發(fā)布時間：2018-03-15 02:37

  本文選題：痔　切入點：頑固性疼痛　出處：《北京中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的：痔瘡是臨床常見病和多發(fā)病,流行病學調查顯示我國痔瘡發(fā)病率為49.14%。臨床癥狀以便血、肛內腫物脫出、肛周異物感、疼痛等為主要表現(xiàn),極大地影響生活質量。目前,對中重度痔瘡臨床上大多以外科手術治療為主,且臨床可供選擇的手術方式也很多,絕大多數(shù)患者都可得到滿意治療。但臨床發(fā)現(xiàn)部分痔術后患者在創(chuàng)面愈合后,仍出現(xiàn)臨床難以解釋的頑固性疼痛。為此,本課題采用回顧性研究,驗證上中下通用痛風湯對痔術后頑固性疼痛的臨床療效。方法：本課題收集2010年08月～2016年01月期間在北京中醫(yī)藥大學東直門醫(yī)院肛腸科門診診斷為痔術后,且門診處方為上中下通用痛風湯(加減)患者63例,作為研究對象。采用電話回訪患者就診時疼痛程度、伴隨癥狀及用藥1w、2w后疼痛程度,并采用疼痛數(shù)字評分(Numeric Rating Scales, NRS)對患者疼痛程度進行客觀記錄。應用SPSS 20.0進行統(tǒng)計學分析,計量資料用均數(shù)加減標準差表示(x±s),正態(tài)分布者,可用t檢驗,不符合正態(tài)分布者,應用非參數(shù)檢驗；計數(shù)資料應用卡方檢驗。結果：63例患者中男性26例,女性37例。最小年齡24歲,最大年齡86歲,平均年齡58.67±11.80歲。63例患者中診斷為單純痔術后患者45例,伴濕疹診斷患者4例,伴結、直腸炎診斷患者5例,伴便秘診斷患者4例,伴結腸黑變病患者2例,伴高血壓病患者1例,伴高脂血癥患者1例,伴腸功能紊亂患者1例。通過電話共有效回訪54例患者,剩余9例患者因電話信息缺失或失聯(lián)致回訪失敗,患者就診時NRS評分范圍在3～5分,平均4.25±0.49分�；卦L患者服用上中下通用痛風湯1w、2w后NRS評分,其中53例患者為用藥1w后評分,1例為用藥2w后評分。平均分為0.87±0.65分,其中0分為15例,顯示治愈率為27.8%�；颊呔驮\時NRS評分和用藥后NRS評分兩組數(shù)據(jù)經T檢驗結果示T=33.828,P0.01,表示兩組數(shù)據(jù)有顯著差異,治療后疼痛NRS評分明顯優(yōu)于就診時。結論：通過本研究證實,上中下通用痛風湯對痔術后頑固性疼痛治療有顯著療效,能有效緩解患者疼痛癥狀,能為臨床治療提供可行性參考。
[Abstract]:Objective: hemorrhoids is a common and frequent clinical disease. Epidemiological investigation shows that the incidence of hemorrhoids in China is 49.14. The main manifestations of hemorrhoids are blood, prolapse of tumor in anus, perianal foreign body sensation, pain and so on, which greatly affect the quality of life. Most of the patients with moderate and severe hemorrhoids are treated by surgery, and there are a lot of surgical methods available in clinic. Most of the patients can get satisfactory treatment. However, it is found that some patients with hemorrhoids healed after the operation. There is still intractable pain that is difficult to explain in clinic. For this reason, a retrospective study was used in this study. To verify the clinical effect of upper, middle and lower general gout decoction in treating intractable pain after hemorrhoids operation. Methods: from August 2010 to January 2016, the subjects were collected and diagnosed as hemorrhoids in the outpatient clinic of Dongzhimen Hospital of Beijing University of traditional Chinese Medicine. The outpatient prescriptions included 63 patients with upper, middle and lower general gout decoction (plus or minus). The patients' pain degree, accompanying symptoms and pain degree after 1 week or 2 weeks of treatment were investigated by telephone. The patients' pain degree was recorded objectively by using Numeric Rating scales (NRS). The statistical analysis was carried out with SPSS 20.0. The measurement data were expressed by the standard deviation of mean addition and subtraction. The patients with normal distribution could use t test, and those who did not accord with normal distribution. Results among 63 patients, 26 were male and 37 were female. The youngest age was 24 years old, the maximum age was 86 years, the average age was 58.67 鹵11.80 years old and the average age was 58.67 鹵11.80 years. There were 4 cases with eczema, 5 cases with colitis, 4 cases with constipation, 2 cases with colonic melanosis, 1 case with hypertension and 1 case with hyperlipidemia. One patient with intestinal dysfunction. 54 patients were effectively visited by telephone. The remaining 9 patients failed due to lack of telephone information or loss of connection. The NRS score range of the patients was 3 ~ 5 points at the time of visit. The average score was 4.25 鹵0.49. The NRS score was 0.87 鹵0.65 in 53 patients after 1 week of treatment, and 0 in 15 patients. The result of T test showed that there was significant difference between the two groups, and that the NRS score of pain after treatment was obviously better than that of the patient. Conclusion: the results of this study indicate that there is a significant difference between the two groups. Upper, middle and lower general gout decoction has significant curative effect on intractable pain after hemorrhoids operation, can effectively relieve pain symptoms of patients, and can provide a feasible reference for clinical treatment.
【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R266

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