【摘要】：目的:對(duì)慢性便秘患者進(jìn)行個(gè)體化干預(yù)和定期的指導(dǎo)、隨訪及管理,觀察干預(yù)前后患者的癥狀、瀉劑的使用情況和病情嚴(yán)重程度的改善情況,從而評(píng)價(jià)慢性便秘的個(gè)體化干預(yù)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(xué)第一醫(yī)院、符合納入標(biāo)準(zhǔn)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(dǎo)其填寫“慢性便秘調(diào)查問卷表”,據(jù)此制定針對(duì)患者自身特征的綜合的個(gè)體化干預(yù)方案,方案包括飲食指導(dǎo)、運(yùn)動(dòng)指導(dǎo)、排便指導(dǎo)、使用藥物指導(dǎo)等多方面內(nèi)容;應(yīng)用“慢病管理”理念對(duì)患者進(jìn)行定期管理、隨訪,每?jī)芍芤淮?時(shí)間共6個(gè)月,每月以28天計(jì)算,隨訪時(shí)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(yù)前患者的自身癥狀為對(duì)照,評(píng)價(jià)干預(yù)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(yán)重程度改善情況;并在隨訪管理過程中分析導(dǎo)致便秘的主要原因,及時(shí)調(diào)整個(gè)體化干預(yù)方案。結(jié)果:1.青年組平均干預(yù)起效時(shí)間為1.64±0.89月,中年組平均干預(yù)起效時(shí)間為2.09±0.83月,老年組平均干預(yù)起效時(shí)間為2.16±0.83月,三組平均干預(yù)起效時(shí)間無(wú)差異(P0.05);2.干預(yù)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(yù)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(zhǎng)期使用瀉劑情況四種情況下,干預(yù)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(yù)前后并不存在差異(P0.05);5.干預(yù)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(yù)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(yù)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(yù)前改善(χ2=3.86,P0.05)。結(jié)論:個(gè)體化干預(yù)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(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R574.62

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 卜佳;許翠萍;;慢性便秘和慢病管理[J];世界華人消化雜志;2016年30期

2 劉海寧;陳玉琢;吳昊;劉韜韜;;腸道菌群與功能性便秘的研究進(jìn)展[J];復(fù)旦學(xué)報(bào)(醫(yī)學(xué)版);2015年04期

3 劉詩(shī);;慢性便秘藥物治療的合理選擇[J];中華內(nèi)科雜志;2015年07期

4 徐國(guó)萍;來(lái)毅;;慢性便秘治療的研究進(jìn)展[J];胃腸病學(xué);2015年06期

5 孫園園;許翠萍;張娜;申宇宏;;不同年齡段慢性便秘患者病因特點(diǎn)分析[J];胃腸病學(xué);2014年06期

6 楊海濤;呂志國(guó);張影;王萍萍;;國(guó)內(nèi)慢病管理的研究現(xiàn)狀[J];中國(guó)社區(qū)醫(yī)師;2014年10期

7 趙勱;譚至柔;;成年人慢性便秘流行病學(xué)的研究現(xiàn)狀[J];世界華人消化雜志;2014年07期

8 劉月星;宗文紅;王偉;嚴(yán)非;;基于慢病管理模式的新型慢病管理模式應(yīng)用的SWOT分析[J];中國(guó)全科醫(yī)學(xué);2013年40期

9 徐國(guó)平;牛麗娟;;從美國(guó)高血壓病防治的經(jīng)驗(yàn)探討中國(guó)慢病防治的挑戰(zhàn)和機(jī)遇[J];中華醫(yī)學(xué)雜志;2013年43期

10 王瑾;佘君;張彥亭;高麥倉(cāng);賈淼;張軍;;慢性便秘患者臨床特征的研究[J];胃腸病學(xué)和肝病學(xué)雜志;2013年08期

相關(guān)會(huì)議論文 前1條

1 謝菡;葛衛(wèi)紅;;淺談慢病管理[A];2014年全國(guó)醫(yī)院藥學(xué)（藥物安全性與評(píng)價(jià)）學(xué)術(shù)會(huì)議論文匯編[C];2014年

，

本文編號(hào)：2147393