本文選題：潰瘍性結(jié)腸炎 + 中醫(yī)證型分布��； 參考：《長春中醫(yī)藥大學》2016年碩士論文

【摘要】：目的:通過研究潰瘍性結(jié)腸炎的中醫(yī)證型分布與潰瘍性結(jié)腸炎患者年齡、病程、臨床類型、病情分期、病變范圍,內(nèi)鏡下粘膜表現(xiàn)等數(shù)據(jù)間相關(guān)性,總結(jié)出潰瘍性結(jié)腸炎證型分布規(guī)律、中醫(yī)證型特點和診治規(guī)律,為臨床的診斷和治療提供指導。方法:將收集到的有完整中醫(yī)臨床資料的90例患者的臨床資料,進行整理和數(shù)據(jù)統(tǒng)計,采用SPSS19.0軟件進行數(shù)據(jù)分析,分析年齡、病程、病變范圍、臨床類型、病情分期、內(nèi)鏡下粘膜表現(xiàn)與中醫(yī)證型分布的關(guān)系。結(jié)果:本次研究的90例UC病例中,男女比例為1.14:1,性別對UC的發(fā)病無明顯差異,發(fā)病的平均年齡為41.07±12.13歲,發(fā)病的高峰年齡段為35至50歲。研究的病例中證型比例由高至低依次為大腸濕熱證、脾虛濕蘊證、肝郁脾虛證、脾腎陽虛證、寒熱錯雜證、陰血虧虛證,其中寒熱錯雜證、陰血虧虛證較少見。研究提示潰瘍性結(jié)腸炎的患者的證型分布與年齡,病程,臨床類型,病情分期,病變范圍,內(nèi)鏡下粘膜表現(xiàn)等存在聯(lián)系。病程的初期以實證為主,漸漸向虛實夾雜轉(zhuǎn)化,后期轉(zhuǎn)化為以虛證為主。病程小于5年的潰瘍性結(jié)腸炎患者多見大腸濕熱證,脾虛濕蘊證次之;病程5-10年的患者證型主要以肝郁脾虛證、脾虛濕蘊證為主;病程多于10年的潰瘍性結(jié)腸炎患者以脾腎陽虛證為主。初發(fā)型以大腸濕熱證(實證)為主,慢性復發(fā)性以脾虛濕蘊證、肝郁脾虛證(虛實夾雜)為主,慢性持續(xù)型以脾腎陽虛證(虛證)為主�；顒悠谝源竽c濕熱、脾虛濕蘊為主;緩解期以脾腎陽虛,肝郁脾虛為主。病變部位以直腸、乙狀結(jié)腸為主,其中大腸濕熱證最為多見。內(nèi)鏡下粘膜表現(xiàn)比例由高到底依次為充血水腫、血管紋理模糊、糜爛潰瘍、膿性分泌物、自發(fā)性出血、表面粗糙、息肉、腸腔狹窄、腸腔短縮、袋囊消失、粘膜橋。不同證型內(nèi)鏡下粘膜表現(xiàn)不同,大腸濕熱、脾虛濕蘊、寒熱錯雜、肝郁脾虛、脾腎陽虛均以病變充血水腫、血管紋理模糊為主。大腸濕熱還常見糜爛潰瘍、膿性分泌物、粘膜質(zhì)脆易出血。脾虛濕蘊證可見糜爛潰瘍、膿性分泌物、自發(fā)性出血、表面粗糙。肝郁脾虛、脾腎陽虛、陰血虧虛證的表現(xiàn)中,有更高的出現(xiàn)表面粗糙、腸腔狹窄、腸腔短縮及袋囊消失可能,由以脾腎陽虛證顯著。息肉常見于各種證型的患者表現(xiàn)。結(jié)論:本病發(fā)生與發(fā)展,是脾虛和濕熱之邪的共同作用的結(jié)果,即本虛標實。根據(jù)不同時期應采用不同的治法治療潰瘍性結(jié)腸炎:活動期應以治療實證為主,清化濕熱,調(diào)理氣血,通因通用,同時健脾益氣,標本兼顧;緩解期以補虛為主,補脾益腎,兼清濕熱之邪。不同患者采取不同治療方案:大腸濕熱證最為多見,在治療上應注重清熱利濕,調(diào)養(yǎng)氣血;虛濕蘊則須注意健脾除濕;熱錯雜證應側(cè)重溫中補虛,扶正祛邪兼顧;郁脾虛應疏肝健脾,和中理氣祛濕;腎陽虛應溫補脾腎,祛濕化飲;陰血虧虛滋陰潤腸,和絡養(yǎng)血。采用局部治療的同時也須注重整體觀念:潰瘍性結(jié)腸炎的病變多發(fā)生于直腸、乙狀結(jié)腸處,局部癥狀明顯,同時跟機體的整體病變關(guān)系也十分密切。因而調(diào)整整體的臟腑陰陽氣血與治療局部病變相結(jié)合,可以取得更好的療效,調(diào)治脾胃和祛除濕邪同樣重要。
[Abstract]:Objective: through the study of ulcerative colitis TCM Syndromes of ulcerative colitis and the age of patients, duration of disease, clinical type, disease staging, lesion, endoscopic mucosal manifestations such as correlation among data, summarize the ulcerative colitis syndromes distribution of TCM syndromes and treatment patterns, to provide guidance for clinical diagnosis and treatment methods: the collected clinical data of 90 cases of patients with complete clinical data of TCM, collation and statistical data, using SPSS19.0 software for data analysis, analysis of age, course of disease, extent of disease, clinical type, disease stage, endoscopic mucosal manifestations and syndromes distribution relationship. Results: 90 cases UC cases of this study, male to female ratio was 1.14:1, no significant difference in the incidence of gender on UC, the average age of onset was 41.07 + 12.13 years old, the peak age of onset was 35 to 50 years. The case study In the card type ratio from high to low is damp heat syndrome, spleen deficiency with dampness syndrome, liver stagnation and spleen deficiency, spleen kidney yang deficiency, cold and heat syndrome, yin and blood deficiency, the cold and heat syndrome, yin and blood deficiency is rare. The study suggests that the syndrome distribution of ulcerative colitis patients with age, duration of disease, clinical type, staging, lesion and associated endoscopic mucosal manifestations. The disease in the early days, gradually to the deficiency of transformation, later converted to deficiency. Less than 5 years history of ulcerative colitis were more common in damp heat syndrome, spleen deficiency and Dampness Retention syndrome; syndrome of 5-10 years duration mainly to stagnation and spleen deficiency syndrome, spleen deficiency and Dampness Retention syndrome; duration of more than 10 years in patients with ulcerative colitis of spleen and kidney yang deficiency syndrome. Early onset with damp heat syndrome (positive), chronic recurrent spleen deficiency with dampness syndrome, liver stagnation and spleen deficiency syndrome (the actual clip Miscellaneous), chronic persistent to spleen deficiency syndrome (deficiency). Active in damp heat syndrome, spleen deficiency wefness; remission with spleen kidney yang deficiency, liver stagnation and spleen deficiency. The lesions in the rectum, sigmoid colon, the damp heat syndrome is the most common. Endoscopic mucosal manifestations of the higher proportion of what were the hyperemia and edema, vascular fuzzy texture, erosion and ulcer, purulent secretions, spontaneous bleeding, rough surface, polyp, intestinal stenosis, intestinal shortening, bag disappear, mucosal bridge different syndromes. Endoscopic mucosal manifestations of different damp heat, spleen wet Yun, chills and fever, liver stagnation and spleen deficiency, spleen and kidney yang were hyperemia and edema lesions, vascular fuzzy texture. The damp heat syndrome is also common debaucjed ulcer, purulent secretions, mucous membrane is crisp and easy bleeding. Spleen wet Yun card visible erosion ulcers, purulent secretions, spontaneous bleeding, rough surface. Liver stagnation and spleen deficiency, spleen kidney yang deficiency, Yin and blood deficiency in performance, higher surface roughness, lumen stenosis, intestinal cavity shortening and may disappear from the bag, Yang deficiency of spleen and kidney significantly. Patients with polyps common in various syndromes. Conclusion: the occurrence and development of this disease is spleen deficiency and damp heat evil work together the result is the vacuity. According to different periods should be used in treatment of ulcerative colitis with different activity period should be mainly empirical treatment, clearing heat, regulating qi and blood, for the general at the same time, spleen qi, both specimens; remission to supplement the deficiency, spleen and kidney, clearing and damp heat evil. Different patients with different treatment regimens: Damp heat syndrome is the most common, the treatment should focus on clearing heat and removing dampness and dampness, Qi and blood deficiency nursed back to health; it must pay attention to the spleen dehumidification syndrome; heat should be empty, fill in the side to paying attention; spleen Yu Shu virtual liver and spleen, kidney qi and dampness; Virtual tonifying the spleen and kidney, dispelling dampness and drinking; Yin deficiency and nourishing Ziyin Runchang, using local treatment should also pay attention to the overall concept of ulcerative colitis lesions occurred in the rectum, sigmoid colon, local symptoms at the same time, with the whole body of the lesions are also very close. Therefore the adjustment of local lesion with the treatment of the whole viscera Yin and Yang Qi combination, can achieve better curative effect, treating the spleen and stomach and eliminate dampness are equally important.

【學位授予單位】：長春中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R259

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本文編號：1757467