五苓散改善良性前列腺增生癥TUPKP術(shù)后排尿情況的臨床觀察
發(fā)布時(shí)間：2018-11-13 20:33
【摘要】：1背景良性前列腺增生癥(benign prostatic hyperplasia,BPH)是中老年男性常見(jiàn)的疾病之一,隨著我國(guó)社會(huì)老齡化的日益加劇,BPH將是臨床高發(fā)病種。BPH主要以下尿路癥狀(Lower urinary tract symptoms,LUTS)為臨床表現(xiàn),常困擾老年男性的晚年生活,應(yīng)引起我們的重視。該病的具體發(fā)病機(jī)制還沒(méi)有完全闡明,目前西醫(yī)治療手段有觀察隨訪、藥物及手術(shù)治療。部分患者通過(guò)手術(shù)能夠迅速解決排尿期癥狀,但術(shù)后儲(chǔ)尿期癥狀改善不明顯常常是困擾醫(yī)患雙方的難題。針對(duì)BPH術(shù)后儲(chǔ)尿期癥狀的常用藥物是α受體阻滯劑和M受體阻滯劑,因這兩類(lèi)藥副作用明顯所以在臨床上未廣泛運(yùn)用。所以,尋找一種更加有益的治療方法來(lái)改善術(shù)后儲(chǔ)尿期癥狀意義重大。BPH在祖國(guó)醫(yī)學(xué)中屬于"精癃"、"癃閉"等范疇,中醫(yī)藥對(duì)BPH的認(rèn)識(shí)具有悠久歷史。經(jīng)過(guò)數(shù)千年來(lái)對(duì)BPH的認(rèn)識(shí)不斷深入,治療上也積累了大量有效經(jīng)驗(yàn)。根據(jù)從大量文獻(xiàn)報(bào)道來(lái)看,中醫(yī)藥治療BPH效果確切,其中五苓散通過(guò)調(diào)節(jié)膀胱氣化功能來(lái)促進(jìn)尿液正常排出有著一定的效果。2目的本研究通過(guò)以國(guó)際前列腺癥狀評(píng)分(I-PSS)、儲(chǔ)尿期癥狀評(píng)分(I-PSS1)、排尿期癥狀評(píng)分(I-PSS2)、生活質(zhì)量評(píng)分(Q0L)以及最大尿流率(Qmax)為療效評(píng)價(jià)指標(biāo),探索五苓散能否在BPH術(shù)后進(jìn)一步改善患者的排尿情況,以期為臨床提供一種更加有效的中西醫(yī)結(jié)合治療方案。3內(nèi)容本研究將符合入組標(biāo)準(zhǔn)的病例進(jìn)行隨機(jī)分組,治療組22例,對(duì)照組21例。對(duì)照組術(shù)后給予常規(guī)治療(如止血、膀胱沖洗、抗感染等),治療組在對(duì)照組基礎(chǔ)之上配合服用五苓散顆粒劑。兩組分別在術(shù)后1周及術(shù)后4周記錄各項(xiàng)觀察指標(biāo),最終將數(shù)據(jù)運(yùn)用SPSS22.0軟件進(jìn)行分析。4結(jié)果術(shù)后1周,對(duì)照組與術(shù)前自身對(duì)比,患者I-PSS、I-PSS2、Q0L評(píng)分均明顯低于手術(shù)前,Qmax明顯大于術(shù)前,差異均有有統(tǒng)計(jì)學(xué)意義(p0.05),而I-PSS1術(shù)前術(shù)后差異不存在統(tǒng)計(jì)學(xué)意義(p0.05);治療組I-PSS、I-PSS1、I-PSS2、Q0L評(píng)分低于術(shù)前、Qmax高于術(shù)前,具有統(tǒng)計(jì)學(xué)意義(p0.05)。兩組間對(duì)比I-PSS、I-PSS1、I-PSS2、QOL評(píng)分、Qmax差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05);治療組顯效率為5%,有效率為95%,總有效率為100%,對(duì)照組顯效率為0%,有效率為85%,總有效率為85%,治療組總有效率明顯高于對(duì)照組,差異存在統(tǒng)計(jì)學(xué)意義(p0.05)。術(shù)后4周,對(duì)照組I-PSS、I-PSS1、I-PSS2、Q0L評(píng)分低于術(shù)前,Qmax高于術(shù)前,有統(tǒng)計(jì)學(xué)意義(p0.05);治療組I-PSS、I-PSS1、I-PSS2、Q0L評(píng)分低于術(shù)前,Qmax高于術(shù)前,有統(tǒng)計(jì)學(xué)意義(p0.05);兩組間對(duì)比,治療組I-PSS、I-PSS1、I-PSS2、Q0L評(píng)分低于對(duì)照組,有統(tǒng)計(jì)學(xué)意義(p0.05),Qmax兩組間差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),兩組總有效率均為95%,但兩組療效分布存在差異,治療組顯效率明顯高于對(duì)照組,有統(tǒng)計(jì)學(xué)意義(P=0.0000.01)。5結(jié)論手術(shù)能快速有效地解決下尿路梗阻問(wèn)題,提高生活質(zhì)量,但對(duì)術(shù)后短期內(nèi)儲(chǔ)尿期癥狀改善不明顯,五苓散能輔助改善術(shù)后短期內(nèi)儲(chǔ)尿期癥狀;患者隨著術(shù)后病情的恢復(fù),儲(chǔ)尿期癥狀能得到一定改善,五苓散能在手術(shù)改善基礎(chǔ)上進(jìn)一步改善患者前列腺癥狀評(píng)分和提高生活質(zhì)量,但對(duì)改善最大尿流率方面尚無(wú)優(yōu)勢(shì)。
[Abstract]:Benign prostatic hyperplasia (BPH) is one of the most common diseases in the middle-aged and the elderly. The majority of the lower urinary tract symptoms (LUTs) of BPH are the clinical manifestations, which often cause the late-year life of the old men, and we should pay more attention to them. The specific pathogenesis of the disease is not fully set out. At present, there are follow-up, drug and surgical treatment in the treatment of western medicine. In some patients, the symptoms of micturition can be resolved quickly by the operation, but the improvement of the symptoms of the post-operative blood-storage period is not often the difficult problem for both the patients and the patients. The commonly used drugs for the treatment of the symptoms of the post-operation of BPH are the opioid receptor blocker and the M-receptor blocker, which are not widely used in clinic because of the obvious side effects of these two drugs. Therefore, it is of great significance to find a more beneficial treatment method to improve the symptoms of the post-operative urine storage period. BPH is a "spermatorrhea" and "close-and-close" in the Chinese medicine, and the traditional Chinese medicine has a long history on the understanding of BPH. After thousands of years of knowledge of BPH, the treatment has accumulated a great deal of effective experience. according to a large number of literature reports, the effect of traditional Chinese medicine on the treatment of BPH has a certain effect by regulating the function of the bladder gasification to promote the normal discharge of the urine. The symptom score (I-PSS2), the quality of life (Q0L) and the maximum urinary flow rate (Qmax) of the voiding period were the evaluation index of the curative effect. In order to provide a more effective treatment for the combination of traditional Chinese and western medicine, this study will provide a more effective and integrated treatment for Chinese and Western medicine. The content of this study will be in accordance with the standard of the enrolled group, and the treatment group is 22 cases and the control group is 21 cases. In the control group, routine treatment (such as hemostasis, bladder flushing, anti-infection, etc.) was given after operation, and the treatment group was combined with five kinds of powder granules on the basis of the control group. All the observation indexes were recorded at 1 week after operation and 4 weeks after operation, and the data was analyzed by using the SPSS10.0 software. The results showed that the scores of I-PSS, I-PSS2 and Q0L in the patients were significantly lower than that before operation. The difference was statistically significant (p0.05), and the difference in the pre-operation of I-PSS1 was not significant (p0.05); the score of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group was lower than that before the operation, and the Qmax was higher than before operation (p0.05). In the treatment group, the effective rate was 5%, the effective rate was 95%, the total effective rate was 100%, the effective rate of the control group was 0%, the effective rate was 85%, and the total effective rate was 85%. The total effective rate of the treatment group was significantly higher than that of the control group (p0.05). The scores of I-PSS, I-PSS1, I-PSS2 and Q0L in the control group were lower than that before the operation. The scores of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group were lower than that before the operation. The score of Q0L was lower than that of the control group (p0.05). There was no statistical difference between the two groups (p0.05). The total effective rate of the two groups was 95%. Conclusion The operation can quickly and effectively solve the problem of lower urinary tract obstruction and improve the quality of life. the symptoms of the urine storage period can be improved, and the five-medicine powder can further improve the symptom score of the prostate and improve the quality of life on the basis of the improvement of the operation, but has no advantage in improving the maximum urine flow rate.
【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(lèi)號(hào)】：R699.8
[Abstract]:Benign prostatic hyperplasia (BPH) is one of the most common diseases in the middle-aged and the elderly. The majority of the lower urinary tract symptoms (LUTs) of BPH are the clinical manifestations, which often cause the late-year life of the old men, and we should pay more attention to them. The specific pathogenesis of the disease is not fully set out. At present, there are follow-up, drug and surgical treatment in the treatment of western medicine. In some patients, the symptoms of micturition can be resolved quickly by the operation, but the improvement of the symptoms of the post-operative blood-storage period is not often the difficult problem for both the patients and the patients. The commonly used drugs for the treatment of the symptoms of the post-operation of BPH are the opioid receptor blocker and the M-receptor blocker, which are not widely used in clinic because of the obvious side effects of these two drugs. Therefore, it is of great significance to find a more beneficial treatment method to improve the symptoms of the post-operative urine storage period. BPH is a "spermatorrhea" and "close-and-close" in the Chinese medicine, and the traditional Chinese medicine has a long history on the understanding of BPH. After thousands of years of knowledge of BPH, the treatment has accumulated a great deal of effective experience. according to a large number of literature reports, the effect of traditional Chinese medicine on the treatment of BPH has a certain effect by regulating the function of the bladder gasification to promote the normal discharge of the urine. The symptom score (I-PSS2), the quality of life (Q0L) and the maximum urinary flow rate (Qmax) of the voiding period were the evaluation index of the curative effect. In order to provide a more effective treatment for the combination of traditional Chinese and western medicine, this study will provide a more effective and integrated treatment for Chinese and Western medicine. The content of this study will be in accordance with the standard of the enrolled group, and the treatment group is 22 cases and the control group is 21 cases. In the control group, routine treatment (such as hemostasis, bladder flushing, anti-infection, etc.) was given after operation, and the treatment group was combined with five kinds of powder granules on the basis of the control group. All the observation indexes were recorded at 1 week after operation and 4 weeks after operation, and the data was analyzed by using the SPSS10.0 software. The results showed that the scores of I-PSS, I-PSS2 and Q0L in the patients were significantly lower than that before operation. The difference was statistically significant (p0.05), and the difference in the pre-operation of I-PSS1 was not significant (p0.05); the score of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group was lower than that before the operation, and the Qmax was higher than before operation (p0.05). In the treatment group, the effective rate was 5%, the effective rate was 95%, the total effective rate was 100%, the effective rate of the control group was 0%, the effective rate was 85%, and the total effective rate was 85%. The total effective rate of the treatment group was significantly higher than that of the control group (p0.05). The scores of I-PSS, I-PSS1, I-PSS2 and Q0L in the control group were lower than that before the operation. The scores of I-PSS, I-PS1, I-PSS2 and Q0L in the treatment group were lower than that before the operation. The score of Q0L was lower than that of the control group (p0.05). There was no statistical difference between the two groups (p0.05). The total effective rate of the two groups was 95%. Conclusion The operation can quickly and effectively solve the problem of lower urinary tract obstruction and improve the quality of life. the symptoms of the urine storage period can be improved, and the five-medicine powder can further improve the symptom score of the prostate and improve the quality of life on the basis of the improvement of the operation, but has no advantage in improving the maximum urine flow rate.
【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(lèi)號(hào)】：R699.8
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