膝骨性关节炎患者围手术期中医证候变化的研究

发布时间：2018-01-02 08:12

  本文关键词：膝骨性关节炎患者围手术期中医证候变化的研究　出处：《新疆医科大学》2016年硕士论文　论文类型：学位论文

  更多相关文章： 膝骨性关节炎 围手术期 流行病学调查 证候研究

【摘要】：目的:本次研究拟通过大样本病例的调查研究,以了解膝骨性关节炎患者在行全膝关节置换术的围手术期的中医证候变化特点,并归纳出膝骨性关节炎患者围手术期的主要症候变化,进而为中医药各种诊治方法在膝骨性关节炎围手术期间的规范合理运用及科学优化组合,指导围手术期不同阶段更有针对性的用药和治疗提供较为可靠的理论依据和临床依据,拟确立出规范有效的膝骨性关节炎围手术期诊疗方案,从而切实实现膝骨性关节炎患者围手术各期的“辨证论治”。方法:本项目研究对象为2014年1月-2015年12月期间在新医大附属中医医院关节外科住院并且自愿接受人工膝关节表面置换手术治疗的患者。采用问卷调查方法,对纳入研究的病例,收集基本资料和围手术期各个观察节点的临床症状学资料建立数据库,以频数分析方法研究患者在围手术期各观察节点的症状的分布情况,再通过聚类及Logistic回归分析,归纳出膝骨性关节炎患者围手术期各观察节点主要的中医证候类型及各症候的诊断要点。结果:此次研究纳入有效病例300例,其中男性占21.3%(64例),女性占78.7%(236例),女性患者是男性患者的3.68倍;病例中最小龄年患者43岁,最大年龄患者80岁,300例患者年龄均数为:65.4±6.20岁,其中年龄超过64岁以上的患者占样本总数的57.7%;按患者族别共可分为7类,包括:汉族、回族、蒙古族、维吾尔族、哈萨克族、东乡族、柯尔克孜族等,其中汉族患者最多,225例,占病例总数75%,维吾尔族患者次之,33例,占病例总数11%;300例患者中,病程跨度为2-26年,平均病程7.4±3.51年;围手术期中医基本证候辨证要素的归纳为:肾阴虚、肾阳虚、肾气虚、肝阴虚、肝阳虚、肝气虚、肝血虚、脾阴虚、脾阳虚、脾气虚、气滞、血瘀、痰、寒湿、湿热等15种。分析后所得围手术期各观察节点主要证候:手术前期以“肾阴虚肾阳虚肝阴虚肝阳虚肝血虚脾阴虚脾阳虚寒湿痰血瘀”证为主要证候;术后1周以“肾阴虚肾阳虚肾气虚脾阴虚脾阳虚脾气虚气滞血瘀”证为主要证候;术后2周以“肾阴虚肾阳虚肾气虚气滞”证为主要证候;术后3周以“肾阴虚肾阳虚脾阴虚脾阳”证为主要证候。结论:膝骨性关节炎患者围手术期主要中医证候变化为:手术前期以“寒湿阻滞证”为主,辨证要点为:关节畸形,膝冷痛、形寒肢冷,下肢冷甚,遇寒痛增,晨僵,耳聋或耳鸣,胸脘痞闷,小便清长,舌淡紫,少津,少苔、无苔,脉弦,脉滑或数,脉细数;术后1周以“气滞血瘀证”为主,辨证要点为:神疲乏力,头重如裹,面色苍白或萎黄,口干苦,咽燥口干,呕吐,纳呆,嗜睡,自汗,盗汗,下肢微肿,晨僵,夜间痛,胀痛,五心烦热,舌质紫暗或见瘀斑瘀点,脉缓,脉弱;术后2周以“脾虚气滞证”为主,辨证要点为:五心烦热,头晕目眩,耳鸣或耳聋,双目干涩,口燥咽干,五更泻,自汗,隐痛,下肢微肿,舌淡紫,舌苔腻,脉弦;术后3周以“脾肾亏虚证”为主,辨证要点为:形体肥胖,五更泻,头晕目眩,喜热饮,盗汗,自汗,隐痛,舌淡,脉弦,脉细或涩。“肾阴虚”,“肾阳虚”是贯穿整个膝骨性关节炎围手术期的主要辨证要素,故与以上述4证均可相兼,形成不同的临床证候。
[Abstract]:Objective: This study through investigation of large sample cases, in order to understand the changes of TCM syndrome characteristics of knee osteoarthritis patients undergoing total knee replacement in perioperative period, and summarizes the changes of the main symptoms of knee osteoarthritis patients in the perioperative period, and for the optimal combination of normative and scientific and reasonable medicine all kinds of medicine diagnosis and treatment of knee osteoarthritis during peri operation, provide a reliable theoretical basis and clinical basis for the treatment and treatment of perioperative stages more, intends to establish a standardized and effective a knee arthritis treatment peri operation period, so as to realize the knee osteoarthritis patients during operation each period of treatment based on syndrome differentiation. Methods: the research object for the January 2014 -2015 year in December during the voluntary acceptance of the artificial knee joint and joint surgery hospital of Xinjiang Medical University Affiliated Hospital of traditional Chinese Medicine Treatment of resurfacing surgery patients. Using the method of questionnaire investigation, the cases included in the study, collecting basic data and clinical symptoms during perioperative period of each observation node data to establish a database, using frequency analysis method to study the distribution of patients in the perioperative period of each observation node symptoms, and then through the analysis of clustering and Logistic regression and summarized the diagnosis of TCM syndrome type of operative observation node and the main symptoms of patients with osteoarthritis of the knee. Results: the study included 300 effective cases, 21.3% were male (64 cases), women accounted for 78.7% (236 cases), 3.68 times as many women as men with the case; the minimum age in patients 43 years of age, the maximum age of the patients was 80 years old, 300 patients age number: 65.4 + 6.20 years old, the age more than 64 years old patients accounted for 57.7% of the total sample; according to the patient's nationality can be divided into 7 categories, package Including: Han, Hui, Mongolian, Uygur, Kazak, Kirgiz nationality in Dongxiang, such as the Han, most patients, 225 cases, accounting for 75% of the total number of cases, 33 cases of Uygur patients, accounted for 11%, the total number of cases; 300 cases of patients, duration of 2-26 years, the average duration of 7.4 + 3.51 years; perioperative TCM syndrome differentiation factors as follows: kidney yin deficiency, kidney yang deficiency, kidney deficiency, liver deficiency, liver deficiency, liver qi deficiency, liver blood deficiency, spleen deficiency, spleen deficiency, spleen deficiency, qi stagnation, blood stasis, phlegm, dampness, damp heat, etc. 15. Analysis of the perioperative period of the the main observation node syndrome: operation early in "kidney yin deficiency and kidney yang deficiency of liver yin deficiency of liver Yang liver blood deficiency of spleen yin deficiency of spleen yang deficiency Phlegm Blood stasis is the main syndrome; 1 weeks after operation with kidney yin deficiency of kidney yang deficiency of kidney qi deficiency of spleen yin deficiency of spleen yang deficiency and spleen deficiency qi stagnation and blood stasis syndrome is the main syndrome; surgery after 2 weeks with kidney yin deficiency 闃宠櫄鑲炬皵铏氭皵婊炩，

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