本文選題：烏梅丸加減　切入點(diǎn)：大腸腺瘤　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：研究目的根據(jù)烏梅丸古方今用的臨床經(jīng)驗(yàn),本課題將其用于治療大腸腺瘤內(nèi)鏡下切除術(shù)后的患者,采用隨機(jī)對(duì)照方法,觀察中醫(yī)藥預(yù)防大腸腺瘤切除術(shù)后復(fù)發(fā)的療效及患者癥狀的改善,并分析大腸腺瘤術(shù)后復(fù)發(fā)的影響因素,從而有效預(yù)防大腸腺瘤術(shù)后復(fù)發(fā),提高臨床療效,為運(yùn)用中醫(yī)藥預(yù)防大腸腺瘤術(shù)后復(fù)發(fā)提供理論依據(jù)。研究方法在我院住院患者中,選擇60例符合大腸腺瘤納入標(biāo)準(zhǔn)的患者,隨機(jī)分成對(duì)照組和治療組。經(jīng)腸鏡行大腸腺瘤切除術(shù)后,兩組患者均給予禁食、抗感染、營(yíng)養(yǎng)支持等常規(guī)治療。治療組則在對(duì)照組基礎(chǔ)上,即于術(shù)后7天加服烏梅丸加減中藥湯劑(炙烏梅30g,太子參10g,炒白術(shù)10g,炮姜5g,川連3g,煨木香10g,陳皮10g,生苡仁20g,升麻10g,炙甘草3g),脾虛,大便乏力,溏爛者,加茯苓15g,淮山藥15g;陽(yáng)虛,形寒怕冷,大便溏薄者,加肉豆蔻6g、訶子5g;氣滯,大便不暢者,加檳榔10g、枳實(shí)10g、大黃5g;濕熱內(nèi)盛,口苦,苔黃膩者,加黃芩10g、煨葛根10g。按上述劑量煎煮,每日1劑,分早晚2次口服,療程為3個(gè)月。對(duì)照組患者不作任何處理。于術(shù)后6個(gè)月復(fù)查腸鏡,觀察復(fù)發(fā)情況及影響復(fù)發(fā)的相關(guān)因素,如患者年齡、性別、腺瘤的部位、大小、數(shù)目、病理類型等性質(zhì),并進(jìn)行臨床癥狀改善情況的比較。研究結(jié)果術(shù)后隨訪,6個(gè)月后統(tǒng)計(jì)結(jié)果顯示60例患者中復(fù)發(fā)28例,總復(fù)發(fā)率為46.7%。其中對(duì)照組復(fù)發(fā)18例,復(fù)發(fā)率為60%,治療組復(fù)發(fā)10例,復(fù)發(fā)率為33%,經(jīng)統(tǒng)計(jì)學(xué)檢驗(yàn),兩組患者術(shù)后復(fù)發(fā)率存在顯著差異(p0.05)。對(duì)大腸腺瘤術(shù)后復(fù)發(fā)的患者進(jìn)行臨床分析,復(fù)發(fā)與患者年齡、腺瘤數(shù)目、瘤變程度比較,p0.05,具有統(tǒng)計(jì)學(xué)意義,復(fù)發(fā)與患者性別、腺瘤大小、部位及腺瘤類型比較,p0.05,無(wú)統(tǒng)計(jì)學(xué)意義。術(shù)前,治療組患者的腹痛、腹脹、便秘、腹瀉、口苦、里急后重的中醫(yī)癥狀評(píng)分與對(duì)照組比較,p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義,術(shù)后6個(gè)月,治療組中醫(yī)證候積分(除里急后重)與治療前相比,p0.05,具有統(tǒng)計(jì)學(xué)意義,對(duì)照組中醫(yī)證候積分與治療前相比,p0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。研究結(jié)論利用烏梅丸加減中藥辯證施治大腸腺瘤術(shù)后患者,在一定程度上可降低大腸腺瘤的術(shù)后復(fù)發(fā)率,有效改善患者腹痛、腹脹、便秘、腹瀉、口苦、里急后重等中醫(yī)癥狀、體征,促進(jìn)患者恢復(fù),且無(wú)明顯不良反應(yīng)。通過(guò)對(duì)術(shù)后復(fù)發(fā)的患者進(jìn)行臨床分析發(fā)現(xiàn),復(fù)發(fā)情況與病患的年齡、腺瘤數(shù)目及瘤變程度皆有一定的相關(guān)性,與病患的性別、腺瘤的大小、部位及類型無(wú)顯著相關(guān)性。
[Abstract]:Objective according to the clinical experience of Wumei Pill, we used it in the treatment of colorectal adenoma after endoscopic resection. To observe the effect of traditional Chinese medicine (TCM) on preventing recurrence of colorectal adenoma after resection and the improvement of patients' symptoms, and to analyze the influencing factors of postoperative recurrence of colorectal adenoma, so as to effectively prevent recurrence of colorectal adenoma and improve clinical curative effect. In order to provide a theoretical basis for the prevention of postoperative recurrence of colorectal adenoma with traditional Chinese medicine, 60 patients with colorectal adenoma were selected in our hospital. The patients in the two groups were treated with fasting, anti-infection, nutritional support and other routine treatments. The treatment group was based on the control group. That is, on the 7th day after operation, add and subtract traditional Chinese medicine decoction (30 g, 10 g of Radix Pseudostellariae, 10 g of Radix Pseudostellariae, 10 g of Atractylodes macrocephala, 5 g of Ginger, 3 g of Sichuan Lian, 10 g of simmer, 10 g of Old Peel, 20 g of seed seed, 10 g of Constantine, 3 g of grilled Glycyrrhiza uralensis, deficiency of spleen, weakness of large stool, loose stool, 15g of Fuling, 15g of yam, Yang deficiency, Cold cold, thin stool, 6 g nutmeg, 5g chebula, 10g areca nut, 10g Areca, 10g Aurantii, 5g rhubarb, 10g damp heat, bitter mouth, greasy moss, 10g baicalin, 10g simmer pueraria root 10g. The patients in the control group were treated with enteroscopy at 6 months after operation to observe the recurrence and related factors, such as age, sex, location, size and number of adenoma. The results showed that 28 of the 60 patients had recurrence, and the total recurrence rate was 46.7.The results showed that 18 patients in the control group were relapsed. The recurrence rate in the treatment group was 10 cases and the recurrence rate was 33%. There was a significant difference in the recurrence rate between the two groups by statistical test (p 0.05). The clinical analysis of the patients with recurrence of colorectal adenoma was made, the recurrence and age of the patients, the number of adenomas, and the number of adenomas were analyzed. There was no significant difference between recurrence and sex, size, location and type of adenoma. Before operation, abdominal pain, abdominal distension, constipation, diarrhea, bitter mouth were found in treatment group. Compared with the control group, the scores of TCM symptoms in the treatment group were significantly higher than those in the control group (P 0.05), and there was no significant difference in the scores of TCM symptoms between the treatment group and the control group. Six months after the operation, the score of TCM syndrome in the treatment group was significantly higher than that in the control group (P 0.05). In the control group, the score of TCM syndromes was not significantly different from that before treatment. Conclusion the postoperative recurrence rate of colorectal adenoma can be reduced to a certain extent by adding and subtracting traditional Chinese medicine with Wumei Pill in the treatment of colorectal adenoma. It can effectively improve the symptoms and signs of TCM, such as abdominal pain, abdominal distension, constipation, diarrhea, bitter mouth, severe internal and external symptoms, and promote the recovery of patients, and there is no obvious adverse reaction. Recurrence was correlated with age, number and degree of adenoma, but not with sex, size, location and type of adenoma.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.34

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