【摘要】：目的:對慢性便秘患者進行個體化干預和定期的指導、隨訪及管理,觀察干預前后患者的癥狀、瀉劑的使用情況和病情嚴重程度的改善情況,從而評價慢性便秘的個體化干預效果,并探討其慢病管理模式。方法:選取2015年5月--2016年10月就診于山西醫(yī)科大學第一醫(yī)院、符合納入標準的慢性便秘患者716例,按年齡分為青年組(18-40歲)218例、中年組(41-65歲)312例、老年組(65歲)186例。獲得患者“知情同意”后指導其填寫“慢性便秘調查問卷表”,據(jù)此制定針對患者自身特征的綜合的個體化干預方案,方案包括飲食指導、運動指導、排便指導、使用藥物指導等多方面內容;應用“慢病管理”理念對患者進行定期管理、隨訪,每兩周一次,時間共6個月,每月以28天計算,隨訪時填寫“排便日記表”以記錄便秘癥狀、伴隨癥狀和瀉劑使用情況。以干預前患者的自身癥狀為對照,評價干預前后患者便秘癥狀和伴隨癥狀的改善情況、瀉劑依賴情況,及病情嚴重程度改善情況;并在隨訪管理過程中分析導致便秘的主要原因,及時調整個體化干預方案。結果:1.青年組平均干預起效時間為1.64±0.89月,中年組平均干預起效時間為2.09±0.83月,老年組平均干預起效時間為2.16±0.83月,三組平均干預起效時間無差異(P0.05);2.干預后三組便秘患者排便次數(shù)均較前明顯增多(P0.001),排便困難程度和糞便性狀積分均較前明顯降低(P0.01);3.干預后三組便秘患者的腹脹、腹痛、噯氣、口腔異味及納差等伴隨癥狀也均較前有所緩解(P0.05);4.在不用、偶爾、間斷、長期使用瀉劑情況四種情況下,干預前后青年組存在明顯差異(χ2青=20.14,P0.01),中年組也有差異(χ2中=25.60,P0.01);但老年組干預前后并不存在差異(P0.05);5.干預后中度、重度患者比例下降,輕度患者比例增加:青年組重度便秘患者所占比例下降5.51%,中度患者下降7.8%,輕度患者增加13.30%,較干預前改善(χ2=3.96,P0.05);中年組重度便秘患者所占比例下降8.84%,中度患者下降5.32%,輕度患者增加13.97%,較干預前改善(χ2=4.48,P0.05);老年組重度便秘患者比例下降6.46%,中度患者下降4.84%,輕度患者增加11.29%,也較干預前改善(χ2=3.86,P0.05)。結論:個體化干預的慢病管理模式可有效緩解慢性便秘患者的便秘癥狀及伴隨癥狀,降低瀉劑依賴。
[Abstract]:Objective: to conduct individualized intervention and regular guidance, follow up and management of patients with chronic constipation, observe the symptoms of the patients before and after intervention, the use of laxatives and the improvement of the severity of the disease, so as to evaluate the individualized intervention effect of chronic constipation and explore the management mode of the chronic constipation. Methods: in May 2015, --2016 year, in October. In the first hospital of Shanxi Medical University, 716 cases of chronic constipation were conformed to the standard. 218 cases were divided into young group (18-40 years old), 312 cases (41-65 years old) and 186 elderly (65 years old) in the middle age group. The "chronic constipation questionnaire" was used to guide them to fill in the "questionnaire of chronic constipation". The combined individualized intervention program included diet guidance, exercise guidance, defecation guidance, and medication guidance. The patients were regularly managed with the "slow disease management" concept and followed up every two weeks for a total of 6 months, 28 days per month, and a "defecation diary" to record constipation symptoms during follow-up. The symptoms and laxatives were used. The symptoms of the patients before intervention were compared, the improvement of constipation and accompanying symptoms before and after intervention, the condition of laxative dependence, and the severity of the disease were improved; the main causes of constipation were analyzed during the follow-up management, and the individualized intervention program was adjusted in time. Results: 1. green. The average intervention time of the year group was 1.64 + 0.89 months, the average intervention time of the middle age group was 2.09 + 0.83 months, the average intervention time of the elderly group was 2.16 + 0.83 months, the average intervention time of the three groups was no difference (P0.05). The number of defecation times in the three groups of the three groups increased significantly (P0.001), the difficulty of defecation and the fecal traits in the three groups after 2. intervention. Scores were significantly lower than before (P0.01); 3. after intervention, abdominal distention, abdominal pain, belching, stomatology and disodorness were also alleviated (P0.05) in the three groups of constipation patients; 4. in four cases, which were not used, occasionally, discontinuous, and long laxative, there were obvious differences between the young group before and after intervention (x 2 green =20.14, P0.01), and the middle age group also had Differences (=25.60, P0.01), but there was no difference in the elderly group before and after intervention (P0.05); 5. was moderate, the proportion of severe patients decreased, the proportion of mild patients increased: the proportion of severe constipation in the young group decreased by 5.51%, the moderate patients decreased by 7.8%, the mild patients increased by 13.30%, compared with those before the intervention (x 2=3.96, P0.05); the middle age group was severe. The proportion of the constipation decreased by 8.84%, the moderate patients decreased by 5.32%, the mild patients increased by 13.97%, compared with those before the intervention (x 2=4.48, P0.05), the proportion of the elderly patients with severe constipation decreased by 6.46%, the moderate patients were 4.84%, the mild patients were 11.29%, and compared with those before the intervention (x 2=3.86, P0.05). Conclusion: the mode of chronic disease management in individualized intervention can be found. It can relieve constipation symptoms and accompany symptoms of chronic constipation patients, and reduce laxative dependence.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R574.62

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