五苓散改善良性前列腺增生症TUPKP术后排尿情况的临床观察
发布时间：2018-11-13 20:33
【摘要】：1背景良性前列腺增生症(benign prostatic hyperplasia,BPH)是中老年男性常见的疾病之一,随着我国社会老龄化的日益加剧,BPH将是临床高发病种。BPH主要以下尿路症状(Lower urinary tract symptoms,LUTS)为临床表现,常困扰老年男性的晚年生活,应引起我们的重视。该病的具体发病机制还没有完全阐明,目前西医治疗手段有观察随访、药物及手术治疗。部分患者通过手术能够迅速解决排尿期症状,但术后储尿期症状改善不明显常常是困扰医患双方的难题。针对BPH术后储尿期症状的常用药物是α受体阻滞剂和M受体阻滞剂,因这两类药副作用明显所以在临床上未广泛运用。所以,寻找一种更加有益的治疗方法来改善术后储尿期症状意义重大。BPH在祖国医学中属于"精癃"、"癃闭"等范畴,中医药对BPH的认识具有悠久历史。经过数千年来对BPH的认识不断深入,治疗上也积累了大量有效经验。根据从大量文献报道来看,中医药治疗BPH效果确切,其中五苓散通过调节膀胱气化功能来促进尿液正常排出有着一定的效果。2目的本研究通过以国际前列腺症状评分(I-PSS)、储尿期症状评分(I-PSS1)、排尿期症状评分(I-PSS2)、生活质量评分(Q0L)以及最大尿流率(Qmax)为疗效评价指标,探索五苓散能否在BPH术后进一步改善患者的排尿情况,以期为临床提供一种更加有效的中西医结合治疗方案。3内容本研究将符合入组标准的病例进行随机分组,治疗组22例,对照组21例。对照组术后给予常规治疗(如止血、膀胱冲洗、抗感染等),治疗组在对照组基础之上配合服用五苓散颗粒剂。两组分别在术后1周及术后4周记录各项观察指标,最终将数据运用SPSS22.0软件进行分析。4结果术后1周,对照组与术前自身对比,患者I-PSS、I-PSS2、Q0L评分均明显低于手术前,Qmax明显大于术前,差异均有有统计学意义(p0.05),而I-PSS1术前术后差异不存在统计学意义(p0.05);治疗组I-PSS、I-PSS1、I-PSS2、Q0L评分低于术前、Qmax高于术前,具有统计学意义(p0.05)。两组间对比I-PSS、I-PSS1、I-PSS2、QOL评分、Qmax差异无统计学意义(p0.05);治疗组显效率为5%,有效率为95%,总有效率为100%,对照组显效率为0%,有效率为85%,总有效率为85%,治疗组总有效率明显高于对照组,差异存在统计学意义(p0.05)。术后4周,对照组I-PSS、I-PSS1、I-PSS2、Q0L评分低于术前,Qmax高于术前,有统计学意义(p0.05);治疗组I-PSS、I-PSS1、I-PSS2、Q0L评分低于术前,Qmax高于术前,有统计学意义(p0.05);两组间对比,治疗组I-PSS、I-PSS1、I-PSS2、Q0L评分低于对照组,有统计学意义(p0.05),Qmax两组间差异无统计学意义(p0.05),两组总有效率均为95%,但两组疗效分布存在差异,治疗组显效率明显高于对照组,有统计学意义(P=0.0000.01)。5结论手术能快速有效地解决下尿路梗阻问题,提高生活质量,但对术后短期内储尿期症状改善不明显,五苓散能辅助改善术后短期内储尿期症状;患者随着术后病情的恢复,储尿期症状能得到一定改善,五苓散能在手术改善基础上进一步改善患者前列腺症状评分和提高生活质量,但对改善最大尿流率方面尚无优势。
[Abstract]:Benign prostatic hyperplasia (BPH) is one of the most common diseases in the middle-aged and the elderly. The majority of the lower urinary tract symptoms (LUTs) of BPH are the clinical manifestations, which often cause the late-year life of the old men, and we should pay more attention to them. The specific pathogenesis of the disease is not fully set out. At present, there are follow-up, drug and surgical treatment in the treatment of western medicine. In some patients, the symptoms of micturition can be resolved quickly by the operation, but the improvement of the symptoms of the post-operative blood-storage period is not often the difficult problem for both the patients and the patients. The commonly used drugs for the treatment of the symptoms of the post-operation of BPH are the opioid receptor blocker and the M-receptor blocker, which are not widely used in clinic because of the obvious side effects of these two drugs. Therefore, it is of great significance to find a more beneficial treatment method to improve the symptoms of the post-operative urine storage period. BPH is a "spermatorrhea" and "close-and-close" in the Chinese medicine, and the traditional Chinese medicine has a long history on the understanding of BPH. After thousands of years of knowledge of BPH, the treatment has accumulated a great deal of effective experience. according to a large number of literature reports, the effect of traditional Chinese medicine on the treatment of BPH has a certain effect by regulating the function of the bladder gasification to promote the normal discharge of the urine. The symptom score (I-PSS2), the quality of life (Q0L) and the maximum urinary flow rate (Qmax) of the voiding period were the evaluation index of the curative effect. In order to provide a more effective treatment for the combination of traditional Chinese and western medicine, this study will provide a more effective and integrated treatment for Chinese and Western medicine. The content of this study will be in accordance with the standard of the enrolled group, and the treatment group is 22 cases and the control group is 21 cases. In the control group, routine treatment (such as hemostasis, bladder flushing, anti-infection, etc.) was given after operation, and the treatment group was combined with five kinds of powder granules on the basis of the control group. All the observation indexes were recorded at 1 week after operation and 4 weeks after operation, and the data was analyzed by using the SPSS10.0 software. The results showed that the scores of I-PSS, I-PSS2 and Q0L in the patients were significantly lower than that before operation. The difference was statistically significant (p0.05), and the difference in the pre-operation of I-PSS1 was not significant (p0.05); the score of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group was lower than that before the operation, and the Qmax was higher than before operation (p0.05). In the treatment group, the effective rate was 5%, the effective rate was 95%, the total effective rate was 100%, the effective rate of the control group was 0%, the effective rate was 85%, and the total effective rate was 85%. The total effective rate of the treatment group was significantly higher than that of the control group (p0.05). The scores of I-PSS, I-PSS1, I-PSS2 and Q0L in the control group were lower than that before the operation. The scores of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group were lower than that before the operation. The score of Q0L was lower than that of the control group (p0.05). There was no statistical difference between the two groups (p0.05). The total effective rate of the two groups was 95%. Conclusion The operation can quickly and effectively solve the problem of lower urinary tract obstruction and improve the quality of life. the symptoms of the urine storage period can be improved, and the five-medicine powder can further improve the symptom score of the prostate and improve the quality of life on the basis of the improvement of the operation, but has no advantage in improving the maximum urine flow rate.
【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】：R699.8
[Abstract]:Benign prostatic hyperplasia (BPH) is one of the most common diseases in the middle-aged and the elderly. The majority of the lower urinary tract symptoms (LUTs) of BPH are the clinical manifestations, which often cause the late-year life of the old men, and we should pay more attention to them. The specific pathogenesis of the disease is not fully set out. At present, there are follow-up, drug and surgical treatment in the treatment of western medicine. In some patients, the symptoms of micturition can be resolved quickly by the operation, but the improvement of the symptoms of the post-operative blood-storage period is not often the difficult problem for both the patients and the patients. The commonly used drugs for the treatment of the symptoms of the post-operation of BPH are the opioid receptor blocker and the M-receptor blocker, which are not widely used in clinic because of the obvious side effects of these two drugs. Therefore, it is of great significance to find a more beneficial treatment method to improve the symptoms of the post-operative urine storage period. BPH is a "spermatorrhea" and "close-and-close" in the Chinese medicine, and the traditional Chinese medicine has a long history on the understanding of BPH. After thousands of years of knowledge of BPH, the treatment has accumulated a great deal of effective experience. according to a large number of literature reports, the effect of traditional Chinese medicine on the treatment of BPH has a certain effect by regulating the function of the bladder gasification to promote the normal discharge of the urine. The symptom score (I-PSS2), the quality of life (Q0L) and the maximum urinary flow rate (Qmax) of the voiding period were the evaluation index of the curative effect. In order to provide a more effective treatment for the combination of traditional Chinese and western medicine, this study will provide a more effective and integrated treatment for Chinese and Western medicine. The content of this study will be in accordance with the standard of the enrolled group, and the treatment group is 22 cases and the control group is 21 cases. In the control group, routine treatment (such as hemostasis, bladder flushing, anti-infection, etc.) was given after operation, and the treatment group was combined with five kinds of powder granules on the basis of the control group. All the observation indexes were recorded at 1 week after operation and 4 weeks after operation, and the data was analyzed by using the SPSS10.0 software. The results showed that the scores of I-PSS, I-PSS2 and Q0L in the patients were significantly lower than that before operation. The difference was statistically significant (p0.05), and the difference in the pre-operation of I-PSS1 was not significant (p0.05); the score of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group was lower than that before the operation, and the Qmax was higher than before operation (p0.05). In the treatment group, the effective rate was 5%, the effective rate was 95%, the total effective rate was 100%, the effective rate of the control group was 0%, the effective rate was 85%, and the total effective rate was 85%. The total effective rate of the treatment group was significantly higher than that of the control group (p0.05). The scores of I-PSS, I-PSS1, I-PSS2 and Q0L in the control group were lower than that before the operation. The scores of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group were lower than that before the operation. The score of Q0L was lower than that of the control group (p0.05). There was no statistical difference between the two groups (p0.05). The total effective rate of the two groups was 95%. Conclusion The operation can quickly and effectively solve the problem of lower urinary tract obstruction and improve the quality of life. the symptoms of the urine storage period can be improved, and the five-medicine powder can further improve the symptom score of the prostate and improve the quality of life on the basis of the improvement of the operation, but has no advantage in improving the maximum urine flow rate.
【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】：R699.8
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