星蒌承气汤治疗急性缺血性中风痰热腑实证患者便秘症状积分的动态观察

发布时间：2018-06-23 10:08

本文选题：便秘症状积分 + 动态观察　；参考：《北京中医药大学》2017年硕士论文

【摘要】：背景:卒中是临床上常见的脑血管病,随着人口老龄化的进展及人们生活方式的改变,卒中的发病率逐年上升。其发病率高、致残率高、死亡率高及复发率高,严重危害人们的生命和健康。卒中后可出现多种并发症。据文献报道,30%-60%的卒中患者会发生便秘。便秘不仅给患者带来躯体上的不适,而且影响其心理健康和生活质量,尤其值得警惕的是,患者因排便用力过度可致颅内压增高,加重脑组织损伤,不利于病情康复,同时腹压升高可诱发再卒中、心肌梗死甚至猝死等严重危害。在卒中后便秘的治疗方面,西医多应用缓泻剂和润滑剂,如果长期使用会产生药物依赖等副作用。中医对中风病的研究源远流长。王永炎教授在总结历代医家经验的基础上,通过长期的临床观察发现,痰热腑实是中风绝大多数患者证候演变的共性规律,且腑实痰热的程度与中风病的预后密切相关。因此,通腑泄浊、清热涤痰对中风急性期的治疗至关重要。作为化痰通腑法代表方的星蒌承气汤已在临床上广泛应用,并取得了良好效果。本研究从疾病、证候的角度出发,探究星蒌承气汤治疗中风后便秘的疗效。目的:探讨星蒌承气汤对缺血性中风急性期痰热腑实型便秘和中风病的临床疗效及对痰热腑实证候的影响。方法:纳入急性缺血性中风痰热腑实证患者57例,以2:1的比例随机分为治疗组和对照组,两组在西医常规治疗的基础上,分别给予星蒌承气汤、乳果糖口服液口服或开塞露灌肠进行干预,疗程为5±2天。入组6天内每日对患者便秘症状积分进行评价,观察两组便秘症状积分、排便患者比例、排便困难患者比例、排便速度、Bristol大便性状及便秘伴随症状的变化。此外,入组当天及腑气通下后分别对患者的中风病症状体征积分及痰热腑实量表积分进行评价,比较两组治疗前后积分的变化。结果:1.基线比较:治疗前两组患者的年龄、性别、生命体征、合并基础疾病、病程及梗死部位等一般情况无统计学差异(P0.05),故两组具有可比性。2.观察指标:入组第4、6天治疗组的便秘症状积分显著低于对照组(P0.05),余观察时点组间比较无明显差异(P0.05)。入组6天内伴腹胀患者的比例组间比较无显著差别(P0.05);入组前3天两组伴食欲不振患者比例的组间比较无统计学差异(P0.05),第4-6天治疗组食欲不振患者比例明显低于对照组(P0.05)。入组6天内两组排便患者比例、排便困难患者比例、排便速度及Bristol大便分型的组间比较,差异均无统计学意义(P0.05)。两组痰热腑实证候积分治疗后均较治疗前显著改善(P0.05),但治疗后组间比较无明显差异(P0.05)。治疗组治疗后的中医症状体征积分较治疗前显著降低(P0.05),对照组治疗前后及治疗后组间比较,差异无统计学意义(P0.05)。3.安全性评价:临床观察期间受试者均未出现明显不适,说明本方案安全可靠,无明显副作用。结论:星蒌承气汤对急性缺血性中风痰热腑实证患者有较好的疗效,能改善中风急性期痰热腑实证候,明显缓解便秘及相关症状,并能改善神经功能缺损程度,促进中风病的康复,值得临床推广应用。
[Abstract]:Background: stroke is a common cerebrovascular disease in clinical. With the progress of population aging and the change of people's way of life, the incidence of stroke is rising year by year. The incidence of stroke is high, the rate of disability is high, the death rate is high and the recurrence rate is high. It is serious harm to people's life and health. There are many complications after stroke. According to the literature, 30%-60% stroke is reported. Constipation causes constipation. Constipation not only brings discomfort to the body, but also affects its mental health and quality of life. It is especially worth vigilant that the patient can increase the intracranial pressure due to excessive defecation, aggravate the injury of the brain tissue and disadvantageous to the recovery of the disease. At the same time, the increase of abdominal pressure can induce further stroke, myocardial infarction and even sudden death. Harm. In the treatment of constipation after stroke, western medicine applies more laxatives and lubricants, if long-term use will produce side effects such as drug dependence. The study of Chinese medicine has a long history of apoplexy. On the basis of summing up the experience of successive generations of doctors, Professor Wang Yongyan, through a long-term clinical observation, found that the phlegm heat is the overwhelming majority of stroke patients. The general rule of syndrome evolution is closely related to the degree of Fu Fu phlegm fever and the prognosis of apoplexy. Therefore, it is very important for the treatment of acute apoplexy in the treatment of the acute stage of apoplexy. To explore the effect of Xing Lou Chengqi Decoction in treating constipation after apoplexy. Objective: To explore the effect of Xing Lou Chengqi Decoction on phlegm constipation and apoplexy in acute phase of ischemic apoplexy and the effect on phlegm heat syndrome. Methods: 57 cases of acute ischemic stroke phlegm hot Fu Fu were divided into treatment group and control group randomly, with the proportion of 2:1. On the basis of conventional treatment of Western medicine, the two groups were given star Chengqi Decoction, orally orally orally or Enema Glycerini enema, with a course of 5 + 2 days. The scores of constipation symptoms were evaluated every day in 6 days, and two groups of constipation symptoms, the proportion of defecation patients, the rate of defecation, the speed of defecation, Bristol Change of constipation and constipation symptoms. In addition, the scores of symptoms and signs of apoplexy and integral of phlegm heat in the patients were evaluated on the day of entering the group and the integral of phlegm heat and Fu Fu, and the results were compared between the two groups before and after treatment. The results were as follows: the 1. baseline was compared: the age, sex, vital signs of the two groups of patients before treatment, and the combination of basic diseases and diseases. There was no statistical difference in the general condition of the course and the infarct location (P0.05), so the two groups had comparable.2. observation indexes: the constipation symptom score of the group on day 4,6 was significantly lower than that of the control group (P0.05), and there was no significant difference between the observation time points group (P0.05). There was no significant difference between the groups with abdominal distension (P0.05) within the group (P0.05). There was no significant difference in the proportion of two groups of anorexia patients in the first 3 days (P0.05), and the proportion of patients with loss of appetite in the 4-6 day group was significantly lower than that of the control group (P0.05). The proportion of the two groups of defecation patients, the proportion of defecating patients, the rate of defecation and the Bristol stool classification were not statistically significant (P0. 05) the two groups of phlegm and heat syndrome were significantly improved after treatment (P0.05), but there was no significant difference between the two groups after treatment (P0.05). The symptoms and signs of TCM in the treatment group were significantly lower than before treatment (P0.05). The difference was not statistically significant (P0.05).3. safety assessment before and after treatment in the control group and after treatment. There was no obvious discomfort during the clinical observation, which showed that the scheme was safe and reliable, and there was no obvious side effect. Conclusion: Xing Lou Chengqi Decoction has good effect on the patients with acute ischemic stroke phlegm and hot Fu Fu, it can improve the phlegm heat syndrome in acute stroke, relieve constipation and related symptoms, and improve the degree of nerve function defect. It is worthy of clinical application to promote the rehabilitation of apoplexy.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

【参考文献】