本文關(guān)鍵詞：IBS-D中醫(yī)證候分型特點(diǎn)及膳食纖維對IBS-D癥狀影響的臨床研究　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 腹瀉型腸易激綜合征 高膳食纖維 中醫(yī)證型 影響

【摘要】：背景:腸易激綜合征(irritable bowel syndrome,IBS)是功能性胃腸病(functional gastrointestinal disorders FGIDs)中,最常見的下消化道疾病;IBS發(fā)病機(jī)制尚未完全闡明,對于IBS的治療也沒有一種徹底有效的治療藥物。研究表明IBS需要采取飲食干預(yù)改善癥狀;目前指南明確的是高膳食纖維食物可能對腸易激綜合征便秘型(IBS with constipation,IBS-C)有效,對腹痛及腹瀉不利。很少有研究報(bào)道高膳食纖維食物與IBS腹瀉型(IBS with diarrhea,IBS-D)的關(guān)系,有研究報(bào)道,不溶性纖維會(huì)加重部分IBS患者的癥狀。本研究運(yùn)用中西醫(yī)結(jié)合的思想,以祖國醫(yī)學(xué)"飲食有節(jié)"的觀點(diǎn),觀察通過飲食節(jié)制后臨床癥狀和中醫(yī)證候積分有無改善。目的:在中醫(yī)理論指導(dǎo)下,對IBS-D進(jìn)行中醫(yī)證候分型,并觀察膳食纖維干預(yù)后中醫(yī)證候積分的情況。了解患者對膳食纖維知曉情況,探索經(jīng)膳食纖維干預(yù)后IBS-D患者癥狀、生活質(zhì)量情況。方法:對于符合納入標(biāo)準(zhǔn)的患者,隨機(jī)分為干預(yù)組和對照組,兩組患者均進(jìn)行飲食知識(shí)普及,干預(yù)組進(jìn)行膳食纖維宣教及干預(yù),對照組進(jìn)行普通飲食干預(yù);在患者入組時(shí),分別采取腸易激綜合征癥狀量表(IBS-SSS)、膳食纖維表、醫(yī)院焦慮抑郁自評量表(HAD)、腸易激綜合征生活質(zhì)量量表(IBS-QOL)、中醫(yī)證候評分表對患者進(jìn)行問卷調(diào)查;在1個(gè)月觀察期后,予IBS-SSS、IBS-QOL及中醫(yī)證候積分表對兩組患者再次進(jìn)行問卷調(diào)查;采用統(tǒng)計(jì)學(xué)方法,對治療前后進(jìn)行比較。結(jié)果:1.根據(jù)IBS-SSS的積分,78.69%患者屬于中度IBS-D,21.31%屬于重度IBS-D,1個(gè)月后兩組患者程度均有所下降,73.77%的IBS-D患者屬于輕度及以下;干預(yù)組治療后IBS-SSS總積分在130.66±51.30,對照組治療后總積分在163.28±55.62;膳食纖維干預(yù)后干預(yù)組IBS-SSS總積分的改善明顯優(yōu)于對照組。2.根據(jù)IBS-SSS臨床療效改善等級,總體有效率占83.61%,干預(yù)組總體有效率為93.75%,對照組總體有效率為72.41%,干預(yù)組IBS-SSS療效的改善明顯優(yōu)于對照組。根據(jù)IBS-SSS的腹脹及腹痛積分,兩組在治療前后腹脹腹痛均有明顯改善,干預(yù)組與對照組比較,在腹痛、腹脹臨床癥狀上,干預(yù)組積分改善明顯優(yōu)于對照組。3.91.80%的患者認(rèn)為食物與IBS有關(guān)系,IBS-D患者認(rèn)為與食物溫度(冷食)占70.49%、食物佐料(辣味和辛味)占59.02%、奶制品(牛奶)占45.90%、水果(西瓜和梨)占27.87%、飲料(咖啡和酒)占24.59%、肉蛋類食物(蝦、螃蟹及貝殼類)占23.23%、蔬菜類(辣椒、木耳、竹筍)占22.95%;食物是誘發(fā)加重IBS癥狀的重要因素之一。4.雖然88.52%的患者認(rèn)可膳食纖維并非多多益善,但是81.97%的患者完全不知道膳食纖維,83.61%的患者不知曉膳食纖維與IBS的關(guān)系。經(jīng)干預(yù)后,干預(yù)組81.25%患者知道一點(diǎn)高膳食纖維食物,18.75%患者完全知道膳食纖維食物;90.63%患者認(rèn)為膳食纖維與IBS-D有關(guān)系,78.13%患者認(rèn)為膳食纖維食物是加重IBS-D的癥狀。5.有37.70%IBS-D患者存在明顯的焦慮和(或)抑郁,焦慮合并抑郁占3.28%,焦慮或抑郁的患者占34.43%;6.在生活質(zhì)量上,IBS-D患者在飲食限制、焦慮不安、行為障礙、健康憂慮4個(gè)維度表現(xiàn)突出,焦慮不安、行為障礙、軀體意念、健康憂慮、社會(huì)反應(yīng)、人際關(guān)系的評分均較治療前有所下降,飲食限制維度在治療后均有所升高。一個(gè)月治療后,兩組評分無明顯差異。表明單純的膳食纖維干預(yù)在患者的生活質(zhì)量上影響較少。7.JBS-D患者,脾虛濕阻證型(36.99%),肝郁脾虛證型(27.40%),脾胃濕熱證型(20.55%),脾腎陽虛證型(12.33%),以脾虛濕阻證型最多,一個(gè)月治療后,兩組病例中醫(yī)證候總積分比治療前均有改善,干預(yù)組治療后總積分5.19±2.96,對照組治療后總積分6.41±3.09。干預(yù)組與對照組療效無明顯差異,膳食纖維干預(yù)在中醫(yī)證候改善中,無明顯療效。
[Abstract]:Background: irritable bowel syndrome (irritable bowel, syndrome, IBS) is a functional gastrointestinal disease (functional gastrointestinal disorders FGIDs), the most common digestive tract disease; the pathogenesis of IBS has not been fully elucidated, nor a thorough and effective therapy for the treatment of IBS. The results show that IBS needs to take to improve the diet intervention the guide is clear symptoms; high dietary fiber food on constipation type irritable bowel syndrome (IBS with, constipation, IBS-C) is effective against abdominal pain and diarrhea. Few studies have reported high dietary fiber food and diarrhea (IBS with diarrhea IBS, IBS-D) relationship, studies have reported that insoluble fiber will aggravate some of the symptoms of the IBS patients. This study uses the ideas of combining traditional Chinese and Western medicine, Chinese medicine to "diet" point of view, through the observation of diet after clinical symptoms and TCM syndromes have no Objective: to improve. Under the guidance of TCM theory, IBS-D syndromes, and to observe the prognosis of TCM syndrome integral of the dietary fiber. To understand the patient awareness of dietary fiber, dietary fiber and explore the intervention of patients with IBS-D symptoms and quality of life. Methods: the patients who met the criteria were randomized. Divided into intervention group and control group, two groups of patients were treated with dietary knowledge popularization, intervention group, dietary fiber education and intervention, the control group with normal diet intervention; patients in group, respectively take the symptoms of irritable bowel syndrome scale (IBS-SSS), dietary fiber, hospital anxiety and Depression Scale (HAD), irritable bowel syndrome, quality of life scale (IBS-QOL), TCM Syndrome Score questionnaire for patients; 1 months after the observation period, with IBS-SSS, IBS-QOL and TCM syndromes scale of two groups of patients to carry out the questionnaire again Check; by statistical method, were compared before and after treatment. Results: 1. according to IBS-SSS score, 78.69% patients with moderate IBS-D, 21.31% belong to severe IBS-D, 1 months after the two groups of patients were decreased, 73.77% patients with IBS-D and mild; the intervention group after treatment IBS-SSS total score in 130.66 + 51.30 the control group, the total score after treatment in the 163.28 + 55.62; improve the total score of IBS-SSS of intervention group after the intervention of dietary fiber was better than the control group improved.2. grade according to the clinical efficacy of IBS-SSS, the overall efficiency accounted for 83.61%, the effective rate of intervention group was 93.75% overall, the control group total effective rate was 72.41%, the efficacy of IBS-SSS intervention group significantly better than the control group. According to the IBS-SSS integral of abdominal distension and abdominal pain, abdominal distension and pain before and after treatment in the two groups were significantly improved, the intervention group compared with the control group, the clinical symptoms of abdominal pain, abdominal distension, the intervention group integral Improved significantly better than the control group.3.91.80% were thought to be related to food and IBS, IBS-D and patients that food temperature (cold) accounted for 70.49%, food seasoning (spicy and pungent) accounted for 59.02%, accounted for 45.90% of dairy products (milk), fruits (watermelon and pear) accounted for 27.87%, drinks (coffee and wine) accounted for 24.59%, meat and eggs food (shrimp, crabs and shellfish) accounted for 23.23%, vegetables (pepper, mushrooms, bamboo shoots) accounted for 22.95%; food is one of the important factors inducing aggravated symptoms of IBS.4. while 88.52% patients accepted dietary fiber is not The more, the better. 81.97% patients fully, but do not know the relationship between dietary fiber, 83.61% of the patients were unaware of dietary fiber and IBS. After the intervention, the intervention group of 81.25% patients knew a little high dietary fiber food, 18.75% patients fully aware of dietary fiber food; 90.63% patients that have the relationship between dietary fiber and IBS-D, 78.13% of patients believed that the dietary fiber food .5. IBS-D had symptoms of 37.70%IBS-D patients have obvious anxiety and depression (or) anxiety with depression, anxiety or depression accounted for 3.28%, accounted for 34.43% of patients; 6. in the quality of life in patients with IBS-D, dietary restriction, anxiety, behavioral disorders, health concerns 4 dimensions of outstanding performance, anxiety, behavior disorders, physical health concerns, ideas, social response, interpersonal relationship scores were decreased after treatment, dietary restriction dimension have increased. After treatment one month after treatment, no significant difference between the scores of the two groups. Show that dietary fiber intervention is less affected in patients with.7.JBS-D in the quality of life of patients. Spleen deficiency and dampness syndrome (36.99%), liver stagnation and spleen deficiency type (27.40%), DHSS (20.55%), spleen kidney yang deficiency type (12.33%), with spleen deficiency and dampness syndromes most, one month after treatment, two cases of TCM syndrome total score than before the treatment After improvement, the total score of the intervention group was 5.19 + 2.96 after treatment. The total score of the control group was 6.41 + 3.09. after treatment. There was no significant difference between the intervention group and the control group. Dietary fiber intervention had no obvious effect in the improvement of TCM syndromes.

【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R259

【參考文獻(xiàn)】

中國期刊全文數(shù)據(jù)庫 前10條

1 卞立群;陸芳;李振華;李保雙;高蕊;王鳳云;張引強(qiáng);唐旭東;;IBS-SSS、AR及IBS-QOL在IBS臨床療效評價(jià)中的反應(yīng)度分析[J];中國中西醫(yī)結(jié)合雜志;2016年10期

2 林鴻;王承黨;;低FODMAP飲食與腸易激綜合征[J];胃腸病學(xué);2016年09期

3 徐萬里;孫建華;;針灸治療腸易激綜合征的研究進(jìn)展[J];世界中醫(yī)藥;2016年06期

4 寇媛;趙倩;聞新麗;楊波;;中醫(yī)三聯(lián)療法治療腹瀉型腸易激綜合征療效觀察[J];西部中醫(yī)藥;2015年11期

5 盧巖;孫英霞;于曉華;張晶;孫釗;李金玲;張喜鵬;王彤;王世軍;;針刺太沖和天樞對腹瀉型腸易激綜合征大鼠5-羥色胺、去甲腎上腺素及降鈣素基因相關(guān)肽的影響[J];中國中醫(yī)藥信息雜志;2015年10期

6 左秀麗;;腸易激綜合征病因及發(fā)病機(jī)制[J];中華消化雜志;2015年07期

7 李莉;熊理守;;腸易激綜合征的流行病學(xué)調(diào)查[J];中華消化雜志;2015年07期

8 王翰瑜;陳勝良;;腸易激綜合征的非常規(guī)藥物治療[J];中華消化雜志;2015年07期

9 劉勁松;;從循證醫(yī)學(xué)證據(jù)看腸易激綜合征的常規(guī)藥物治療[J];中華消化雜志;2015年07期

10 胡s，

本文編號：1407549