本文選題：腸動(dòng)力 + 兒童�。� 參考：《北京中醫(yī)藥大學(xué)》2017年碩士論文

【摘要】：目的:探討哮喘緩解期患兒腸動(dòng)力障礙癥狀及腸電圖參數(shù)的改變情況,比較哮喘緩解期患兒各中醫(yī)證型之間腸動(dòng)力障礙癥狀及腸電圖參數(shù)有無差異,進(jìn)一步探討扶正止哮方對哮喘緩解期患兒腸動(dòng)力的影響。方法:入選本課題的60例患兒均來源于2014年11月至2016年12月到空軍總醫(yī)院兒科門診就診的4-14歲緩解期哮喘患兒。對所有入組患兒填寫病情基線調(diào)查表,記錄其中醫(yī)癥候積分,同時(shí)進(jìn)行中醫(yī)辨證分型,分為肺虛型、脾虛型、腎虛型,并進(jìn)行腸電圖檢測。另選取30例健康兒童為對照組,進(jìn)行腸電圖檢測。采用隨機(jī)單盲對照試驗(yàn),將60例哮喘緩解期患兒隨機(jī)分為中藥組40例和對照組20例,中藥組給予扶正止哮方加孟魯司特鈉口服,對照組給予孟魯司特鈉口服,治療療程為3個(gè)月,記錄兩組患兒治療1個(gè)月、治療2個(gè)月、治療3個(gè)月的中醫(yī)癥候積分和治療3個(gè)月后腸電圖參數(shù)。所得試驗(yàn)數(shù)據(jù)均應(yīng)用SPSS21.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析,P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:①60例緩解期哮喘患兒中,其中56例患兒存在一種或同時(shí)存在多種腸動(dòng)力障礙癥狀,其中45.000%的患兒存在腹痛,43.33%的患兒出現(xiàn)腹脹,61.67%的患兒存在大便干結(jié)癥狀,46.67%的患兒存大便頻率異常。②哮喘組患兒腸電圖升結(jié)腸導(dǎo)聯(lián)和降結(jié)腸導(dǎo)聯(lián)其平均幅值和平均頻率較正常對照組兒童均顯著降低,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。③60例哮喘緩解期患兒中,其中脾虛證40例,肺虛證17例,腎虛證3例,因腎虛證患兒病例數(shù)較少,故在此僅比較脾虛證與肺虛證患兒腸動(dòng)力障礙癥狀積分及腸電圖參數(shù)。肺虛型17例,29.41%的患兒出現(xiàn)腹痛,29.41%的患兒存在腹脹,47.05%的患兒存在大便干結(jié)、大便費(fèi)力癥狀,29.41%的患兒存大便頻率異常。脾虛型患兒共40例,52.05%的患兒出現(xiàn)腹痛,47.50%的患兒存在腹脹,67.50%的患兒存在大便干結(jié)、大便費(fèi)力癥狀,55.00%的患兒存大便頻率異常。脾虛證患兒腸動(dòng)力障礙癥狀積分較肺虛證患兒有升高趨勢,差異無統(tǒng)計(jì)學(xué)意義(p0.05)。脾虛證患兒各導(dǎo)聯(lián)平均頻率較肺虛證患兒無明顯差異。脾虛證患兒各導(dǎo)聯(lián)平均幅值較肺虛證患兒有下降趨勢,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。④中藥組患兒40例,共36例完成臨床試驗(yàn)。對照組患兒20例,共18例完成臨床試驗(yàn)。中藥組患兒在治療1個(gè)月后全身癥狀總積分即有所下降,3個(gè)月時(shí)明顯下降,與治療前及對照組均有明顯差異,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。而對照組患兒全身癥狀總積分治療前后無明顯變化(P0.05)。⑤中藥組患兒在治療3個(gè)月后腸動(dòng)力障礙癥狀積分較前均明顯下降,與治療前及對照組患兒比較均有顯著差異,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對照組患兒腸動(dòng)力障礙癥狀積分較治療前無明顯變化(P0.05)。⑥中藥組患兒在治療3個(gè)月后升結(jié)腸導(dǎo)聯(lián)平均幅值明顯升高,與治療前及對照組比較均有顯著差異,差異有統(tǒng)計(jì)學(xué)意義(P0.05),平均頻率亦較前升高,但與治療前及對照組比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);降結(jié)腸導(dǎo)聯(lián)平均幅值及平均頻率在治療3個(gè)月后均明顯升高,與治療前及對照組比較有顯著差異,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。對照組患兒在治療3個(gè)月后各導(dǎo)聯(lián)平均幅值及平均頻率較治療前均無明顯變化(P0.05)。結(jié)論:緩解期哮喘患兒多數(shù)有不同程度腸動(dòng)力障礙的臨床表現(xiàn),主要表現(xiàn)為腹脹、腹痛、大便干結(jié)及大便頻率異常。與健康兒童腸電圖相比,緩解期哮喘患兒的餐后腸電活動(dòng)異常,腸電功率降低,腸電基本節(jié)律減慢,腸推進(jìn)性運(yùn)用較少,腸動(dòng)過緩,腸動(dòng)力不足。哮喘與腸動(dòng)力之間有一定關(guān)系,二者互為因果。哮喘緩解期脾虛證患兒腸動(dòng)力障礙程度較肺虛證患兒可能更加明顯。扶正止哮方能有效的改善哮喘期患兒的全身癥狀,能改善哮喘緩解期患兒腸動(dòng)力不足癥狀,增加其餐后腸電功率和節(jié)律,促進(jìn)腸推進(jìn)性運(yùn)動(dòng),增加腸動(dòng)力。扶正止哮方可能通過作用于某些胃腸激素,增加腸動(dòng)力,預(yù)防哮喘發(fā)作。
[Abstract]:Objective: To investigate the changes of intestinal motility disorders and electrogram parameters in children with asthma at remission stage, and to compare the differences of intestinal motility and electrogram parameters between the TCM Syndromes of asthma remission period, and further explore the effect of Fuzheng Zhi Zhi Fang on the intestinal motility in children with asthma in remission stage. Methods: 60 children enrolled in this subject All of the 4-14 year old children with asthma in the outpatient department of Pediatrics of General Hospital of the Air Force PLA from November 2014 to December 2016 were selected to fill in the baseline questionnaire of all the children and record the TCM syndrome scores. Meanwhile, the syndrome differentiation of traditional Chinese medicine was divided into lung deficiency type, spleen deficiency type, kidney deficiency type, and 30 cases of healthy children were selected. 60 cases of asthma remission period were randomly divided into 40 cases of traditional Chinese medicine and 20 cases of control group. The Chinese medicine group was given Fuzheng Zhi Xiao Fang plus montelukast sodium, and the control group was given montelukast sodium orally, the treatment course was 3 months, and two groups of children were treated for 1 months and 2 were treated for 2. In the month, the TCM syndrome score of 3 months and the parameters of the Enterogram after 3 months of treatment were treated. The results of the experimental data were statistically analyzed with SPSS21.0 software, and the difference was statistically significant. Results: (1) among the 60 children with remission asthma, 56 of them had one or more intestinal motility disorders, of which 45 were 45. % of the children had abdominal pain, 43.33% of the children had abdominal distention, 61.67% of the children had stool symptoms, and 46.67% of the children had abnormal frequency of stool. The average amplitude and average frequency of the ascending colon and descending colon in the asthmatic group were significantly lower than those in the normal control group (P0.05). (3) 60 cases. Among the children with asthma, there were 40 cases of spleen deficiency syndrome, 17 cases of asthenia of lung and 3 cases of kidney deficiency syndrome, and the number of children with kidney deficiency was less. Therefore, there were only 17 cases of intestinal motility disorders in children with spleen deficiency syndrome and lung deficiency syndrome, 17 cases of lung deficiency type, 29.41% of children with abdominal pain, 29.41% of children with abdominal distention, 47.05% of the children had stool. 29.41% of children had abnormal stool frequency, 40 cases with spleen deficiency, 52.05% of children with abdominal pain, 47.50% of children with abdominal distention, 67.50% of children with bowel movement, feces and feces, 55% of children with abnormal stool frequency. The score of intestinal motility disorder in children with spleen deficiency syndrome was higher than that of children with deficiency of lung syndrome. There was no significant difference in the high trend (P0.05). The average frequency of each lead in children with spleen deficiency syndrome had no significant difference compared with that of children with lung deficiency syndrome. The average amplitude of each lead in children with spleen deficiency syndrome was lower than that of asthenia syndrome in children (P0.05). (4) 40 cases of children in the Chinese medicine group, a total of 36 cases completed clinical trials. 20 cases in the control group were completed, a total of 18 cases were finished. After 1 months of treatment, the total score of the total body symptoms of the children in the Chinese medicine group decreased and decreased obviously at 3 months. There was a significant difference between the group and the control group (P0.05). There was no significant change in the whole body symptom score of the control group (P0.05). (5) the children in the Chinese medicine group were treated for 3 months after the treatment. The score of the symptoms of dynamic disorder was significantly lower than that before the treatment and the control group. The difference was statistically significant (P0.05). The score of the intestinal motility disorder in the control group was not significantly changed (P0.05). (6) the average amplitude of the ascending colon in the Chinese medicine group was significantly higher after 3 months of treatment and before the treatment. There was significant difference between the control group and the control group, the difference was statistically significant (P0.05), the average frequency was also higher, but there was no significant difference between the pre treatment and the control group (P0.05). The average amplitude and average frequency of the descending colon lead were significantly increased after 3 months of treatment, and there were significant differences compared with those before and in the control group. The mean amplitude and average frequency of the lead in the control group had no significant changes after 3 months of treatment (P0.05). Conclusion: most of the children with asthma in remission period have different degrees of intestinal motility disorders, mainly manifested in abdominal distention, abdominal pain, stool dry knot and abnormal frequency of stool. In children with asthma, the intestinal electrical activity was abnormal, the power of intestinal electricity decreased, the basic rhythm of intestinal electricity slowed, intestinal propulsion was less used, intestinal motility was slow, intestinal motility was insufficient. There was a certain relationship between asthma and intestinal motility, and the two were mutually causality. The degree of intestinal motility disorder in children with spleen deficiency syndrome in the remission period of asthma was more obvious than that of the asthmatic children. Fuzheng Zhi Zhi Xiao Fang can effectively improve the systemic symptoms of children with asthma, improve the symptoms of intestinal motility in children with asthma, increase the electric power and rhythm of the intestinal posterior intestine, promote intestinal propulsive movement and increase the intestinal motility. It may help to increase intestinal motility, increase intestinal motility and prevent asthma attacks.

【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】：R272

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