舒尿通煎剂防治肛肠病术后尿潴留的临床实验

发布时间：2018-06-15 20:06

本文选题：舒尿通煎剂 + 肛肠病　；参考：《辽宁中医药大学》2014年博士论文

【摘要】：目的：我国肛肠病的治疗目前多采用中西医结合疗法治疗，很多复杂的肛肠病需要手术治疗。手术后并发症以术后尿潴留最为常见，其中尤以混合痔、高位肛瘘、高位肛周脓肿术后发生率最高。本研究选取最易发生术后尿潴留的病人观察舒尿通煎剂防治肛肠病术后尿潴留的临床疗效，为进一步在更多病种及更多的医疗机构进行临床推广提供依据。方法：把病人先分层再按完全随机法将符合入组标准的病人随机分为3组，观察组30例，辅助治疗组29例，哈乐口服治疗组29例，为保证实验的均衡性，所有入组的同一病种病人均采用相近手术方式及麻醉方式。观察组：术前夜及术后2小时，顿服我院中药局煎制的250毫升舒尿通煎剂。辅助治疗组：包括心理安慰鼓励排尿、恢复平素排尿体位等。哈乐口服治疗组术前夜及术后2小时，盐酸坦索罗辛缓释胶囊0.2mg顿服。术后能自主排尿的病人均记录首次排尿时间；术后6小时内能自主排尿者应用膀胱扫描仪测定残余尿，术后4小时未排尿者应用膀胱扫描仪监测膀胱容量；术后第2日未发生尿潴留的病人排尿2小时后尿动力仪测定自由尿流率；采用视觉模拟量表（VAS）卡，观察对比病人术后4小时和6小时的疼痛评分。依据1994年国家中医药管理局发布的中华人民共和国中医药行业标准《中医病证诊断疗效标准》，同时结合2003年Breebaart的文献拟定临床疗效标准。依据疗效判定标准，所有判定为“无效”者均视为尿潴留。尿潴留的病人予以留置导尿3天，观察组尿潴留病人连续3天每晚口服舒尿通煎剂250毫升，哈乐组尿潴留病人连续3天每晚睡前口服盐酸坦索罗辛缓释胶囊0.2mg，辅助治疗组尿潴留病人仅予以留置导尿3天。3天后拔导尿管观察排尿情况再次依据疗效判定标准，符合“无效”标准者视为再次尿潴留。结果:3组病人术后首次排尿时间比较差异有统计学意义（H=5.166，P=0.047），其中观察组首次排尿时间短于辅助治疗组和哈乐口服组，差异均有统计学意义（u=1.91，P=0.045；u=2.15，P=0.03），而辅助治疗组和哈乐口服组比较，差异无统计学意义（u=0.209，P=0.835）；3组病人术后第2日最大尿流率比较差异有统计学意义（H=6.92，P=0.031），其中观察组尿流率高于辅助治疗组和哈乐口服组，差异均有统计学意义（u=2.304，P=0.021；u=2.429，P=0.015），而辅助治疗组和哈乐口服组比较，差异无统计学意义（u=0.075，P=0.94）；3组病人临床疗效比较，差异有统计学意义（H=7.044，P=0.03），，其中观察组临床疗效优于辅助治疗组和哈乐口服组，差异均有统计学意义（u=2.446，P=0.014；u=2.128，P=0.033），而辅助治疗组和哈乐口服组比较，差异无统计学意义（u=0.351，P=0.725）；3组病人术后4、6小时VAS评分比较，差异有统计学意义（P＜0.05），其中观察组VAS评分低于辅助治疗组和哈乐口服组，差异均有统计学意义（q=8.1，P=0.000；q=8.45，P=0.000），而辅助治疗组和哈乐口服组VAS评分比较，差异无统计学意义（q=0.36，P=0.796）；观察组与哈乐口服组尿潴留的病人导尿管拔出成功率高于辅助治疗组。结论:舒尿通煎剂可改善病人术后排尿情况，减少尿潴留的发生率；应用舒尿通煎剂可明显改善病人术后疼痛症状；舒尿通煎剂可以提高术后尿潴留病人拔出导尿管的成功率。舒尿通煎剂具有散瘀、通经、止痛、利尿之功效，对肛肠病术后尿潴留有较好的防治效果，有助于减轻病人痛苦，提高病人生活质量，有临床推广价值。
[Abstract]:Objective: the treatment of anorectal diseases in China is mostly treated with integrated traditional Chinese and Western medicine. Many complicated anorectal diseases need surgical treatment. Postoperative complications are the most common postoperative urinary retention, especially mixed hemorrhoids, high anal fistula and high perianal abscess. The clinical efficacy of Cha Shu Tong Tong Decoction in prevention and treatment of postoperative urinary retention after anorectal diseases is to provide evidence for further clinical promotion in more diseases and more medical institutions.
Methods: the patients were divided into 3 groups randomly and according to the complete random method. The patients were randomly divided into 3 groups, 30 cases in the observation group, 29 in the auxiliary treatment group and 29 in the Harle oral treatment group, in order to ensure the balance of the experiment. All the patients in the same disease of the group adopted the similar operation formula and the anesthesia way. The observation group: the night before operation and the 2 hours after the operation. 250 milliliter Shu diuren Decoction made by Chinese herbal medicine bureau of our hospital. The auxiliary treatment group, including psychological comfort, urination, and restoration of the level of urination, 2 hours after the operation on the eve of the Harle oral treatment group and the 2 hours after the operation of Tamsulosin Hydrochloride Sustained Release Capsules 0.2mg. The first urination time per person who can make the urine after the operation is recorded for the first time within 6 hours after the operation. Patients who had independent urination were measured with bladder scanners for residual urine. Bladder scanners were used to monitor bladder capacity at 4 hours after operation. Patients who had no urinary retention on second days after operation were urinating for 2 hours after urination, and the urinary power meter was measured after 2 hours. The visual analogue scale (VAS) card was used to observe and compare the pain of 4 and 6 hours after the operation. According to the standard of the curative effect of TCM syndrome in People's Republic of China issued by the State Administration of traditional Chinese medicine of 1994, the clinical curative effect standard for the diagnosis of TCM syndrome was set up, and the clinical curative effect standard was drawn up with the literature of Breebaart in 2003. According to the standard of judging the curative effect, all those who were judged "invalid" were regarded as urinary retention. The patients with urinary retention were given the indwelling guide. After 3 days of urine, the patients with urinary retention in the observation group were taken oral diurant 250 ml every night for 3 days. The patients with urinary retention in harale group took Tamsulosin Hydrochloride Sustained Release Capsules 0.2mg every night for 3 days. The urine retention patients in the auxiliary treatment group only given the indwelling catheterization for 3 days and.3 days later to observe the urination. The "invalid" standard is regarded as a re retention of urine.
Results: the difference of the first urination time between the 3 groups was statistically significant (H=5.166, P=0.047), and the first urination time of the observation group was shorter than that of the adjuvant therapy group and the harale oral group (u=1.91, P=0.045; u=2.15, P=0.03), while the difference was not statistically significant (u=0.209, P) in the adjuvant treatment group and the harale oral group. =0.835): the maximum urinary flow rate of the 3 groups was statistically significant (H=6.92, P=0.031) after second days of operation, and the urine flow rate of the observation group was higher than that of the adjuvant therapy group and harale oral group (u=2.304, P=0.021; u=2.429, P=0.015), while the difference was not statistically significant (u=0.075, P) in the adjuvant treatment group and the harale oral group. =0.94); the clinical curative effect of the 3 groups was statistically significant (H=7.044, P=0.03), and the clinical efficacy of the observation group was better than that of the adjuvant therapy group and the harale oral group (u=2.446, P=0.014; u=2.128, P=0.033), but the difference was not statistically significant (u=0.351, P=0.725) in the adjuvant treatment group and the harale oral group (P=0.725); 3 The difference was statistically significant (P < 0.05) in the group of patients after 4,6 hours VAS score (P < 0.05). The VAS score of the observation group was lower than that of the adjuvant therapy group and harale oral group (q=8.1, P=0.000; q=8.45, P=0.000), but the difference was not statistically significant (q=0.36, P=0.796) in the auxiliary treatment group and the harale oral group. The success rate of catheter withdrawal in observation group and Harle oral group was higher than that in adjuvant therapy group.
Conclusion: Shu urong decoction can improve the postoperative urination of patients and reduce the incidence of urinary retention. The application of Shu urong decoction can obviously improve the symptoms of postoperative pain in patients. Shu urong decoction can improve the success rate of urethral catheter removal in patients with postoperative urinary retention. Post urinary retention is effective in preventing and treating pain, improving patient's quality of life and promoting clinical value.
【学位授予单位】：辽宁中医药大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R657.1

【参考文献】