上中下通用痛风汤治疗痔术后顽固性疼痛的回顾性研究

发布时间：2018-03-15 02:37

本文选题：痔　切入点：顽固性疼痛　出处：《北京中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：痔疮是临床常见病和多发病,流行病学调查显示我国痔疮发病率为49.14%。临床症状以便血、肛内肿物脱出、肛周异物感、疼痛等为主要表现,极大地影响生活质量。目前,对中重度痔疮临床上大多以外科手术治疗为主,且临床可供选择的手术方式也很多,绝大多数患者都可得到满意治疗。但临床发现部分痔术后患者在创面愈合后,仍出现临床难以解释的顽固性疼痛。为此,本课题采用回顾性研究,验证上中下通用痛风汤对痔术后顽固性疼痛的临床疗效。方法：本课题收集2010年08月～2016年01月期间在北京中医药大学东直门医院肛肠科门诊诊断为痔术后,且门诊处方为上中下通用痛风汤(加减)患者63例,作为研究对象。采用电话回访患者就诊时疼痛程度、伴随症状及用药1w、2w后疼痛程度,并采用疼痛数字评分(Numeric Rating Scales, NRS)对患者疼痛程度进行客观记录。应用SPSS 20.0进行统计学分析,计量资料用均数加减标准差表示(x±s),正态分布者,可用t检验,不符合正态分布者,应用非参数检验；计数资料应用卡方检验。结果：63例患者中男性26例,女性37例。最小年龄24岁,最大年龄86岁,平均年龄58.67±11.80岁。63例患者中诊断为单纯痔术后患者45例,伴湿疹诊断患者4例,伴结、直肠炎诊断患者5例,伴便秘诊断患者4例,伴结肠黑变病患者2例,伴高血压病患者1例,伴高脂血症患者1例,伴肠功能紊乱患者1例。通过电话共有效回访54例患者,剩余9例患者因电话信息缺失或失联致回访失败,患者就诊时NRS评分范围在3～5分,平均4.25±0.49分。回访患者服用上中下通用痛风汤1w、2w后NRS评分,其中53例患者为用药1w后评分,1例为用药2w后评分。平均分为0.87±0.65分,其中0分为15例,显示治愈率为27.8%。患者就诊时NRS评分和用药后NRS评分两组数据经T检验结果示T=33.828,P0.01,表示两组数据有显著差异,治疗后疼痛NRS评分明显优于就诊时。结论：通过本研究证实,上中下通用痛风汤对痔术后顽固性疼痛治疗有显著疗效,能有效缓解患者疼痛症状,能为临床治疗提供可行性参考。
[Abstract]:Objective: hemorrhoids is a common and frequent clinical disease. Epidemiological investigation shows that the incidence of hemorrhoids in China is 49.14. The main manifestations of hemorrhoids are blood, prolapse of tumor in anus, perianal foreign body sensation, pain and so on, which greatly affect the quality of life. Most of the patients with moderate and severe hemorrhoids are treated by surgery, and there are a lot of surgical methods available in clinic. Most of the patients can get satisfactory treatment. However, it is found that some patients with hemorrhoids healed after the operation. There is still intractable pain that is difficult to explain in clinic. For this reason, a retrospective study was used in this study. To verify the clinical effect of upper, middle and lower general gout decoction in treating intractable pain after hemorrhoids operation. Methods: from August 2010 to January 2016, the subjects were collected and diagnosed as hemorrhoids in the outpatient clinic of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine. The outpatient prescriptions included 63 patients with upper, middle and lower general gout decoction (plus or minus). The patients' pain degree, accompanying symptoms and pain degree after 1 week or 2 weeks of treatment were investigated by telephone. The patients' pain degree was recorded objectively by using Numeric Rating scales (NRS). The statistical analysis was carried out with SPSS 20.0. The measurement data were expressed by the standard deviation of mean addition and subtraction. The patients with normal distribution could use t test, and those who did not accord with normal distribution. Results among 63 patients, 26 were male and 37 were female. The youngest age was 24 years old, the maximum age was 86 years, the average age was 58.67 卤11.80 years old and the average age was 58.67 卤11.80 years. There were 4 cases with eczema, 5 cases with colitis, 4 cases with constipation, 2 cases with colonic melanosis, 1 case with hypertension and 1 case with hyperlipidemia. One patient with intestinal dysfunction. 54 patients were effectively visited by telephone. The remaining 9 patients failed due to lack of telephone information or loss of connection. The NRS score range of the patients was 3 ~ 5 points at the time of visit. The average score was 4.25 卤0.49. The NRS score was 0.87 卤0.65 in 53 patients after 1 week of treatment, and 0 in 15 patients. The result of T test showed that there was significant difference between the two groups, and that the NRS score of pain after treatment was obviously better than that of the patient. Conclusion: the results of this study indicate that there is a significant difference between the two groups. Upper, middle and lower general gout decoction has significant curative effect on intractable pain after hemorrhoids operation, can effectively relieve pain symptoms of patients, and can provide a feasible reference for clinical treatment.
【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】：2016
【分类号】：R266

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