老年人上消化道出血的病因及中医证治的相关因素浅析

发布时间：2018-03-09 08:43

本文选题：老年人　切入点：上消化道出血　出处：《广西中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:探讨老年人(≥60岁)上消化道出血(upper gastrointestinal bleeding,UGIB)的病因及中医药治疗的现状,以回顾性分析方法对此进行归纳、总结、研究、探讨本病的流行病学特点、病因病机、发病规律、症候特征及中医辨证论治,从而对本病形成一定的认识,并对中医药治疗老年人上消化道出血提供一定的参考依据。方法:回顾分析173例符合条件的上消化道出血的住院患者病例,筛选2012年9月至2015年9月在广西中医药大学第一附属医院脾胃病科出院以上消化道出血为第一诊断的患者,收集其中的年龄、性别、诱因、病因、症状、体征、中医辨证分型、治疗用药、预后等资料,并根据计数及计量资料进行相应的统计分析,现阶段对老年人上消化道出血患者病例资料及其诊疗进行归纳总结,希望对以后的诊治有所帮助。结果:1、173例老年人上消化道出血患者以男性居多,男女比例2.93:1,平均发病年龄72.53±7.92岁;2、老年人上消化道出血患者发病集中在1、9、12;3、老年人上消化道出血患者常见的病因以消化性溃疡,以十二指肠溃疡(DU)、胃溃疡(GU)、复合性溃疡(CU)为主,其次常见胃癌(GC)、食管静脉曲张(EGV);老年人上消化道出血的发病多无明显诱因,主要的诱因以非甾体抗炎药物为常见,其次为饮食不节;4、老年人上消化道出血患者以呕血和(或)黑便为主要症状,其次为头晕、心悸、乏力、出冷汗、频率最高,其次为恶心、反酸、嗳气、腹胀、烧心、呕吐、气短、纳差、口等症状;舌脉以舌淡苔薄白脉细为主;5、老年人上消化道出血主要表现以虚证为主,中医证型以气虚不摄及气虚血溢证最为常见;6、老年人上消化道出血主要以O型血为主;7、中药汤剂主要以归脾汤为主,其次为泻心汤;抑酸药物主要以埃索美拉唑钠为主,占据82.7%;其次以泮托拉唑钠为主,占据14.4%;止血药物使用频率49.1%,31例使用云南白药,40例使用白眉蛇毒凝血酶,14例使用尖吻蝮蛇凝血酶;临床上以辩证论治为主;8、本研究痊愈134例,显效28例,有效4例,总治愈率96.0%,死亡7例:死亡率4.0%。结论:老年人上消化道出血发病以男性居多;季节以秋冬多发;非甾体类抗炎药为本病发病的主要诱因;病因主要为消化性溃疡,其中以十二指肠溃疡多发;主要首发症状为黑便及呕血,中医证型主要以气虚不摄及气虚血溢证为主,中医治疗多以益气、补血、止血为主,中药汤剂主要以归脾汤为主,其次为泻心汤。
[Abstract]:Objective: To investigate the elderly (over 60 years) of upper gastrointestinal hemorrhage (upper gastrointestinal bleeding, UGIB) of the etiology and treatment of traditional Chinese medicine, by retrospective analysis method to summarize, summarize, research, to investigate the epidemiological characteristics of the disease, etiology and pathogenesis, pathogenesis, syndrome characteristics and syndrome differentiation of TCM thus, a certain understanding of the disease, and the treatment of traditional Chinese medicine to provide certain reference for upper gastrointestinal bleeding in elderly patients. Methods: retrospective analysis of 173 cases with upper digestive tract hemorrhage patients hospitalized from September 2012 to September 2015, screening at the First Affiliated Hospital of Guangxi TCM University Hospital Department of digestive tract of spleen and stomach bleeding of the patients with first diagnosis, and collect the age, gender, etiology, symptoms, causes, symptoms, treatment of TCM syndrome differentiation, prognosis, such information, and according to the counting and measurement data The corresponding statistical analysis, at this stage to summarize the clinical data of patients with diagnosis and treatment of upper gastrointestinal bleeding in elderly patients after the treatment, we hope to help. Results: mostly male patients with gastrointestinal bleeding in 1173 elderly patients with upper gastrointestinal, male to female ratio was 2.93:1, the average age of onset was 72.53 + 7.92; 2 patients concentrated in the 1,9,12 of upper gastrointestinal bleeding in elderly patients with peptic ulcer; 3 patients with common causes of upper gastrointestinal bleeding in elderly patients with duodenal ulcer, gastric ulcer (DU), (GU), compound ulcer (CU), the second common gastric cancer (GC), esophageal varices (EGV); the elderly the incidence of upper digestive tract hemorrhage without apparent inducement, the main inducement to non steroidal anti-inflammatory drugs are common, followed by diet; 4 patients with gastrointestinal bleeding hematemesis and elderly upper gastrointestinal (or black) as the main symptom, followed by dizziness, palpitations, fatigue, sweating, frequency The highest, followed by nausea, abdominal distension, belching, acid regurgitation, heartburn, anorexia, vomiting, shortness of breath, mouth and other symptoms; tongue pale tongue with thin white veins fine; 5, mainly to the main deficiency of upper gastrointestinal bleeding in elderly patients, TCM syndrome type of qi deficiency and blood deficiency syndrome is not taken over the most 6, mainly in common; O blood type mainly elderly patients with upper gastrointestinal hemorrhage; 7, decoction of Chinese medicine mainly Guipi Decoction, followed by Xiexin Decoction; acid suppressive drugs mainly esomeprazole sodium, occupy 82.7%; followed by pantoprazole sodium, accounted for 14.4%; the frequency of 49.1% hemostatic drug use. 31 cases of the use of Yunnan Baiyao, 40 cases with 14 cases using bird snake venom thrombin, Agkistrodon thrombin; in clinical dialectical treatment; 8, the 134 cases were cured, 28 cases markedly effective in 4 cases, the total cure rate was 96%, 7 cases of death, mortality 4.0%. conclusion: mostly male incidence road the elderly upper gastrointestinal bleeding; season Multiple festival in autumn and winter; non steroidal anti-inflammatory drugs as the main cause of the disease; the major cause of peptic ulcer, duodenal ulcer with multiple; main symptom was melena and hematemesis, the main syndromes of qi deficiency and Qi deficiency syndrome not taking the blood spilled, Chinese medicine treatment with Qi the blood, hemostatic, traditional Chinese medicine decoction mainly by Guipi Decoction, followed by Xiexin Decoction.

【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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