应用坦索罗辛联合针刺预防痔术后排尿困难的临床研究

发布时间：2019-01-25 10:52

【摘要】：目的:混合痔是一种常见病,手术是治疗中重度混合痔的最佳方案之一,然而混合痔术后排尿困难却严重影响患者的就医体验。目前相关文献已证实坦索罗辛及针刺相关穴位对术后排尿困难有着不错的疗效,然而大多数研究都是在患者出现排尿困难后再给与相应的治疗措施,却鲜有人关注预防该并发症的发生。因此,本研究通过探讨痔术后排尿困难的病因病机,以期寻找可以有效预防痔术后排尿困难的方法来提升患者的就医体验,使患者术后的生活质量得到一定程度的改善。通过该研究科学系统地评价坦索罗辛联合针刺对预防痔术后排尿困难的安全性与有效性,为临床医生提供一种创新的预防方案。方法:本研究通过前瞻性随机对照的临床研究方案,将广东省中医院肛肠科住院部在2016年10月到2017年2月期间收治的符合纳入条件的150名研究对象随机分为针药联合组、单用哈乐组、对照组各50例。针药联合组患者在术后4h予口服哈乐0.2mg,待患者有尿意时予针刺中极、关元、气海、双侧三阴交、双侧太冲穴,所有穴位行针得气后留针15分钟。单用哈乐组患者在术后4h予口服哈乐0.2mg治疗,不予针刺。对照组则不提前干预。观察术后排尿困难的情况、术后首次排尿时间、首次排尿尿量、是否导尿、手术后8h内总尿量、术后首次排尿的尿流率、术后8h总排尿次数。将所有病例观察表中资料信息输入SPSS 19.0中,建立数据库,将录入的资料信息进行两次重复,尽量防止录入错误。统计方法采用方差分析,χ2检验,秩和检验。检验水平 α = 0.05。结果:三组在性别、年龄、病程、术式、手术切口、补液量等各方面分布较均衡,经统计学方法检验,三组资料基线指标的差异无统计学意义(P0.05),具有可比性。三组在术后排尿困难情况、首次排尿时间、首次排尿量、术后8h内总尿量、术后首次排尿的尿流率方面存在差异,具有统计学意义(P0.05)。结论:研究结果显示针药联合组与单用哈乐组在预防混合痔术后排尿困难上均有疗效,但针药联合组在首次排尿时间、首次排尿量及术后首次排尿尿流率方面有明显优势,对预防痔术后排尿困难的疗效明显且安全性较高,值得在临床上推广。而对于不接受针刺治疗的患者,单用哈乐也可以起到一定的预防术后排尿困难的效果,从而提升患者的就医体验。
[Abstract]:Objective: mixed hemorrhoids is a common disease. Surgery is one of the best methods to treat moderate and severe mixed hemorrhoids. At present, the relevant literature has confirmed that tamsoloxin and acupuncture related acupoints have good effect on dysuria after operation. However, most studies have given corresponding treatment measures after the patients have dysuria. But little attention has been paid to preventing this complication. Therefore, this study is to explore the etiology and pathogenesis of dysuria after hemorrhoid surgery, in order to find effective methods to prevent dysuria after hemorrhoids operation to improve the experience of medical treatment and improve the quality of life of patients after operation to a certain extent. The safety and effectiveness of tamsoloxin combined with acupuncture in the prevention of dysuria after hemorrhoids surgery were evaluated scientifically and systematically, and an innovative prophylaxis scheme was provided for clinicians. Methods: through a prospective randomized controlled clinical study, 150 subjects who were admitted to the Department of anorectal Medicine of Guangdong traditional Chinese Medicine Hospital from October 2016 to February 2017 were randomly divided into acupuncture and medicine combined group. Each group was treated with halo alone and control group (n = 50). The patients in the combined acupuncture and medicine group were given orally halo 0.2 mg at 4 hours after operation. When the patients had urine intention, they were given acupuncture in Zhongji, Guanyuan, Qihai, bilateral Sanyinjiao, bilateral Taichong, and all acupoints were treated with QI for 15 minutes. Patients in Hal group were treated with oral 0.2mg 4 h after operation without acupuncture. The control group did not intervene in advance. The difficulty of urination after operation was observed. The first time of urination, the quantity of urination, the total volume of urine within 8 hours after operation, the flow rate of the first time after operation and the total number of times of urination at 8 h after operation were observed. The data information in all case observation tables was input into SPSS 19.0, the database was established, and the input information was repeated twice so as to prevent the inputting errors as far as possible. ANOVA, 蠂 2 test and rank sum test were used. The test level is 伪 = 0.05. Results: the distribution of gender, age, course of disease, operation, incision and fluid rehydration in the three groups were more balanced. The baseline data of the three groups had no statistical significance (P0.05). There were significant differences among the three groups in terms of dysuria, the first time of urination, the total amount of urine within 8 hours after operation, and the flow rate of the first urination after operation (P0.05). Conclusion: the results showed that both acupuncture and medicine combination group and Hal alone group were effective in the prevention of dysuria after mixed hemorrhoids operation, but the acupuncture and medicine combination group had obvious advantages in the first urination time, the first urination volume and the first urination flow rate after operation. The effect on preventing dysuria after hemorrhoids operation is obvious and safe, so it is worth popularizing in clinic. For the patients who do not receive acupuncture alone can also play a certain role in preventing postoperative dysuria thereby improving the patient's experience.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R657.18

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