本文選題：反流性食管炎 + 胃鏡分級(jí)��； 參考：《云南中醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:本研究通過設(shè)計(jì)調(diào)查表,收集胃鏡下確診的反流性食管炎(Reflux Esoph agitis,RE)患者的基本信息,總結(jié)275例反流性食管炎患者的中醫(yī)證候以及胃鏡下的表現(xiàn),采用臨床流行病學(xué)調(diào)查的方式,探討反流性食管炎患者的胃鏡分級(jí)與中醫(yī)證候的分布規(guī)律,將西醫(yī)“辨病論治”與中醫(yī)“辨證論治”相結(jié)合,為反流性食管炎的中醫(yī)辨證分型及患者下一步防治提供客觀依據(jù)。方法:采用臨床流行病學(xué)的方式設(shè)計(jì)問卷調(diào)查表,通過橫斷面研究的方法,對(duì)2015年04月-2017年03月云南省中醫(yī)學(xué)院第三附屬醫(yī)院(昆明市中醫(yī)醫(yī)院)門診及病房經(jīng)胃鏡確診RE的患者,符合納入標(biāo)準(zhǔn)的患者275例,對(duì)患者如實(shí)進(jìn)行問卷調(diào)查并記錄填寫,將所得數(shù)據(jù)錄入并進(jìn)行統(tǒng)計(jì),使用SPSS19.0統(tǒng)計(jì)軟件,采用(x|-)±s、χ~2檢驗(yàn)、構(gòu)成比(%)、秩和檢驗(yàn)、相關(guān)性分析等。結(jié)果:1.本研究經(jīng)胃鏡檢查確診并符合納入標(biāo)準(zhǔn)的反流性食管炎患者275例,其中男性168例(61.09%),女性107例(38.91%);誘發(fā)因素以飲食因素109例(39.64%)為主,情志因素21例(7.64%)次之;患者平素多喜食辛辣、甜膩之品,多發(fā)病于餐后,且容易復(fù)發(fā),患者夏季發(fā)病率較高。2.患者的中醫(yī)證型分布,由多到少依次為肝胃不和99例(36.00%);肝胃郁熱66例(24.00%);脾胃虛寒60例(21.82%);氣郁痰熱18例(6.54%);氣滯血瘀13例(4.73%);脾虛痰阻11例(4.00%);胃陰不足8例(2.91%)。3.患者胃鏡檢查結(jié)果分布,0級(jí)55例(20.00%);I級(jí)(Ia、Ib)155例(56.36%);II級(jí)38例(13.82%);III級(jí)27例(9.82%)。4.本課題中患者胃鏡檢查分級(jí)與中醫(yī)證型的調(diào)查研究,0級(jí)以肝胃不和、肝胃郁熱證為主,I級(jí)以肝胃不和、肝胃郁熱、脾胃虛寒證為主,II級(jí)以肝胃不和證為主,III級(jí)以肝胃郁熱、氣滯血瘀證為主。經(jīng)秩和檢驗(yàn)(Kruskal-Wallis),P=0.030.05,患者胃鏡分級(jí)與中醫(yī)證型存在顯著差異;經(jīng)相關(guān)性分析,得出Pearson系數(shù)為0.121,P=0.0460.05,不同胃鏡分級(jí)與中醫(yī)證型分布具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1.從患者基本信息來看,中年男性發(fā)病率較高,患者多為已婚,職業(yè)分布以職員多發(fā),文化水平多為中學(xué),且長(zhǎng)期居住于城鎮(zhèn),多為飲食不適引起,多喜嗜辛辣、甜膩之品,喜飲酒,常于餐后癥狀明顯,病程多小于3年,且反復(fù)發(fā)作。2.從患者中醫(yī)癥狀分布來看:本病以氣機(jī)不調(diào)為主。3.從患者中醫(yī)證候分布來看:多為肝胃不和、肝胃郁熱證。虛證多為脾氣虛、氣陰陽(yáng)兩虛,實(shí)證多為痰、熱、氣、瘀互結(jié)。4.從患者胃鏡下分級(jí)來看:胃鏡下分級(jí)的分布情況為I級(jí)(Ia、Ib)0級(jí)II級(jí)III級(jí)。5.胃鏡下分級(jí)對(duì)反流性食管炎的中醫(yī)辨證分型及指導(dǎo)患者的下一步防治具有一定的臨床意義。
[Abstract]:Objective: to collect the basic information of patients with reflux esophagitis (RER) diagnosed by gastroscopy and summarize the TCM syndromes of 275 patients with reflux esophagitis. By means of clinical epidemiological investigation, the distribution of gastroscope classification and TCM syndromes in patients with reflux esophagitis was discussed. To provide objective basis for TCM syndrome differentiation and prevention and treatment of reflux esophagitis. Methods: a questionnaire was designed by clinical epidemiology, and a cross-sectional study was carried out. From April 2015 to March 2017, 275 patients with RE confirmed by gastroscopy in outpatients and wards of the third affiliated Hospital of Yunnan Institute of traditional Chinese Medicine (Kunming traditional Chinese Medicine Hospital) were investigated by questionnaire and recorded. The data were inputted and counted, SPSS 19.0 software was used, X -) 鹵s, 蠂 ~ 2 test was used to make up ratio, rank sum test, correlation analysis and so on. The result is 1: 1. In this study, 275 patients with reflux esophagitis were confirmed by gastroscopy and met the inclusion criteria, including 168 male patients with reflux esophagitis, 107 women with 38.91C, 109 patients with dietary factors (39.64), and emotional factors with 21 patients (7.64). Sweet and greasy products, frequent after meals, and easy to relapse, the summer incidence of patients is higher. 2. 2. The distribution of TCM syndromes from more to less was as follows: liver and stomach disharmony in 99 cases (36.00); stagnation of liver and stomach in 66 cases (P < 24.00); deficiency of spleen and stomach in 60 cases; Qi stagnation and phlegm heat in 18 cases; Qi stagnation and blood stasis in 13 cases; spleen deficiency and phlegm obstruction in 11 cases; spleen deficiency and phlegm obstruction in 11 cases; stomach yin deficiency in 8 cases. The results of gastroscopy were distributed in 55 cases of grade 0 (20. 00) and 155 cases of Iahe Ibma of grade I (56.36) and 38 cases of grade II (13. 82%) and 27 cases of grade III (9. 82%). Investigation on the classification of gastroscopy and TCM syndromes in this subject; grade 0 was divided into liver and stomach disharmony, liver and stomach stagnation heat syndrome was mainly divided into liver and stomach disharmony, liver and stomach stagnation heat, spleen and stomach deficiency cold syndrome were mainly divided into liver and stomach disharmony syndrome and grade III was liver and stomach stagnation heat. Qi stagnation and blood stasis syndrome. By rank sum test, there was a significant difference between the grade of gastroscope and the type of TCM syndrome, and the Pearson coefficient was 0.121%, 0.0460.05. The distribution of different grades of gastroscope and TCM syndromes was statistically significant. Conclusion 1. According to the basic information of the patients, the incidence rate of middle-aged men is relatively high, the patients are mostly married, the occupation distribution is mainly by the staff, the education level is mostly middle school, and the long-term living in the town is caused by the food discomfort, more happy and spicy, sweet and greasy products. Like drinking, often obvious symptoms after the meal, the course of disease is less than 3 years, and repeated attacks. 2. From the distribution of TCM symptoms of patients: this disease is mainly intonation of Qi. 3. From the distribution of TCM syndromes of patients: liver and stomach discord, liver and stomach stagnation heat syndrome. Deficiency syndrome is mostly spleen qi deficiency, qi yin and yang deficiency, and the empirical evidence is phlegm, heat, qi and blood stasis. According to the classification of the patients under gastroscope, the distribution of the grade was Iahe, Ib0, grade II, grade III, and grade 5. The classification under gastroscope has certain clinical significance for TCM syndrome differentiation of reflux esophagitis and guiding the next step of prevention and treatment of reflux esophagitis.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R259

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