發(fā)布時(shí)間：2018-02-26 02:26

  本文關(guān)鍵詞： 痔瘡 手術(shù) 氣病 中醫(yī)證候　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本課題從氣病辨證的角度,按病與證相結(jié)合的思想制定臨床觀察表,在運(yùn)用統(tǒng)計(jì)方法對(duì)臨床觀察所得的痔瘡患者圍手術(shù)期的一般資料、四診信息及手術(shù)信息進(jìn)行處理、分析的基礎(chǔ)上,以術(shù)前為參照,從癥狀、證候及其與術(shù)中相關(guān)因素的關(guān)聯(lián)等方面研究痔術(shù)后氣病中醫(yī)證候的分布特點(diǎn),再進(jìn)一步探討痔手術(shù)與氣病的關(guān)系,并從氣病論治,指導(dǎo)中醫(yī)藥干預(yù)在痔圍手術(shù)期的應(yīng)用,以提高臨床療效,促進(jìn)患者早日康復(fù),同時(shí)為相關(guān)的科研提供一定的參考價(jià)值。方法:1.查閱相關(guān)文獻(xiàn)利用文獻(xiàn)數(shù)據(jù)庫查閱痔瘡、圍手術(shù)期、氣病辨證、中醫(yī)證候等方面的相關(guān)文獻(xiàn),在本課題的研究思路和方法上形成一個(gè)提綱式的認(rèn)識(shí)。2.咨詢專家教授向有關(guān)專家及教授咨詢痔瘡、氣病等相關(guān)理論的疑難問題,進(jìn)一步明確本課題研究的側(cè)重點(diǎn)。3.組建課題研究小組由課題負(fù)責(zé)人召集小組成員商討臨床觀察表的制定、填寫及信息資料的采集等相關(guān)事宜,并對(duì)相關(guān)的研究人員進(jìn)行培訓(xùn)。4.制定臨床觀察表按中醫(yī)望、聞、問、切四診合參的要求,依據(jù)痔瘡及氣病的診斷標(biāo)準(zhǔn),初步設(shè)計(jì)表格并進(jìn)行預(yù)調(diào)研,再根據(jù)反饋結(jié)果,制定《痔瘡患者圍手術(shù)期的氣病中醫(yī)證候臨床觀察表》。5.搜集臨床資料,填寫相關(guān)信息搜集符合研究標(biāo)準(zhǔn)的痔瘡患者的一般資料、四診信息及手術(shù)信息,按要求把它們填寫到對(duì)應(yīng)的表格中,整理后交給有高級(jí)職稱的醫(yī)師篩選關(guān)鍵信息,并及時(shí)修正調(diào)查研究的策略。6.匯總有效信息,建立數(shù)據(jù)庫對(duì)符合研究標(biāo)準(zhǔn)的126例痔瘡患者的一般資料、四診信息及手術(shù)信息進(jìn)行匯總,再分別導(dǎo)入IBM SPSS statistics version 22.0軟件包中,建立相應(yīng)的數(shù)據(jù)庫。7.運(yùn)行統(tǒng)計(jì)軟件按本課題的研究目的、思路與方法分別提取相應(yīng)的有效數(shù)據(jù),再針對(duì)不同類型的數(shù)據(jù)資料,分別采用頻數(shù)統(tǒng)計(jì)分析、多重響應(yīng)分析、logistic回歸分析、獨(dú)立性檢驗(yàn)、卡方檢驗(yàn)、非參數(shù)檢驗(yàn)等統(tǒng)計(jì)方法對(duì)其進(jìn)行處理,并將統(tǒng)計(jì)軟件的運(yùn)行結(jié)果繪制成相應(yīng)的表格或圖形。8.解釋并討論統(tǒng)計(jì)結(jié)果結(jié)合基礎(chǔ)理論知識(shí)、臨床實(shí)踐的反饋及相關(guān)的科研資料,對(duì)統(tǒng)計(jì)軟件的運(yùn)行結(jié)果及對(duì)應(yīng)的表格與圖形,分別進(jìn)行合乎專業(yè)的解釋與討論。結(jié)果:(1)在126例痔瘡患者中,男性有72例,女性有54例,男女發(fā)病的性別比例為1.33:1。發(fā)病年齡最小的為19歲,最大的為79歲。發(fā)病人數(shù)最多的為34～48歲這個(gè)年齡段,共41例,占總體的32.5%,其次為49～63歲,共40例,占總體的31.7%。(2)從術(shù)前1天到術(shù)后第7天,痔瘡患者的舌色與舌形、苔色與苔質(zhì)以及脈象的變化均無顯著性差異。(3)術(shù)前1天氣病中醫(yī)證候的分布以氣陷證為主,其次為氣滯證,所占的比例分別為51.6%、25.4%;術(shù)后第1天氣病中醫(yī)證候的分布以氣虛證為主,占53.2%,氣滯證所占比例減至19.0%;術(shù)后第3天氣病中醫(yī)證候的分布仍以氣虛證為主,所占比例為43.7%,其次是氣滯證,所占比例為34.9%;術(shù)后第7天氣病中醫(yī)證候的分布以氣滯證為主,所占比例為47.6%,比例最少的為氣逆證,僅占7.2%。(4)圍手術(shù)期痔瘡患者氣病中醫(yī)證候的整體分布有顯著性差異。與術(shù)前1天比較,術(shù)后第1天氣病中醫(yī)證候的分布有顯著性差異,術(shù)后第3、7天氣病中醫(yī)證候的分布均無顯著性差異;與術(shù)后第1天比較,術(shù)后第3天氣病中醫(yī)證候的分布無顯著性差異,術(shù)后第7天氣病中醫(yī)證候的分布有顯著性差異;與術(shù)后第3天比較,術(shù)后第7天氣病中醫(yī)證候的分布無顯著性差異。(5)從術(shù)前1天到術(shù)后第7天,隨著時(shí)間的推移,氣虛證與氣逆證的頻數(shù)均呈先增加后減少的趨勢(shì),氣陷證的頻數(shù)呈逐漸減少的趨勢(shì),氣滯證的頻數(shù)呈逐步增多的趨勢(shì)。(6)痔術(shù)后第一天氣病中醫(yī)證候的整體分布與術(shù)中出血量無相關(guān)性,而與麻醉方式、手術(shù)方式、手術(shù)時(shí)間存在相關(guān)性。痔術(shù)后第一天氣虛證、氣陷證、氣逆證的分布與手術(shù)時(shí)間存在相關(guān)性,與麻醉方式、手術(shù)方式及術(shù)中出血量無相關(guān)性;氣滯證的分布與手術(shù)時(shí)間等均不存在相關(guān)性。結(jié)論:痔手術(shù)會(huì)促進(jìn)氣病的產(chǎn)生與發(fā)展,也對(duì)痔術(shù)后氣病中醫(yī)證候的分布與變化帶來影響。痔圍手術(shù)期的氣病辨證應(yīng)秉承中醫(yī)整體觀念的思想,在氣病論治方面堅(jiān)持祛邪扶正的原則,根據(jù)氣病的證候分布特點(diǎn)合理使用中醫(yī)藥進(jìn)行干預(yù),以促進(jìn)患者早日康復(fù),達(dá)到"陰平陽秘、精神乃治"的和諧狀態(tài)。本課題的研究成果可在一定程度上指導(dǎo)痔圍手術(shù)期的臨床用藥,縮短痔瘡患者的康復(fù)進(jìn)程,踐行近年來外科學(xué)界提出的"控制性損傷"及"快速康復(fù)"等相關(guān)理念。
[Abstract]:Objective: this topic from the dialectical point of disease, disease and syndrome according to the idea of combining the development of clinical observation table, in general data using statistical methods of perioperative patients with hemorrhoids clinical observation on the treatment of the diagnostic information and operation information, based on the analysis of the preoperative reference, from the distribution of symptoms. The characteristics of the syndrome and its related factors in operation and related aspects of hemorrhoid postoperative disease syndromes, to further explore the relationship of hemorrhoids surgery and disease, and from disease treatment, the guidance of Chinese medicine intervention in the perioperative period of hemorrhoids, to improve clinical curative effect, promote the rehabilitation of patients, at the same time provide a certain reference value for related research. Methods: 1. literatures using literature database access hemorrhoids, perioperative period, disease differentiation, syndrome of traditional Chinese medicine related literature and other aspects of the formation, on the road and method in this research thinking A more understanding of.2. consulting experts and professors to the relevant experts and professors of hemorrhoids, disease and other related theoretical problems, to further clarify the research emphases of.3. to set up the research team by team members to discuss the topics for the convener of the clinical observation table for acquisition and other related matters, and fill in the information, and Study on relevant personnel training.4. make the clinical observation table according to the traditional Chinese medicine look, smell, ask, cut the requirements of four diagnostic methods, based on the diagnostic criteria of hemorrhoids and disease, the preliminary design form and the pre survey, according to the feedback results, making "perioperative patients with hemorrhoids in TCM syndrome disease clinical observation table >.5. collected the clinical data, fill in the relevant information collected in accordance with general information of patients with hemorrhoids research standard, diagnostic information and operation information, according to the requirements of them to fill in the corresponding table, finishing After given the title of senior physician screening strategy.6. key information, and timely correction of investigation and research summary of effective information, establish a database of general information on 126 cases of hemorrhoids patients met the study criteria, diagnostic information and operation information were collected, then import the IBM SPSS statistics version 22 software,.7. database operation statistics the corresponding software according to the purpose of the study, the ideas and methods of the corresponding data were extracted effectively, then according to the different types of data, respectively, using frequency statistical analysis, multiple response analysis, logistic regression analysis, independent test, chi square test, nonparametric test and other statistical methods for its treatment, and statistics the operation of the software was drawn into.8. tables or graphics to explain and discuss the corresponding statistics combined with theoretical knowledge, clinical practice and feedback related department 鐮旇祫鏂，

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