温阳行气脐贴膏对PPH手术感觉功能障碍综合征的疗效观察

发布时间：2018-04-09 14:52

本文选题：感觉功能障碍综合征　切入点：敷脐疗法　出处：《北京中医药大学》2014年硕士论文

【摘要】：PPH手术感觉功能障碍综合征是一组以下腹部牵拉疼痛、术后肛门疼痛、肛门坠胀、排尿障碍等为主要症状群的综合征。有相当一部分病人在PPH治疗中出现此类症状,患者病情往往轻重不一,有的患者仅有一种症状,亦有多个症状并存,临床上无法具体定名和诊断。西医认为PPH击发吻合器时下腹部牵拉疼痛是迷走神经反射所引起,引起术后肛门疼痛、坠胀、排尿障碍原因有多种,可能与麻醉、荷包缝合技术、手术操作损伤、患者过敏等都有关系,但仍缺乏系统的认识以及完善的治疗方法,临床上大多随症处理。该综合征在临床上发生率高,且影响治疗效果,给患者带来极大痛苦,逐渐得到医者重视。祖国医学擅长对症治疗,近年来很多学者从祖国医学角度提出了很多针对PPH手术感觉功能障碍综合征的治疗方法。目的：本课题试从中医学角度探讨PPH手术感觉功能障碍综合征发生机理,并观察中药温阳行气脐贴对PPH手术感觉功能障碍综合征的治疗效果。方法：本临床研究以2012-2013年度我科符合诊断标准并采用PPH手术治疗的90例患者作为研究对象,将患者随机分为三组,脐贴治疗组(A组),地佐辛组(B组),空白对照组(C组),每组各30例病人,其中A组术前1h予温阳行气脐贴贴脐, B组术前15min静脉注射地佐辛5mg,C组给予常规治疗。记录90例患者手术中心率、血压的指标变化；对术中下腹部牵拉疼痛程度,及A组、C组术后1d、2d、3d肛门疼痛、肛门坠胀、排尿障碍症状进行评分,利用SPSS20.0软件对结果进行统计分析。结果：术中A、B、C三组进行比较,①心率变化率上,与C组比较,A、B组在PPH击发时及击发后5min心率变化率小；与B组比较,A组心率变化率大,且均有统计学差异。②平均动脉压变化率上,与C组比较,A组在PPH击发时及击发后5minMAP变化率小,但不具有统计学差异,B组变化率小,具有统计学差异。与B组比较,A组MAP变化率大,且具有统计学差异。③下腹牵拉痛上,与C组比较,A、B组术中疼痛评分低,且具有统计学差异；与B组比较,A组术中疼痛评分高,且具有统计学差异。术后1、2、3天A组、C组进行比较,在术后第1、第2天,A组在肛门坠胀、肛门疼痛、排尿障碍三组症状评分均较低,且具有统计学差异,第3天,三组症状评分亦较低,但无统计学差异。总体疗效评价： A组对于PPH手术感觉障碍综合征的治疗效果明显,30例病人,23例显效,5例有效,2例无效,总有效率为93.3%, C组30例病人13例显效,11例有效,6例无效,总有效率为80.0%,但无统计学差异。结论：温阳行气脐贴在PPH手术感觉功能障碍综合征治疗中,改善局部及全身气血运行状态,加速肛门部气血功能的自我恢复,在缓解术中心率下降、牵拉痛以及改善术后肛门坠胀、肛门疼痛、排尿障碍等症状上有一定疗效,在治疗PPH手术感觉功能障碍综合征上,总体有效率高,可操作性强,具有一定临床意义。
[Abstract]:Sensory dysfunction syndrome in PPH operation is a group of patients with abdominal traction pain, postoperative anal pain, anal distension and dysuria.There are quite a number of patients in the treatment of PPH such symptoms, patients often have different degrees of disease, some patients have only one symptom, but also have multiple symptoms, clinical can not be specified and diagnosed.Western medicine thinks that the pain caused by vagus nerve reflex in the lower abdomen of PPH stapling device is caused by anus pain, distension, and dysuria after operation. There are many reasons for the dysuria, which may be related to anaesthesia, pocket suture technique, and surgical operation injury.The allergy of patients is related, but there is still a lack of systematic understanding and perfect treatment methods, most of them are treated with the disease.The syndrome has a high clinical incidence and affects the therapeutic effect, which brings great pain to the patients, and gradually gets the attention of the doctors.Chinese medicine is good at symptomatic treatment. In recent years, many scholars have put forward a lot of methods for the treatment of sensory dysfunction syndrome in PPH surgery from the point of view of Chinese medicine.Objective: to explore the mechanism of sensory dysfunction syndrome in PPH operation from the perspective of traditional Chinese medicine, and to observe the therapeutic effect of Wenyang Xingqi navel paste on sensory dysfunction syndrome in PPH operation.Methods: in this clinical study, 90 patients who met the diagnostic criteria in our department in 2012-2013 and were treated with PPH surgery were randomly divided into three groups.Group A was treated with navel patch, group B with dizoxin and group C with 30 patients in each group. Group A was given Qi navel patch 1 hour before operation, and group B received routine therapy with dizoxin 5 mg / g before operation.The changes of heart rate and blood pressure were recorded in 90 patients during operation, and the degree of pain in lower abdomen during operation and anus pain, anus falling distention and dysuria in group A and C were evaluated 1 day after operation, 2 days after operation and 3 days after operation. The results were statistically analyzed by SPSS20.0 software.Results: the rate of heart rate change in group C was lower than that in group C, and the change rate of heart rate in group A was higher than that in group B during and after PPH, and the change rate of heart rate in group A was higher than that in group B, and the change rate of heart rate in group A was higher than that in group C, and that in group A was higher than that in group C.Compared with group C, the change rate of 5minMAP in group A was smaller than that in group C, but there was no statistical difference between group B and group B.Compared with group B, the rate of MAP change in group A was greater than that in group B, and there was statistical difference between group A and group C, the score of intraoperative pain in group A was lower than that in group C, and there was statistical difference between group A and group B, and the score of intraoperative pain in group A was higher than that in group B.And there is statistical difference.On the 1st and 2nd day after operation, the scores of symptoms of group A were lower than those of group A on the 1st and 2nd day after operation, and there were statistical differences among the three groups, and on the third day, the scores of symptoms in the three groups were also lower than those in group A, and the scores of symptoms in group A were lower than those in group A on the 1st and 2nd day after operation, and the scores of symptoms in group A were lower than those in group A.But there was no statistical difference.Evaluation of the overall curative effect: in group A, there were 30 cases of sensorinesia syndrome treated by PPH operation, 23 cases of which were effective and 2 cases were ineffective, and the total effective rate was 93.33%. In group C, there were 30 cases of patients with marked effect and 11 cases of effective and 6 cases of ineffectiveness, and the total effective rate was 93. 3% in group C and 30 cases in group C, respectively.The total effective rate was 80.0, but there was no statistical difference.Conclusion: warm yang and Qi navel application in the treatment of sensory dysfunction syndrome in PPH surgery can improve the local and systemic qi and blood movement, accelerate the self recovery of anal qi and blood function, and decrease the rate of relief operation center.Pulling pain and improving postoperative anal distension, anal pain, dysuria and other symptoms have a certain effect. In the treatment of PPH surgery sensory dysfunction syndrome, the overall effective rate is high, maneuverability is strong, has a certain clinical significance.
【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】：2014
【分类号】：R266

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