顽固性功能性便秘患者躯体症状分类的规律研究及治疗

发布时间：2018-01-24 16:34

本文关键词： 顽固性功能性便秘躯体症状规律研究顽固性功能性便秘躯体症状治疗　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：本研究通过对顽固性功能性便秘患者躯体症状分类的规律研究来指导临床上伴有多种躯体症状的顽固性功能性便秘患者的诊断问题。方法：将2015年6月1日—2016年2曰1日期间在成都肛肠专科医院门诊就诊或在便秘科住院并符合纳入标准的顽固性功能性便秘患者进行相关量表的调查,包括《一般情况调查表》、《便秘症状评分量表》、《躯体症状分类量表》。分析患者一般情况、躯体症状分类特点、躯体症状与便秘相关症状的相关性,找出顽固性功能性便秘患者的一般规律基躯体症状分类规律结果：54例顽固性功能性便秘伴多种躯体症状的患者中,性别分布呈现女性明显超过男性患者趋势;年龄构成中患者人群主要分布在40-59岁这个年龄段;受教育程度分布,患者人群处于小学、初高中文化水平占了大部分比例;职业分布中,农民和无业人员占了人部分比例;躯体症状对社会功能有严重影响,患者对躯体症状的肯定的关注度;临床症状以排便不尽感、肛门坠胀最为突出;躯体症状分类主要以抑制性躯体症状为主;抑制性躯体症状与排便困难、排便不尽感、排便时间呈正相关;患者激惹性躯体症状与腹痛、腹胀呈正相关;生物性躯体症状与病程、排便频率呈正相关.结论：本课题通过研究表明中年女性、文化水平不高、从事农业及无业人员在顽固性功能性便秘患者比例较高,顽固性功能性便秘患者所表现出的躯体症状对社会功能有严重影响,患者对躯体症状有肯定的关注度,提示临床医师应重视此类便秘患者。顽固性功能性便秘患者临床表现特征主要为排便不尽感和排便时间长。对于以肛门坠胀感,排便不尽感、排便时间长为主要症状前来就诊的便秘患者应格外重视。顽固性功能性便秘患者以抑制性躯体症状为主,不同躯体症状与不同的便秘症状有关联。用躯体症状分类量表评估患者精神心理状态简单易操作,适用于所有临床工作者。目的：本研究通过对顽固性功能性便秘伴随躯体症状患者进行个体化治疗,以观察躯体症状分类治疗的临床疗效。方法：本研究对20例顽固性功能性便秘患者,明确躯体症状类型后,采取相应的推荐治疗方案。采用自身前后对照的方法,比较治疗前后患者便秘相关症状量表评分及躯体症状量表评分,同时观察药物副反应。结果：20例患者完成3个月随访,均无明显不良反应发生。1个月治疗后有效率为60%,3个月治疗后总有效率为75%。患者基线与治疗4周躯体症状总分比较(56.80±9.96VS43.5±7.87),双侧近似P1值=0.0000.05,差异有统计学意义。患者基线与治疗12周躯体症状总分比较(56.80±9.96VS37,70±8.52),双侧近似P2值=().0000.05,差异有统计学意义。患者基线与治疗4周便秘总分比较(15.10±2.75VS10.50±3.24),双侧近似P1值=0.0000.05,差异有统计学意义。患者基线与治疗12周便秘总分比较(15.10±2.75VS8.00±3.93),双侧近似P2值=0.0000.05,差异有统计学意义。结论：根据病人躯体症状的分类具体情况而采用个体化的治疗方案,能显著改善患者消化道症状及焦虑抑郁情绪,疗效满意,且无明显不良反应发生。
[Abstract]:Objective: through the study on the regularity of obstinate functional constipation patients symptoms classification to guide the diagnosis of obstinate functional constipation patients with multiple somatic symptoms in clinic. Methods: from June 1, 2015 to 2016 2, 1 days during hospitalization of constipation in Chengdu anorectal Hospital outpatient or with intractable patients with functional constipation were investigated into the standard scale, including the general situation questionnaire < >, < > constipation symptom score, "analysis of the general condition of the patient body symptoms. Classification scale, characteristics of somatic symptoms, physical symptoms and related constipation symptoms, find a general rule based classification of somatic symptoms the results of patients with obstinate functional constipation: 54 cases of patients with obstinate functional constipation with somatic symptoms of various, gender distribution showed women significantly more than men suffering from Age structure trend; people were mainly distributed in the 40-59 year old age; education distribution, patients in the primary school, junior high school and senior high school educational level accounted for most of proportion; occupation distribution, farmers and the unemployed accounted for the proportion of people; physical symptoms have serious impact on the social function of patients with somatic symptoms the positive attention; clinical symptoms with endless defecation, anal bulge is most prominent; somatic symptoms classification mainly inhibited somatic symptoms; inhibition of somatic symptoms and defecation difficulties, endless defecation, defecation time was positively correlated with somatic symptoms; irritability and abdominal pain, abdominal distension was positively related to biology; of course with somatic symptoms, defecation frequency was positively correlated. Conclusion: through the study showed that middle-aged women, cultural level is not high, engaged in agriculture and the unemployed in obstinate functional constipation patients compared with High in patients with obstinate functional constipation showed somatic symptoms have serious impact on the social function of patients with somatic symptoms have certain degree of concern, suggesting that clinicians should pay more attention to such patients with constipation. Obstinate functional constipation in patients with clinical features included defecation imcompletely and defecation time for anal bulge long. The sense of endless defecation, defecation time as the main symptoms of constipation patients come to treatment should be paid special attention. Patients with obstinate functional constipation by inhibition of somatic symptoms, different somatic symptoms. Associated with different symptoms of constipation with somatic symptoms classification scale to assess mental state with simple and easy to operate, suitable for all clinical workers. Objective: This study of obstinate functional constipation in patients with somatic symptoms of individual treatment, to observe clinical curative effect of physical symptoms classification treatment. Methods: the study of 20 cases of obstinate functional constipation, clear body symptom type, take the recommended treatment accordingly. By self-control method, comparison of patients before and after treatment of constipation related symptoms score and physical symptoms scale score, and observe the adverse drug reaction. Results: 20 patients completed 3 months of follow-up, there were no.1 months after treatment of adverse reaction rate was 60%, 3 months after treatment, the total efficiency of 75%. patients at baseline and after 4 weeks of treatment, body symptom scores (56.80 + 9.96VS43.5 + 7.87), bilateral approximate P1 value of =0.0000.05, there were statistically significant differences in baseline and treatment in 12. Week of somatic symptoms scores (56.80 + 9.96VS37,70 + 8.52), bilateral P2 =.0000.05 (approximate), the difference was statistically significant. The baseline and 4 weeks of treatment in patients with constipation scores (15.10 + 2.75VS10.50 + 3.24), bilateral approximate P1 value =0 .0000.05, the difference was statistically significant. The baseline and 12 weeks of treatment in patients with constipation scores (15.10 + 2.75VS8.00 + 3.93), bilateral approximate P2 value =0.0000.05, the difference was statistically significant. Conclusion: the individualized treatment according to the patient's specific situation and classification of physical symptoms with emotional symptoms and anxiety, depression in patients with digestive tract significantly to improve the curative effect, with no obvious adverse reactions.

【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.35

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