136例慢性便秘病例证治规律回顾性分析

发布时间：2018-11-20 20:21

【摘要】：目的:通过回顾性分析,探索辽宁中医药大学附属医院近3年来慢性便秘住院患者的发病特点及中医证型分布情况,并且分析中医用药规律,通过回顾性分析对慢性便秘的证治规律进行总结,以便为今后开展针对慢性便秘的中西医结合治疗提供客观依据和帮助。资料与方法:收集自2014年1月至2016年9月在辽宁中医药大学附属医院脾胃科住院治疗的136例慢性便秘患者的基本自然信息、发病相关因素以及中医辨证分型和用药等资料,将收集整理后的数据建立成数据库,运用SPSS17.0软件,对其进行统计分析处理,P0.05认为差异有统计学意义。结果:1.一般资料分析:本次研究共收集慢性便秘患者病例136例,其中男性患者49例占36.02%,女性患者87例占63.98%,男女比例为1:1.77,总体平均年龄为(65.67±12.73)岁;年龄区间在60-89岁的老年组患者人数比例最大,为68.4%(P0.05);患者的职业构成中业务员及离退休人员占据绝大多数,为总人数的86.8%(P0.05);病程最短为1年,病程最长为40年,患病2-5年的人数最多为40.4%(P0.05);不同季节患病人数基本相同。2.证型分布情况:慢性便秘分为四个证型,肠道实热证28例(20.59%),肺脾气虚证58例(42.65%),肠道气滞证42例(30.88%),津亏血少证8例(5.88%),肺脾气虚证和肠道气滞证的人数较多(P0.05);各个证型在不同年龄区间的差异没有统计学意义(P0.05),各年龄段均以肺脾气虚证及肠道气滞证占多数;不同性别的各证型比例无统计学差异(P0.05)。3.中医用药统计:136名患者共使用药物总数为115味,总频次为1605次,使用频次最高的20味药:郁李仁、枳实、陈皮、大黄、甘草、桃仁、柴胡、杏仁、白术、厚朴、白芍、茯苓、木香、槟榔、火麻仁、当归、牛膝、莱菔子、生地黄、黄芪。不同证型的常用药:肠道实热证应用频次最高的10味药:杏仁、枳实、桃仁、牛膝、厚朴、麦冬、白术、白芍、麻子仁、大黄,为麻子仁丸加减的主要药物组成;肺脾气虚证应用频次最高的10味药:枳实、甘草、陈皮、白术、火麻仁、厚朴、桃仁、茯苓、黄芪、党参,为黄芪汤加减的主要药物组成;肠道气滞证应用频次最高的10味药:枳实、大黄、柴胡、木香、火麻仁、槟榔、郁李仁、厚朴、陈皮、乌药,为六磨汤加减的主要药物组成;津亏血少证应用频次最高的10味药:火麻仁、陈皮、黄芪、生地黄、当归、桃仁、芒硝、枳实、厚朴、大黄,为润肠丸的主要药物组成。结论:1.一般资料分析:慢性便秘的发生与年龄、性别、职业、季节相关,患病病程以2-5年者最多。中年人、工作生活压力较大的脑力劳动者及平时缺乏运动的退休老年人为本病高发人群,本病秋季多发。2.中医证型分布以肺脾气虚证和肠道气滞证所占比例最大,患病证型与年龄无关,各年龄段发病均以肺脾气虚证和肠道气滞为主。3.辨证用药:本病的常用药:厚朴、大黄、火麻仁、甘草、桃仁、当归、郁李仁、柴胡、杏仁、枳实、白芍、茯苓、陈皮、木香、槟榔、黄芪、牛膝、莱菔子、生地黄。4.基本方:根据实际治疗情况,归纳出治疗本病的基本方由黄芪、白术、枳实、陈皮、厚朴、火麻仁、桃仁、大黄8味药物构成。
[Abstract]:Objective: To study the characteristics of the patients with chronic constipation and the distribution of the syndrome of traditional Chinese medicine in the last three years of the affiliated hospital of the University of Traditional Chinese Medicine in Liaoning Province through the retrospective analysis, and to analyze the rule of the traditional Chinese medicine, and to make a summary of the rule of the treatment of the chronic constipation by retrospective analysis. so as to provide an objective basis and a help for future combined treatment of the traditional Chinese medicine and the western medicine aiming at the chronic constipation. Materials and Methods: 136 cases of chronic constipation were collected from January 2014 to September 2016 in the Department of the Spleen and the Stomach of the Affiliated Hospital of the University of Traditional Chinese Medicine. The collected data was established as a database, and the software of SPSS17.0 was used to carry out the statistical analysis and treatment, and the difference was considered to be of statistical significance. Results: 1. General data analysis: In this study, 136 cases of patients with chronic constipation were collected. Among them, 49 of the male patients accounted for 36.02%, 87 of the female patients were 63. 98%, the ratio of the male to female was 1: 1.77, the overall average age was (65. 67 to 12. 73) years, and the proportion of patients in the old group with the age range of 60 to 89 years was the largest. The number of men and the retirees in the occupational group of the patients was 60.8% (P0.05). The duration of the course was 1 year, the duration of the course was 40 years, and the number of the patients with the disease of 2 to 5 years was 40.4% (P0.05); the number of patients with different seasons was basically the same. The pattern of syndrome distribution: chronic constipation was divided into four syndrome types: 28 cases (20. 59%) of intestinal solid heat syndrome, 58 cases (42. 65%) of lung-qi deficiency syndrome, 42 cases of intestinal qi stagnation syndrome (30. 88%), 8 cases (5.88%) with less blood-deficient blood syndrome, and a higher number of lung-qi and qi-stagnation syndrome (P <0.05). There was no significant difference in the different age range (P0.05), and all the different age groups were in the majority of the lung-spleen-qi deficiency syndrome and the intestinal qi-stagnation syndrome, and there was no statistical difference in the number of the different sexes (P0.05). The traditional Chinese medicine statistics: 136 patients have a total of 115 drugs, the total frequency is 1605, and the most frequently used 20-flavor medicines are: Yu Liren, Fructus Aurantii, Chen Pi, Radix et Rhizoma Rhei, Radix Glycyrrhizae, Semen Persicae, Bupleuri Radix, Semen Armeniacae Amarum, Rhizoma Atractylodis Macrocephalae, Cortex Magnolia Officinalis, Radix Paeoniae Alba, Poria, Radix Aucklandiae, Semen Arecae, Fructus Cannabae, and Radix Angelicae Sinensis. Achyranthis Achyranthis, Lepidium, Radix Rehmanniae, and Radix et Rhizoma Rhei. The common medication of different syndrome type: 10 medicines with the highest application frequency of the intestinal solid heat syndrome: Semen Armeniacae Amarum, Fructus Aurantii, Semen Persicae, Achyranthis Radix, Cortex Magnolia Officinalis, Radix Ophiopogonis, Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba, Fructus Cannabis, and Radix et Rhizoma Rhei, and is the main drug added or modified by the Fructus Cannabinae pill; and the lung qi deficiency syndrome has the highest application frequency of 10 medicines: Fructus Aurantii Immaturus, Radix Glycyrrhizae, Pericarpium Citri Reticulatae, Rhizoma Atractylodis Macrocephalae, Fructus Cannabis, Cortex Magnolia Officinalis, Semen Persicae, Poria, Rhizoma Dioscoreae, and Radix Codonopsis, and is the main drug for adding and subtracting the yellow decoction; the ten medicines with the highest application frequency of the intestinal qi stagnation syndrome: Fructus Aurantii, Radix et Rhizoma Rhei, Bupleuri Radix, Radix Aucklandiae, Fructus Cannabae, Semen Arecae, Semen Pruni, Cortex Magnolia Officinalis, Pericarpium Citri Reticulatae, and Radix Linderae, The preparation method comprises the following components in parts by weight: 10 Chinese-medicinal materials with the highest application frequency, such as fructus cannabis, Chen Pi, Huang Yi, Radix Rehmanniae, Radix Angelicae Sinensis, Semen Persicae, Natrii Sulfas, Fructus Aurantii Immaturus, Cortex Magnolia Officinalis, and Radix et Rhizoma Rhei, and is the main drug for moistening the intestine. Conclusion: 1. General data analysis: The occurrence of chronic constipation is related to age, sex, occupation and season, and the disease course is the most in 2-5 years. middle-aged people, mental workers with high working life pressure and retired old people who do not normally lack exercise are the high-risk group of the disease, and the disease is more frequent in autumn. The pattern of the syndrome of TCM is the largest in the deficiency of the lung-qi and the syndrome of the qi-stagnation of the intestinal tract, and the type of the disease is not related to the age, and the morbidity of each age group is mainly due to the deficiency of the lung-qi and the qi-stagnation of the intestine. The medicine for the treatment of this disease: the common use of the disease: Magnolia officinalis, Radix et Rhizoma Rhei, Fructus Cannabis, Radix Glycyrrhizae, Semen Persicae, Radix Angelicae Sinensis, Semen Pruni, Bupleuri Radix, Semen Armeniacae Amarum, Fructus Aurantii, Radix Paeoniae Alba, Poria, Pericarpium Citri Reticulatae, Radix Aucklandiae, Arecae Semen, Radix Achyranthis Bidentatae, Achyranthis Achyranthis Bidentatae, and Radix Rehmanniae. The basic prescription: according to the actual treatment, it is concluded that the basic prescription for treating the disease is composed of the following Chinese medicinal materials: Huang Yi, Atractylodis Rhizoma, Fructus Aurantii Immaturus, Pericarpium Citri Reticulatae, Cortex Magnolia Officinalis, Fructus Cannabei, Semen Persicae, and Radix et Rhizoma Rhei.
【学位授予单位】：辽宁中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R256.35

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