本文選題：便秘癥狀積分 + 動(dòng)態(tài)觀察��； 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：背景:卒中是臨床上常見的腦血管病,隨著人口老齡化的進(jìn)展及人們生活方式的改變,卒中的發(fā)病率逐年上升。其發(fā)病率高、致殘率高、死亡率高及復(fù)發(fā)率高,嚴(yán)重危害人們的生命和健康。卒中后可出現(xiàn)多種并發(fā)癥。據(jù)文獻(xiàn)報(bào)道,30%-60%的卒中患者會(huì)發(fā)生便秘。便秘不僅給患者帶來軀體上的不適,而且影響其心理健康和生活質(zhì)量,尤其值得警惕的是,患者因排便用力過度可致顱內(nèi)壓增高,加重腦組織損傷,不利于病情康復(fù),同時(shí)腹壓升高可誘發(fā)再卒中、心肌梗死甚至猝死等嚴(yán)重危害。在卒中后便秘的治療方面,西醫(yī)多應(yīng)用緩瀉劑和潤滑劑,如果長期使用會(huì)產(chǎn)生藥物依賴等副作用。中醫(yī)對中風(fēng)病的研究源遠(yuǎn)流長。王永炎教授在總結(jié)歷代醫(yī)家經(jīng)驗(yàn)的基礎(chǔ)上,通過長期的臨床觀察發(fā)現(xiàn),痰熱腑實(shí)是中風(fēng)絕大多數(shù)患者證候演變的共性規(guī)律,且腑實(shí)痰熱的程度與中風(fēng)病的預(yù)后密切相關(guān)。因此,通腑泄?jié)帷⑶鍩釡焯祵χ酗L(fēng)急性期的治療至關(guān)重要。作為化痰通腑法代表方的星蔞承氣湯已在臨床上廣泛應(yīng)用,并取得了良好效果。本研究從疾病、證候的角度出發(fā),探究星蔞承氣湯治療中風(fēng)后便秘的療效。目的:探討星蔞承氣湯對缺血性中風(fēng)急性期痰熱腑實(shí)型便秘和中風(fēng)病的臨床療效及對痰熱腑實(shí)證候的影響。方法:納入急性缺血性中風(fēng)痰熱腑實(shí)證患者57例,以2:1的比例隨機(jī)分為治療組和對照組,兩組在西醫(yī)常規(guī)治療的基礎(chǔ)上,分別給予星蔞承氣湯、乳果糖口服液口服或開塞露灌腸進(jìn)行干預(yù),療程為5±2天。入組6天內(nèi)每日對患者便秘癥狀積分進(jìn)行評(píng)價(jià),觀察兩組便秘癥狀積分、排便患者比例、排便困難患者比例、排便速度、Bristol大便性狀及便秘伴隨癥狀的變化。此外,入組當(dāng)天及腑氣通下后分別對患者的中風(fēng)病癥狀體征積分及痰熱腑實(shí)量表積分進(jìn)行評(píng)價(jià),比較兩組治療前后積分的變化。結(jié)果:1.基線比較:治療前兩組患者的年齡、性別、生命體征、合并基礎(chǔ)疾病、病程及梗死部位等一般情況無統(tǒng)計(jì)學(xué)差異(P0.05),故兩組具有可比性。2.觀察指標(biāo):入組第4、6天治療組的便秘癥狀積分顯著低于對照組(P0.05),余觀察時(shí)點(diǎn)組間比較無明顯差異(P0.05)。入組6天內(nèi)伴腹脹患者的比例組間比較無顯著差別(P0.05);入組前3天兩組伴食欲不振患者比例的組間比較無統(tǒng)計(jì)學(xué)差異(P0.05),第4-6天治療組食欲不振患者比例明顯低于對照組(P0.05)。入組6天內(nèi)兩組排便患者比例、排便困難患者比例、排便速度及Bristol大便分型的組間比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組痰熱腑實(shí)證候積分治療后均較治療前顯著改善(P0.05),但治療后組間比較無明顯差異(P0.05)。治療組治療后的中醫(yī)癥狀體征積分較治療前顯著降低(P0.05),對照組治療前后及治療后組間比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。3.安全性評(píng)價(jià):臨床觀察期間受試者均未出現(xiàn)明顯不適,說明本方案安全可靠,無明顯副作用。結(jié)論:星蔞承氣湯對急性缺血性中風(fēng)痰熱腑實(shí)證患者有較好的療效,能改善中風(fēng)急性期痰熱腑實(shí)證候,明顯緩解便秘及相關(guān)癥狀,并能改善神經(jīng)功能缺損程度,促進(jìn)中風(fēng)病的康復(fù),值得臨床推廣應(yīng)用。
[Abstract]:Background: stroke is a common cerebrovascular disease in clinical. With the progress of population aging and the change of people's way of life, the incidence of stroke is rising year by year. The incidence of stroke is high, the rate of disability is high, the death rate is high and the recurrence rate is high. It is serious harm to people's life and health. There are many complications after stroke. According to the literature, 30%-60% stroke is reported. Constipation causes constipation. Constipation not only brings discomfort to the body, but also affects its mental health and quality of life. It is especially worth vigilant that the patient can increase the intracranial pressure due to excessive defecation, aggravate the injury of the brain tissue and disadvantageous to the recovery of the disease. At the same time, the increase of abdominal pressure can induce further stroke, myocardial infarction and even sudden death. Harm. In the treatment of constipation after stroke, western medicine applies more laxatives and lubricants, if long-term use will produce side effects such as drug dependence. The study of Chinese medicine has a long history of apoplexy. On the basis of summing up the experience of successive generations of doctors, Professor Wang Yongyan, through a long-term clinical observation, found that the phlegm heat is the overwhelming majority of stroke patients. The general rule of syndrome evolution is closely related to the degree of Fu Fu phlegm fever and the prognosis of apoplexy. Therefore, it is very important for the treatment of acute apoplexy in the treatment of the acute stage of apoplexy. To explore the effect of Xing Lou Chengqi Decoction in treating constipation after apoplexy. Objective: To explore the effect of Xing Lou Chengqi Decoction on phlegm constipation and apoplexy in acute phase of ischemic apoplexy and the effect on phlegm heat syndrome. Methods: 57 cases of acute ischemic stroke phlegm hot Fu Fu were divided into treatment group and control group randomly, with the proportion of 2:1. On the basis of conventional treatment of Western medicine, the two groups were given star Chengqi Decoction, orally orally orally or Enema Glycerini enema, with a course of 5 + 2 days. The scores of constipation symptoms were evaluated every day in 6 days, and two groups of constipation symptoms, the proportion of defecation patients, the rate of defecation, the speed of defecation, Bristol Change of constipation and constipation symptoms. In addition, the scores of symptoms and signs of apoplexy and integral of phlegm heat in the patients were evaluated on the day of entering the group and the integral of phlegm heat and Fu Fu, and the results were compared between the two groups before and after treatment. The results were as follows: the 1. baseline was compared: the age, sex, vital signs of the two groups of patients before treatment, and the combination of basic diseases and diseases. There was no statistical difference in the general condition of the course and the infarct location (P0.05), so the two groups had comparable.2. observation indexes: the constipation symptom score of the group on day 4,6 was significantly lower than that of the control group (P0.05), and there was no significant difference between the observation time points group (P0.05). There was no significant difference between the groups with abdominal distension (P0.05) within the group (P0.05). There was no significant difference in the proportion of two groups of anorexia patients in the first 3 days (P0.05), and the proportion of patients with loss of appetite in the 4-6 day group was significantly lower than that of the control group (P0.05). The proportion of the two groups of defecation patients, the proportion of defecating patients, the rate of defecation and the Bristol stool classification were not statistically significant (P0. 05) the two groups of phlegm and heat syndrome were significantly improved after treatment (P0.05), but there was no significant difference between the two groups after treatment (P0.05). The symptoms and signs of TCM in the treatment group were significantly lower than before treatment (P0.05). The difference was not statistically significant (P0.05).3. safety assessment before and after treatment in the control group and after treatment. There was no obvious discomfort during the clinical observation, which showed that the scheme was safe and reliable, and there was no obvious side effect. Conclusion: Xing Lou Chengqi Decoction has good effect on the patients with acute ischemic stroke phlegm and hot Fu Fu, it can improve the phlegm heat syndrome in acute stroke, relieve constipation and related symptoms, and improve the degree of nerve function defect. It is worthy of clinical application to promote the rehabilitation of apoplexy.
【學(xué)位授予單位】：北京中醫(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)】：R277.7

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