝外敷治疗,B组患者采用硫酸镁外敷治疗,C组患者采用患肢膝关节注射曲安奈德治疗.比较3组患者治疗前和治疗后10 d的患肢膝关节、腓肠肌中段、踝关节周径以及治疗后的B超检查结果、患者满意度.结果 3组患者性别、发病年龄、疾病活动性评分(DAS28)比较,差异无统计学意义(P>0.05);A组患者病程长于C组,差异有统计学意义(P<0.05).治疗前3组患者患肢膝关节、腓肠肌中段、踝关节周径比较,差异无统计学意义(P>0.05).治疗后3组患者患肢踝关节周径比较,差异无统计学意义(P>0.05);C组患者患肢膝关节、腓肠肌中段周径小于A、B组,差异有统计学意义(P<0.05);A、B组患者患肢膝关节、腓肠肌中段周径比较,差异无统计学意义(P>0.05).治疗后C组患者B超检查结果优于A、B组,差异有统计学意义(P<0.05);A、B组患者B超检查结果比较,差异无统计学意义(P>0.05).治疗后C组患者满意度高于A、B组,差异有统计学意义(P<0.05);A、B组患者满意度比较,差异无统计学意义(P>0.05).结论 芒硝外敷治疗活动性RA伴腓肠肌肿胀的疗效尚不明确,且患者满意度不高,在护理工作中应注意与患者的沟通.%Objective To investigate the clinical efficacy of external application of mirabilite in the treatment of active rheumatoid arthritis (RA)with gastrocnemius swelling and its significance to nursing. Methods Sixty patients who were diagnosed with active RA accompanied by gastrocnemius swelling and received inpatient treatment in Rheumatology and Immunology Department,the Affiliated Hospital of Southwest Medical University from 2014 to 2016 were selected and divided into groups A,B,C by random number table,20 cases in each. Patients in groups A,B,C were respectively treated with external application of mirabilite,external application of magnesium sulfate,intra - articular injection of triamcinolone acetonide. The circumference of the affected knee joint,middle gastrocnemius and ankle joint were measured before treatment and at the end of 10 - day treatment. The volume of effusion in these three parts were detected by B - mode ultrasonography before treatment and at the end of 10 - day treatment. And patient satisfaction with treatment was assessed after treatment. Results All the groups were found with similar sex distribution,age of onset and Disease Activity Score 28 (DAS28)(P > 0. 05). The course of active RA with gastrocnemius swelling was longer in group A than that in group C (P < 0. 05 ). Before treatment,the values of circumference of the affected knee joint,middle gastrocnemius and ankle joint did not differ significantly between the 3 groups (P > 0. 05). After treatment,the values of circumference of the ankle joint in the groups were still similar (P > 0. 05);the values of circumference of the affected knee joint and middle gastrocnemius in group C were identified to be the lowest (P <0. 05),but they were similar in groups A and B (P > 0. 05). After treatment,B - mode ultrasonography detected that the greatest improvement was achieved in group C (P < 0. 05),while the degrees of improvement in the other groups were similar (P > 0. 05). The level of patient satisfaction with treatment was the highest in group C (P < 0. 05),whereas it was similar in the other groups (P > 0. 05). Conclusion The efficacy of external application of mirabilite in active RA with gastrocnemius swelling has not been clearly identified yet. Moreover,this therapy has not achieved high level of patient satisfaction. Therefore, nursing - patient communication should be paid attention during nursing.
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