本文選題：功能性排便障礙 + 中西醫(yī)��； 參考：《福建中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:本課題通過采取中醫(yī)辨證施治結(jié)合生物反饋訓(xùn)練治療功能性排便障礙,對比采用單純生物反饋訓(xùn)練治療對功能性排便障礙患者臨床癥狀、生活質(zhì)量、盆底Glazer評估各項(xiàng)指標(biāo)的影響,比較二者之間的療效差異,為后期臨床治療提供參考。方法:在福建省第二人民醫(yī)院脾胃病重點(diǎn)�？崎T診或住院便秘患者中選取符合功能性排便障礙診斷標(biāo)準(zhǔn)和納排標(biāo)準(zhǔn)患者72例(就診于2016年2月-2017年2月)。采用簡單隨機(jī)方法將72例患者分為中醫(yī)辨證施治結(jié)合生物反饋訓(xùn)練組(治療組)和單純生物反饋訓(xùn)練組(對照組)各36例,治療組脫落4例(中途服用其他通便藥物),最終納入統(tǒng)計(jì)分析32例;對照組脫落6例(中途服用其他通便藥物)6例,最終納入統(tǒng)計(jì)分析30例。治療2個(gè)療程后觀察比較兩組臨床主癥積分、生活質(zhì)量問卷(PAC-QOL)積分及盆底Glazer評估各項(xiàng)指標(biāo)情況。用SSPS20統(tǒng)計(jì)軟件進(jìn)行分析。P0.05表示有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.總體療效比較:兩組比較具有統(tǒng)計(jì)學(xué)差異(P0.05),治療組優(yōu)于對照組。符合方案集:治療組總有效率93.75%,對照組總有效率80.00%;全分析集:治療組總有效率83.33%;對照組總有效率66.67%。2.兩組治療前后便秘主癥積分、生活質(zhì)量問卷(PAC-QOL)積分比較:兩組患者治療后便秘主癥、生活質(zhì)量問卷(PAC-QOL)積分均較治療前明顯下降,具有統(tǒng)計(jì)學(xué)意義(P0.05),提示兩種方案均可明顯改善本病癥狀、生活質(zhì)量。兩組治療后積分比較均具有統(tǒng)計(jì)學(xué)差異(P0.05),治療組積分均低于對照組,提示治療組在改善便秘臨床癥狀、生活質(zhì)量上更為顯著。3.盆底Glazer評估:兩組治療后與治療前相比快速、持續(xù)和耐久收縮波幅較治療前明顯升高(P0.05);快速收縮反應(yīng)時(shí)間、持續(xù)和耐久收縮變異系數(shù)較治療前降低(P0.05);前基線波幅、后基線波幅及變異系數(shù)均值較治療前降低,但無統(tǒng)計(jì)學(xué)差異(P0.05)。兩組治療后盆底Glazer評估各項(xiàng)指標(biāo)比較(P0.05)�？梢钥闯龆M經(jīng)過訓(xùn)練,盆底肌纖維收縮力較前明顯升高,募集功能較前好轉(zhuǎn),穩(wěn)定性升高,且治療組改善程度優(yōu)于對照組。前基線、后基線波幅、前基線變異系數(shù)及后基線變異系數(shù)均值較治療前降低(P0.05),但無統(tǒng)計(jì)學(xué)意義。結(jié)論:本研究結(jié)果表明,采取中醫(yī)辨證施治結(jié)合生物反饋訓(xùn)練與單純生物反饋訓(xùn)練治療功能性排便障礙相比,在改善功能性排便障礙患者臨床癥狀、生活質(zhì)量及總體療效上均具有明顯優(yōu)勢;中醫(yī)辨證施治結(jié)合生物反饋訓(xùn)練治療功能性排便障礙在改善患者盆底肌功能方面也優(yōu)于單純生物反饋訓(xùn)練治療;可見二者結(jié)合可以提高臨床治療效果。
[Abstract]:Objective: to treat functional defecation disorder by TCM syndrome differentiation and biofeedback training, and to compare the clinical symptoms and quality of life of patients with functional defecation disorder treated by biofeedback training alone. The pelvic floor Glazer was used to evaluate the effect of each index, to compare the curative effect between the two indexes, and to provide reference for the later clinical treatment. Methods: a total of 72 patients with constipation who met the diagnostic criteria of functional defecation disorder and those who were in constipation were selected from the inpatient department of the second people's Hospital of Fujian Province from February 2016 to February 2017. 72 patients were randomly divided into two groups: the treatment group (treatment group) and the control group (36 cases). In the treatment group, 4 cases were dropped off (other defecation drugs were taken midway, 32 cases were included in the statistical analysis), and 6 cases in the control group (6 cases took other defecating drugs in the midway, 30 cases were included in the statistical analysis). After two courses of treatment, the clinical main symptom score, quality of life questionnaire PAC-QOLscore and pelvic floor Glazer evaluation were observed and compared between the two groups. Statistical software SSPS20 was used to analyze. The result is 1: 1. Comparison of the total curative effect: there was statistical difference between the two groups (P 0.05), and the treatment group was superior to the control group. The total effective rate of the treatment group was 93.75 and the total effective rate of the control group was 80.00. the total effective rate of the treatment group was 83.33; the total effective rate of the control group was 66.67.2. Comparison of PAC-QOLI scores of patients with constipation before and after treatment: the scores of PAC-QOLs in patients with constipation before and after treatment were significantly lower than those before and after treatment, and the scores of PAC-QOLs in the two groups were significantly lower than those before and after treatment. The results showed that the two schemes could significantly improve the symptoms and quality of life. The scores of the treatment group were lower than that of the control group, indicating that the clinical symptoms of constipation were improved and the quality of life was more significant in the treatment group than in the control group. Pelvic floor Glazer evaluation: after treatment, the amplitude of sustained and durable contraction was significantly higher in both groups than that before treatment, and the response time, coefficient of variation of sustained and durable contraction was significantly lower than that before treatment, and the amplitude of anterior baseline wave was decreased. The amplitude and coefficient of variation of posterior baseline were lower than those before treatment, but there was no statistical difference (P 0.05). Comparison of various indexes of pelvic floor Glazer evaluation between the two groups after treatment (P 0.05). It can be seen that after training, the contractility of pelvic floor muscle fiber was obviously increased, the recruitment function was improved, the stability was improved, and the improvement degree of the treatment group was better than that of the control group. The amplitude of the front baseline, the amplitude of the posterior baseline, the coefficient of variation of the anterior baseline and the coefficient of variation of the posterior baseline were lower than those before treatment (P 0.05), but there was no statistical significance. Conclusion: the results of this study indicate that the clinical symptoms of patients with functional defecation disorder can be improved by applying TCM syndrome differentiation combined with biofeedback training and treating functional defecation disorder with biofeedback training alone. The treatment of functional defecation disorder with TCM syndrome differentiation combined with biofeedback training is also superior to that of pure biofeedback training in improving the function of pelvic floor muscle. It can be seen that the combination of the two can improve the effect of clinical treatment.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R574.62

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