本文關(guān)鍵詞：膝骨性關(guān)節(jié)炎患者圍手術(shù)期中醫(yī)證候變化的研究　出處：《新疆醫(yī)科大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 膝骨性關(guān)節(jié)炎 圍手術(shù)期 流行病學(xué)調(diào)查 證候研究

【摘要】：目的:本次研究擬通過大樣本病例的調(diào)查研究,以了解膝骨性關(guān)節(jié)炎患者在行全膝關(guān)節(jié)置換術(shù)的圍手術(shù)期的中醫(yī)證候變化特點,并歸納出膝骨性關(guān)節(jié)炎患者圍手術(shù)期的主要癥候變化,進(jìn)而為中醫(yī)藥各種診治方法在膝骨性關(guān)節(jié)炎圍手術(shù)期間的規(guī)范合理運用及科學(xué)優(yōu)化組合,指導(dǎo)圍手術(shù)期不同階段更有針對性的用藥和治療提供較為可靠的理論依據(jù)和臨床依據(jù),擬確立出規(guī)范有效的膝骨性關(guān)節(jié)炎圍手術(shù)期診療方案,從而切實實現(xiàn)膝骨性關(guān)節(jié)炎患者圍手術(shù)各期的“辨證論治”。方法:本項目研究對象為2014年1月-2015年12月期間在新醫(yī)大附屬中醫(yī)醫(yī)院關(guān)節(jié)外科住院并且自愿接受人工膝關(guān)節(jié)表面置換手術(shù)治療的患者。采用問卷調(diào)查方法,對納入研究的病例,收集基本資料和圍手術(shù)期各個觀察節(jié)點的臨床癥狀學(xué)資料建立數(shù)據(jù)庫,以頻數(shù)分析方法研究患者在圍手術(shù)期各觀察節(jié)點的癥狀的分布情況,再通過聚類及Logistic回歸分析,歸納出膝骨性關(guān)節(jié)炎患者圍手術(shù)期各觀察節(jié)點主要的中醫(yī)證候類型及各癥候的診斷要點。結(jié)果:此次研究納入有效病例300例,其中男性占21.3%(64例),女性占78.7%(236例),女性患者是男性患者的3.68倍;病例中最小齡年患者43歲,最大年齡患者80歲,300例患者年齡均數(shù)為:65.4±6.20歲,其中年齡超過64歲以上的患者占樣本總數(shù)的57.7%;按患者族別共可分為7類,包括:漢族、回族、蒙古族、維吾爾族、哈薩克族、東鄉(xiāng)族、柯爾克孜族等,其中漢族患者最多,225例,占病例總數(shù)75%,維吾爾族患者次之,33例,占病例總數(shù)11%;300例患者中,病程跨度為2-26年,平均病程7.4±3.51年;圍手術(shù)期中醫(yī)基本證候辨證要素的歸納為:腎陰虛、腎陽虛、腎氣虛、肝陰虛、肝陽虛、肝氣虛、肝血虛、脾陰虛、脾陽虛、脾氣虛、氣滯、血瘀、痰、寒濕、濕熱等15種。分析后所得圍手術(shù)期各觀察節(jié)點主要證候:手術(shù)前期以“腎陰虛腎陽虛肝陰虛肝陽虛肝血虛脾陰虛脾陽虛寒濕痰血瘀”證為主要證候;術(shù)后1周以“腎陰虛腎陽虛腎氣虛脾陰虛脾陽虛脾氣虛氣滯血瘀”證為主要證候;術(shù)后2周以“腎陰虛腎陽虛腎氣虛氣滯”證為主要證候;術(shù)后3周以“腎陰虛腎陽虛脾陰虛脾陽”證為主要證候。結(jié)論:膝骨性關(guān)節(jié)炎患者圍手術(shù)期主要中醫(yī)證候變化為:手術(shù)前期以“寒濕阻滯證”為主,辨證要點為:關(guān)節(jié)畸形,膝冷痛、形寒肢冷,下肢冷甚,遇寒痛增,晨僵,耳聾或耳鳴,胸脘痞悶,小便清長,舌淡紫,少津,少苔、無苔,脈弦,脈滑或數(shù),脈細(xì)數(shù);術(shù)后1周以“氣滯血瘀證”為主,辨證要點為:神疲乏力,頭重如裹,面色蒼白或萎黃,口干苦,咽燥口干,嘔吐,納呆,嗜睡,自汗,盜汗,下肢微腫,晨僵,夜間痛,脹痛,五心煩熱,舌質(zhì)紫暗或見瘀斑瘀點,脈緩,脈弱;術(shù)后2周以“脾虛氣滯證”為主,辨證要點為:五心煩熱,頭暈?zāi)垦?耳鳴或耳聾,雙目干澀,口燥咽干,五更瀉,自汗,隱痛,下肢微腫,舌淡紫,舌苔膩,脈弦;術(shù)后3周以“脾腎虧虛證”為主,辨證要點為:形體肥胖,五更瀉,頭暈?zāi)垦?喜熱飲,盜汗,自汗,隱痛,舌淡,脈弦,脈細(xì)或澀。“腎陰虛”,“腎陽虛”是貫穿整個膝骨性關(guān)節(jié)炎圍手術(shù)期的主要辨證要素,故與以上述4證均可相兼,形成不同的臨床證候。
[Abstract]:Objective: This study through investigation of large sample cases, in order to understand the changes of TCM syndrome characteristics of knee osteoarthritis patients undergoing total knee replacement in perioperative period, and summarizes the changes of the main symptoms of knee osteoarthritis patients in the perioperative period, and for the optimal combination of normative and scientific and reasonable medicine all kinds of medicine diagnosis and treatment of knee osteoarthritis during peri operation, provide a reliable theoretical basis and clinical basis for the treatment and treatment of perioperative stages more, intends to establish a standardized and effective a knee arthritis treatment peri operation period, so as to realize the knee osteoarthritis patients during operation each period of treatment based on syndrome differentiation. Methods: the research object for the January 2014 -2015 year in December during the voluntary acceptance of the artificial knee joint and joint surgery hospital of Xinjiang Medical University Affiliated Hospital of traditional Chinese Medicine Treatment of resurfacing surgery patients. Using the method of questionnaire investigation, the cases included in the study, collecting basic data and clinical symptoms during perioperative period of each observation node data to establish a database, using frequency analysis method to study the distribution of patients in the perioperative period of each observation node symptoms, and then through the analysis of clustering and Logistic regression and summarized the diagnosis of TCM syndrome type of operative observation node and the main symptoms of patients with osteoarthritis of the knee. Results: the study included 300 effective cases, 21.3% were male (64 cases), women accounted for 78.7% (236 cases), 3.68 times as many women as men with the case; the minimum age in patients 43 years of age, the maximum age of the patients was 80 years old, 300 patients age number: 65.4 + 6.20 years old, the age more than 64 years old patients accounted for 57.7% of the total sample; according to the patient's nationality can be divided into 7 categories, package Including: Han, Hui, Mongolian, Uygur, Kazak, Kirgiz nationality in Dongxiang, such as the Han, most patients, 225 cases, accounting for 75% of the total number of cases, 33 cases of Uygur patients, accounted for 11%, the total number of cases; 300 cases of patients, duration of 2-26 years, the average duration of 7.4 + 3.51 years; perioperative TCM syndrome differentiation factors as follows: kidney yin deficiency, kidney yang deficiency, kidney deficiency, liver deficiency, liver deficiency, liver qi deficiency, liver blood deficiency, spleen deficiency, spleen deficiency, spleen deficiency, qi stagnation, blood stasis, phlegm, dampness, damp heat, etc. 15. Analysis of the perioperative period of the the main observation node syndrome: operation early in "kidney yin deficiency and kidney yang deficiency of liver yin deficiency of liver Yang liver blood deficiency of spleen yin deficiency of spleen yang deficiency Phlegm Blood stasis is the main syndrome; 1 weeks after operation with kidney yin deficiency of kidney yang deficiency of kidney qi deficiency of spleen yin deficiency of spleen yang deficiency and spleen deficiency qi stagnation and blood stasis syndrome is the main syndrome; surgery after 2 weeks with kidney yin deficiency 闃寵櫄鑲炬皵铏氭皵婊炩，

本文編號：1368384