基于气病辨证探讨痔术后中医证候的分布特点

发布时间：2018-02-26 02:26

  本文关键词： 痔疮 手术 气病 中医证候　出处：《广州中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本课题从气病辨证的角度,按病与证相结合的思想制定临床观察表,在运用统计方法对临床观察所得的痔疮患者围手术期的一般资料、四诊信息及手术信息进行处理、分析的基础上,以术前为参照,从症状、证候及其与术中相关因素的关联等方面研究痔术后气病中医证候的分布特点,再进一步探讨痔手术与气病的关系,并从气病论治,指导中医药干预在痔围手术期的应用,以提高临床疗效,促进患者早日康复,同时为相关的科研提供一定的参考价值。方法:1.查阅相关文献利用文献数据库查阅痔疮、围手术期、气病辨证、中医证候等方面的相关文献,在本课题的研究思路和方法上形成一个提纲式的认识。2.咨询专家教授向有关专家及教授咨询痔疮、气病等相关理论的疑难问题,进一步明确本课题研究的侧重点。3.组建课题研究小组由课题负责人召集小组成员商讨临床观察表的制定、填写及信息资料的采集等相关事宜,并对相关的研究人员进行培训。4.制定临床观察表按中医望、闻、问、切四诊合参的要求,依据痔疮及气病的诊断标准,初步设计表格并进行预调研,再根据反馈结果,制定《痔疮患者围手术期的气病中医证候临床观察表》。5.搜集临床资料,填写相关信息搜集符合研究标准的痔疮患者的一般资料、四诊信息及手术信息,按要求把它们填写到对应的表格中,整理后交给有高级职称的医师筛选关键信息,并及时修正调查研究的策略。6.汇总有效信息,建立数据库对符合研究标准的126例痔疮患者的一般资料、四诊信息及手术信息进行汇总,再分别导入IBM SPSS statistics version 22.0软件包中,建立相应的数据库。7.运行统计软件按本课题的研究目的、思路与方法分别提取相应的有效数据,再针对不同类型的数据资料,分别采用频数统计分析、多重响应分析、logistic回归分析、独立性检验、卡方检验、非参数检验等统计方法对其进行处理,并将统计软件的运行结果绘制成相应的表格或图形。8.解释并讨论统计结果结合基础理论知识、临床实践的反馈及相关的科研资料,对统计软件的运行结果及对应的表格与图形,分别进行合乎专业的解释与讨论。结果:(1)在126例痔疮患者中,男性有72例,女性有54例,男女发病的性别比例为1.33:1。发病年龄最小的为19岁,最大的为79岁。发病人数最多的为34～48岁这个年龄段,共41例,占总体的32.5%,其次为49～63岁,共40例,占总体的31.7%。(2)从术前1天到术后第7天,痔疮患者的舌色与舌形、苔色与苔质以及脉象的变化均无显著性差异。(3)术前1天气病中医证候的分布以气陷证为主,其次为气滞证,所占的比例分别为51.6%、25.4%;术后第1天气病中医证候的分布以气虚证为主,占53.2%,气滞证所占比例减至19.0%;术后第3天气病中医证候的分布仍以气虚证为主,所占比例为43.7%,其次是气滞证,所占比例为34.9%;术后第7天气病中医证候的分布以气滞证为主,所占比例为47.6%,比例最少的为气逆证,仅占7.2%。(4)围手术期痔疮患者气病中医证候的整体分布有显著性差异。与术前1天比较,术后第1天气病中医证候的分布有显著性差异,术后第3、7天气病中医证候的分布均无显著性差异;与术后第1天比较,术后第3天气病中医证候的分布无显著性差异,术后第7天气病中医证候的分布有显著性差异;与术后第3天比较,术后第7天气病中医证候的分布无显著性差异。(5)从术前1天到术后第7天,随着时间的推移,气虚证与气逆证的频数均呈先增加后减少的趋势,气陷证的频数呈逐渐减少的趋势,气滞证的频数呈逐步增多的趋势。(6)痔术后第一天气病中医证候的整体分布与术中出血量无相关性,而与麻醉方式、手术方式、手术时间存在相关性。痔术后第一天气虚证、气陷证、气逆证的分布与手术时间存在相关性,与麻醉方式、手术方式及术中出血量无相关性;气滞证的分布与手术时间等均不存在相关性。结论:痔手术会促进气病的产生与发展,也对痔术后气病中医证候的分布与变化带来影响。痔围手术期的气病辨证应秉承中医整体观念的思想,在气病论治方面坚持祛邪扶正的原则,根据气病的证候分布特点合理使用中医药进行干预,以促进患者早日康复,达到"阴平阳秘、精神乃治"的和谐状态。本课题的研究成果可在一定程度上指导痔围手术期的临床用药,缩短痔疮患者的康复进程,践行近年来外科学界提出的"控制性损伤"及"快速康复"等相关理念。
[Abstract]:Objective: this topic from the dialectical point of disease, disease and syndrome according to the idea of combining the development of clinical observation table, in general data using statistical methods of perioperative patients with hemorrhoids clinical observation on the treatment of the diagnostic information and operation information, based on the analysis of the preoperative reference, from the distribution of symptoms. The characteristics of the syndrome and its related factors in operation and related aspects of hemorrhoid postoperative disease syndromes, to further explore the relationship of hemorrhoids surgery and disease, and from disease treatment, the guidance of Chinese medicine intervention in the perioperative period of hemorrhoids, to improve clinical curative effect, promote the rehabilitation of patients, at the same time provide a certain reference value for related research. Methods: 1. literatures using literature database access hemorrhoids, perioperative period, disease differentiation, syndrome of traditional Chinese medicine related literature and other aspects of the formation, on the road and method in this research thinking A more understanding of.2. consulting experts and professors to the relevant experts and professors of hemorrhoids, disease and other related theoretical problems, to further clarify the research emphases of.3. to set up the research team by team members to discuss the topics for the convener of the clinical observation table for acquisition and other related matters, and fill in the information, and Study on relevant personnel training.4. make the clinical observation table according to the traditional Chinese medicine look, smell, ask, cut the requirements of four diagnostic methods, based on the diagnostic criteria of hemorrhoids and disease, the preliminary design form and the pre survey, according to the feedback results, making "perioperative patients with hemorrhoids in TCM syndrome disease clinical observation table >.5. collected the clinical data, fill in the relevant information collected in accordance with general information of patients with hemorrhoids research standard, diagnostic information and operation information, according to the requirements of them to fill in the corresponding table, finishing After given the title of senior physician screening strategy.6. key information, and timely correction of investigation and research summary of effective information, establish a database of general information on 126 cases of hemorrhoids patients met the study criteria, diagnostic information and operation information were collected, then import the IBM SPSS statistics version 22 software,.7. database operation statistics the corresponding software according to the purpose of the study, the ideas and methods of the corresponding data were extracted effectively, then according to the different types of data, respectively, using frequency statistical analysis, multiple response analysis, logistic regression analysis, independent test, chi square test, nonparametric test and other statistical methods for its treatment, and statistics the operation of the software was drawn into.8. tables or graphics to explain and discuss the corresponding statistics combined with theoretical knowledge, clinical practice and feedback related department 鐮旇祫鏂，

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