中药治疗小儿抽动障碍的远期随访及预后相关因素分析

发布时间：2018-07-21 14:22

【摘要】：研究目的：本课题对临床8年来经中药治疗后症状消失的TD患儿进行回顾性调查研究,并从患儿的发病情况、中医症候改善状况、精神心理因素方面进行对比分析,以观察静心止动方治疗TD的远期疗效、了解抽动患儿的预后情况、以及探究抽动障碍患儿症状复发的相关因素,为提高临床疗效、降低复发率和指导TD患儿的后期调护提供更多依据。研究方法：从广安门医院儿科门诊就诊病例中,选取确诊为抽动障碍,并于2007年9月～2015年9月期间经中药治疗后症状消失的205份病例为研究对象,通过随访调查表的填写,对患儿的发病情况、停药后症状复发情况、中医症候改善状况、精神心理变化情况进行了回顾性调查研究,并通过各因素与抽动患儿症状复发之间相关性的研究,探讨影响抽动患儿预后的相关因素。研究结果：1.基本情况分析：205例停药患儿中,发病高峰在5-7岁,发病的平均年龄为6.55±2.02岁。抽动患儿平均服药时长为30.68±12.13月,最短为11个月,最长为68个月。调查的205例患儿中86例在停药后又出现或曾出现抽动症状,占总研究人数的42.0%,119例未见抽动症状,占总研究人数的58.0%；停药后6个月～1年期间再次出现抽动症状的患儿最多,占复发总人数的58.1%,患儿再次出现的抽动症状大多较为单一且发作频率低,发作持续时间最长不超过2个月,最短数天症状即可消失,耶鲁量表评分均为轻度。其中84例在经过饮食控制及生活习惯调整后症状可自行消失；5例出现症状时即再次服用中药治疗,后症状消失。未见停药2年后出现抽动症状的患儿。2.不同证候类型、性别、病程、停药时间、曾服西药与抽动患儿症状的复发经卡验,显示P值分别为0.215,0.834,0.735,0.65,0.952(P0.05),差异没有统计学意义,提示此5项与抽动患儿症状的复发无相关性。随着停药时间的增长,再次出现抽动症状的患儿与未见复发的患儿比例逐渐增大,距离停药时间在6个月-1年内出现症状的频数最高,占总复发病例的58.1%。3.升学压力与抽动症状复发经x2检验后有显著的统计学意义(P0.05),说明升学压力与抽动症状复发有相关性。运动情况、手机电视控制情况、饮食控制状况与抽动患儿症状的复发经卡方检验,显示P值0.05,差异没有统计学意义。4.中医治疗在各项症状的改善方面效果显著。在比较纳食差、睡眠差、遗尿、尿频、便秘、鼻塞、咽部不适、多汗、过敏性皮肤瘙瘁、腹痛、胸闷11项抽动患儿常见症状与复发的相关性中,睡眠差、尿频和鼻塞症状与复发有相关性,余8项均无相关。5.精神心理因素方面,脾气急、胆小、爱委屈、焦虑敏感、运动性行为问题、注意力差、交往障碍与抽动患儿症状的复发经卡方检验,显示P值分别为0.303,0.088,0.000,0.000,0.000,0.886,0.247,爱委屈、焦虑敏感、运动性行为问题(P0.05),差异有统计学意义,提示此3项与复发有相关性。结论：TD患儿的发病高峰为5-7岁,在症状消失停药的初期病情仍不稳定,停药后的6个月～1年之间容易出现抽动症状的复发,在此期间对患儿的饮食起居仍应给予适当的控制。导师认为本病的病理基础是心主神明失调,通过从心论治,TD患儿中医症候明显改善且疗效持久,静心止动方治疗TD的远期疗效显著。升学压力大是造成患儿抽动症状复发的原因之一,处于小升初或初升高阶段的患儿停药后更容易再次出现抽动症状,故在此阶段对患儿应予重视,注意休息,避免劳累。发病时伴有鼻塞、睡眠差、尿频症状的患儿后期出现症状的概率高于不伴有此症状的患儿,且此三方面症状的改善对抽动症状复发风险的降低有一定的影响。平素性格易委屈、焦虑、敏感、或伴有吃手、抠鼻子、啃指甲等运动性行为问题的患儿更容易在停药后再次出现症状,说明精神心理问题是影响TD患儿抽动症状复发的主要因素。这一方面佐证了导师对本病病机心主神明失调认识的正确性及从心论治的有效性,另一方面,在中药治疗的基础上应对此类患儿给予适当的心理疏导,缓解患儿的紧张情绪从而稳定病情,预防症状复发。
[Abstract]:The purpose of this study was to investigate the relationship between the symptoms and recurrence of children with acute stroke . The results were as follows : 1 . The results of this study were as follows : 1 . The clinical curative effect , the symptoms of relapse after drug withdrawal , the improvement of TCM syndrome and the change of mental state were investigated . The results were as follows : 1 . The average age of the patients with withdrawal symptoms was 6.55 卤 2.02 years .
Most of the children with recurrent symptoms occurred 6 months to 1 year after the drug withdrawal , accounting for 58.1 % of the total number of recurrent symptoms . The symptoms of the re - emergence of the children were mostly single and the frequency of attack was low , the duration of the onset was not more than 2 months , and the scores of Yale scale were mild . Among them , 84 cases were able to disappear spontaneously after diet control and lifestyle adjustment .
There was no significant difference between the symptoms and the recurrence of the symptoms of the children . The results showed that there was no correlation between the symptoms and the recurrence of the symptoms of the children . The results showed that the difference was 0 . 3 . 0 . 0 . 0 . 0 .
【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】：R277.7

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