本文選題：感覺(jué)功能障礙綜合征　切入點(diǎn)：敷臍療法　出處：《北京中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：PPH手術(shù)感覺(jué)功能障礙綜合征是一組以下腹部牽拉疼痛、術(shù)后肛門疼痛、肛門墜脹、排尿障礙等為主要癥狀群的綜合征。有相當(dāng)一部分病人在PPH治療中出現(xiàn)此類癥狀,患者病情往往輕重不一,有的患者僅有一種癥狀,亦有多個(gè)癥狀并存,臨床上無(wú)法具體定名和診斷。西醫(yī)認(rèn)為PPH擊發(fā)吻合器時(shí)下腹部牽拉疼痛是迷走神經(jīng)反射所引起,引起術(shù)后肛門疼痛、墜脹、排尿障礙原因有多種,可能與麻醉、荷包縫合技術(shù)、手術(shù)操作損傷、患者過(guò)敏等都有關(guān)系,但仍缺乏系統(tǒng)的認(rèn)識(shí)以及完善的治療方法,臨床上大多隨癥處理。該綜合征在臨床上發(fā)生率高,且影響治療效果,給患者帶來(lái)極大痛苦,逐漸得到醫(yī)者重視。祖國(guó)醫(yī)學(xué)擅長(zhǎng)對(duì)癥治療,近年來(lái)很多學(xué)者從祖國(guó)醫(yī)學(xué)角度提出了很多針對(duì)PPH手術(shù)感覺(jué)功能障礙綜合征的治療方法。 目的：本課題試從中醫(yī)學(xué)角度探討PPH手術(shù)感覺(jué)功能障礙綜合征發(fā)生機(jī)理,并觀察中藥溫陽(yáng)行氣臍貼對(duì)PPH手術(shù)感覺(jué)功能障礙綜合征的治療效果。 方法：本臨床研究以2012-2013年度我科符合診斷標(biāo)準(zhǔn)并采用PPH手術(shù)治療的90例患者作為研究對(duì)象,將患者隨機(jī)分為三組,臍貼治療組(A組),地佐辛組(B組),空白對(duì)照組(C組),每組各30例病人,其中A組術(shù)前1h予溫陽(yáng)行氣臍貼貼臍, B組術(shù)前15min靜脈注射地佐辛5mg,C組給予常規(guī)治療。記錄90例患者手術(shù)中心率、血壓的指標(biāo)變化；對(duì)術(shù)中下腹部牽拉疼痛程度,及A組、C組術(shù)后1d、2d、3d肛門疼痛、肛門墜脹、排尿障礙癥狀進(jìn)行評(píng)分,利用SPSS20.0軟件對(duì)結(jié)果進(jìn)行統(tǒng)計(jì)分析。 結(jié)果：術(shù)中A、B、C三組進(jìn)行比較,①心率變化率上,與C組比較,A、B組在PPH擊發(fā)時(shí)及擊發(fā)后5min心率變化率��；與B組比較,A組心率變化率大,且均有統(tǒng)計(jì)學(xué)差異。②平均動(dòng)脈壓變化率上,與C組比較,A組在PPH擊發(fā)時(shí)及擊發(fā)后5minMAP變化率小,但不具有統(tǒng)計(jì)學(xué)差異,B組變化率小,具有統(tǒng)計(jì)學(xué)差異。與B組比較,A組MAP變化率大,且具有統(tǒng)計(jì)學(xué)差異。③下腹?fàn)坷瓷?與C組比較,A、B組術(shù)中疼痛評(píng)分低,且具有統(tǒng)計(jì)學(xué)差異；與B組比較,A組術(shù)中疼痛評(píng)分高,且具有統(tǒng)計(jì)學(xué)差異。 術(shù)后1、2、3天A組、C組進(jìn)行比較,在術(shù)后第1、第2天,A組在肛門墜脹、肛門疼痛、排尿障礙三組癥狀評(píng)分均較低,且具有統(tǒng)計(jì)學(xué)差異,第3天,三組癥狀評(píng)分亦較低,但無(wú)統(tǒng)計(jì)學(xué)差異。 總體療效評(píng)價(jià)： A組對(duì)于PPH手術(shù)感覺(jué)障礙綜合征的治療效果明顯,30例病人,23例顯效,5例有效,2例無(wú)效,總有效率為93.3%, C組30例病人13例顯效,11例有效,6例無(wú)效,總有效率為80.0%,但無(wú)統(tǒng)計(jì)學(xué)差異。 結(jié)論：溫陽(yáng)行氣臍貼在PPH手術(shù)感覺(jué)功能障礙綜合征治療中,改善局部及全身氣血運(yùn)行狀態(tài),加速肛門部氣血功能的自我恢復(fù),在緩解術(shù)中心率下降、牽拉痛以及改善術(shù)后肛門墜脹、肛門疼痛、排尿障礙等癥狀上有一定療效,在治療PPH手術(shù)感覺(jué)功能障礙綜合征上,總體有效率高,可操作性強(qiáng),具有一定臨床意義。
[Abstract]:Sensory dysfunction syndrome in PPH operation is a group of patients with abdominal traction pain, postoperative anal pain, anal distension and dysuria.There are quite a number of patients in the treatment of PPH such symptoms, patients often have different degrees of disease, some patients have only one symptom, but also have multiple symptoms, clinical can not be specified and diagnosed.Western medicine thinks that the pain caused by vagus nerve reflex in the lower abdomen of PPH stapling device is caused by anus pain, distension, and dysuria after operation. There are many reasons for the dysuria, which may be related to anaesthesia, pocket suture technique, and surgical operation injury.The allergy of patients is related, but there is still a lack of systematic understanding and perfect treatment methods, most of them are treated with the disease.The syndrome has a high clinical incidence and affects the therapeutic effect, which brings great pain to the patients, and gradually gets the attention of the doctors.Chinese medicine is good at symptomatic treatment. In recent years, many scholars have put forward a lot of methods for the treatment of sensory dysfunction syndrome in PPH surgery from the point of view of Chinese medicine.Objective: to explore the mechanism of sensory dysfunction syndrome in PPH operation from the perspective of traditional Chinese medicine, and to observe the therapeutic effect of Wenyang Xingqi navel paste on sensory dysfunction syndrome in PPH operation.Methods: in this clinical study, 90 patients who met the diagnostic criteria in our department in 2012-2013 and were treated with PPH surgery were randomly divided into three groups.Group A was treated with navel patch, group B with dizoxin and group C with 30 patients in each group. Group A was given Qi navel patch 1 hour before operation, and group B received routine therapy with dizoxin 5 mg / g before operation.The changes of heart rate and blood pressure were recorded in 90 patients during operation, and the degree of pain in lower abdomen during operation and anus pain, anus falling distention and dysuria in group A and C were evaluated 1 day after operation, 2 days after operation and 3 days after operation. The results were statistically analyzed by SPSS20.0 software.Results: the rate of heart rate change in group C was lower than that in group C, and the change rate of heart rate in group A was higher than that in group B during and after PPH, and the change rate of heart rate in group A was higher than that in group B, and the change rate of heart rate in group A was higher than that in group C, and that in group A was higher than that in group C.Compared with group C, the change rate of 5minMAP in group A was smaller than that in group C, but there was no statistical difference between group B and group B.Compared with group B, the rate of MAP change in group A was greater than that in group B, and there was statistical difference between group A and group C, the score of intraoperative pain in group A was lower than that in group C, and there was statistical difference between group A and group B, and the score of intraoperative pain in group A was higher than that in group B.And there is statistical difference.On the 1st and 2nd day after operation, the scores of symptoms of group A were lower than those of group A on the 1st and 2nd day after operation, and there were statistical differences among the three groups, and on the third day, the scores of symptoms in the three groups were also lower than those in group A, and the scores of symptoms in group A were lower than those in group A on the 1st and 2nd day after operation, and the scores of symptoms in group A were lower than those in group A.But there was no statistical difference.Evaluation of the overall curative effect: in group A, there were 30 cases of sensorinesia syndrome treated by PPH operation, 23 cases of which were effective and 2 cases were ineffective, and the total effective rate was 93.33%. In group C, there were 30 cases of patients with marked effect and 11 cases of effective and 6 cases of ineffectiveness, and the total effective rate was 93. 3% in group C and 30 cases in group C, respectively.The total effective rate was 80.0, but there was no statistical difference.Conclusion: warm yang and Qi navel application in the treatment of sensory dysfunction syndrome in PPH surgery can improve the local and systemic qi and blood movement, accelerate the self recovery of anal qi and blood function, and decrease the rate of relief operation center.Pulling pain and improving postoperative anal distension, anal pain, dysuria and other symptoms have a certain effect. In the treatment of PPH surgery sensory dysfunction syndrome, the overall effective rate is high, maneuverability is strong, has a certain clinical significance.
【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】：2014
【分類號(hào)】：R266

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本文編號(hào)：1726897