本文選題：阿片類藥物 + 便秘�。� 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：便秘是使用強阿片類藥物后最常見的不良反應(yīng)之一,影響患者鎮(zhèn)痛治療的效果,加重患者痛苦的情緒。阿片類藥物相關(guān)性便秘已經(jīng)成為腫瘤科醫(yī)生亟待解決的問題。本文總結(jié)了腫瘤患者使用阿片類藥物鎮(zhèn)痛治療后引起便秘的中醫(yī)病因病機、西醫(yī)機制及中西醫(yī)治療方法,提出采用中醫(yī)熱敏灸作為治療阿片類藥物相關(guān)性便秘的治療方法。在系統(tǒng)整理了中西醫(yī)治療阿片類藥物相關(guān)性便秘的文獻(xiàn)資料后,發(fā)現(xiàn)對該類型藥源性不良反應(yīng),中醫(yī)相對于西醫(yī)積累了更為豐富的治療經(jīng)驗,臨床效果更為理想。灸法是中醫(yī)臨床中常用的治療手段,熱敏灸作為艾灸的一種新型灸法,適應(yīng)癥更廣,便秘為其優(yōu)勢病種。本研究與口服酚酞片作為對照,來觀察熱敏灸治療阿片類藥物相關(guān)性便秘的臨床效果。目的：觀察熱敏灸療法治療阿片類藥物相關(guān)性便秘的臨床效果及對患者生活質(zhì)量的改善情況。方法：采用隨機對照試驗研究方法,將廣州市中醫(yī)醫(yī)院符合納入標(biāo)準(zhǔn)的病例70例,隨機分成治療組和對照組,兩組病例各35例。治療組以熱敏灸療法治療,對照組給予口服酚酞片治療。觀察時間為3周期(5天為1周期,共15天),其中治療2周期,停治療1周期。分別在治療1周期后、治療2周期后及停止治療1周期后進(jìn)行隨訪觀察,記錄患者便秘癥狀及生活質(zhì)量的改善情況,并進(jìn)行統(tǒng)計學(xué)處理,得出結(jié)論。結(jié)果：1.縱向比較：兩組治療前后自身對照研究,經(jīng)重復(fù)測量方差分析比較兩組不同測量時間差異,結(jié)果提示：治療組：①與治療前比較,治療組與治療1周期后、治療2周期后及停止治療1周期后便秘癥狀明顯改善(P0.05)；②與治療前比較,治療組治療1周期后比較生活質(zhì)量改善不明顯(P0.05),治療2周期后及停止治療1周期后生活質(zhì)量明顯改善(K0.05)；對照組：①與治療前比較,對照組治療1周期后、治療2周期后及停止治療1周期后便秘癥狀明顯改善(P0.05)；②與治療前比較,對照組治療1周期后、治療2周期后及停止治療1周期后比較生活質(zhì)量均無明顯改善(P0.05)。2.組間比較：各組間效應(yīng)經(jīng)Bonferroni檢驗顯示治療組和對照組組間便秘評分和生活質(zhì)量評分均存在顯著性差異(P0.05)。對不同時間點治療組和對照組便秘評分進(jìn)行比較,結(jié)果提示：與對照組比較,治療組治療前和治療1周期后便秘評分比較無顯著性差異(P0.05),而在治療2周期后及停止治療1周期后便秘評分比較具有顯著性差異(P0.05),治療組優(yōu)于對照組；對不同時間點治療組和對照組生活質(zhì)量評分進(jìn)行比較,結(jié)果提示：與對照組比較,治療組治療前和治療1周期后生活質(zhì)量評分無顯著性差異(P0.05),在治療2周期后及停止治療1周期后生活質(zhì)量評分比較具有顯著性差異(P0.05),治療組優(yōu)于對照組。3.便秘量表和生活質(zhì)量單項癥狀的比較：治療組：①便秘量表單項評分中,與治療前比較,治療組停止治療1周期后“排便頻率”、“排便感到未排凈”2項無明顯改善(P0.05),“排便費勁”、“腹部疼痛”、“每次大便需要時間”、“排便需要的類型”及“每天排便不成功的次數(shù)”5項均明顯改善(P0.05)；②生活質(zhì)量量表單項評分中,與治療前比較,停止治療1周期后“日常生活”單項無明顯改善(P0.05),“精神狀態(tài)”、“疲乏”、“食欲”、“睡眠”4項均有明顯改善(P0.05)；對照組：①便秘量表單項評分中,與治療前比較,對照組治療1周期后“排便感到未排凈”、“腹部疼痛”、“每次大便需要時間”、“每天排便不成功次數(shù)”4項均無明顯改善(P0.05),“排便頻率”、“排便費勁”、“排便需要的類型”3項均有明顯改善(P0.05)。②生活質(zhì)量量表單項評分中,與治療前比較,對照組停止治療1周期后、“精神狀態(tài)”、“疲乏”、“食欲”、“睡眠”及“日常生活”5項均無明顯改善(P0.05)。以上結(jié)果說明,熱敏灸治療對患者“排便費勁”、“腹部疼痛”、“每次大便需要時間”、“排便需要的類型”及“每天排便不成功的次數(shù)”便秘癥狀5方面有改善,對“精神狀態(tài)”、“疲乏”“食欲”、“睡眠”生活質(zhì)量4方面有改善；口服酚酞片對患者“排便頻率”、“排便費勁”及“排便需要的類型”3方面有改善,而對患者生活質(zhì)量5個單項方面均無明顯改善。4.治療有效率：治療組35例,對照組35例。停止治療1周期后,治療組痊愈7例,顯效15例,有效8例,無效5例,總有效率85.8%；對照組痊愈2例,顯效10例,有效13例,無效10例,總有效率71.4%。結(jié)論：1.熱敏灸治療能有效改善阿片類藥物相關(guān)性便秘的癥狀。2.熱敏灸治療改善便秘癥狀的療效優(yōu)于口服酚酞片。3.熱敏灸治療在改善便秘癥狀的同時,還可以提高腫瘤患者的生活質(zhì)量。
[Abstract]:Constipation is one of the most common adverse reactions after the use of strong opioid drugs, which affects the effect of the patient's analgesic treatment and aggravates the suffering emotion of the patients. Opioid related constipation has become an urgent problem for the oncologist. This paper summarizes the causes of constipation caused by opioid analgesics in patients with cancer. The pathogenesis, the western medicine mechanism and the traditional Chinese and Western medicine treatment methods, proposed the use of traditional Chinese medicine hot moxibustion as the treatment of opioid related constipation. After systemically collating the literature on the treatment of opioid related constipation in Chinese and Western medicine, it was found that the negative response to this type of drug origin was found, and the traditional Chinese medicine has accumulated a more abundant treatment relative to the western medicine. The clinical effect is more ideal. Moxibustion is a common therapeutic method in traditional Chinese medicine. Thermosensitive moxibustion is a new moxibustion method of moxibustion. It is more widely used and constipation is the dominant disease. The clinical effect of thermosensitive moxibustion on the treatment of opioid related constipation is observed with oral Phenolphthalein Tablets. Objective: To observe the thermal moxibustion The clinical effect of the treatment of opioid related constipation and the improvement of the quality of life of the patients. Methods: 70 cases of Guangzhou traditional Chinese medicine hospital were randomly divided into the treatment group and the control group, and the two groups were 35 cases. The treatment group was treated with thermosensitive moxibustion therapy and the control group. The oral Phenolphthalein Tablets treatment was given. The observation time was 3 cycles (5 days as 1 cycles, 15 days), of which 2 cycles were treated and 1 cycles were stopped. After the 1 cycle, after the 2 cycle, and after the cessation of the 1 cycle, the patients were followed up to record the symptoms of constipation and the improvement of the quality of life, and the results were statistically treated. The results were concluded. 1. longitudinal comparison: two groups of self-control study before and after treatment, through repeated measurement of variance analysis to compare the difference between the two groups of different measurement time, the results suggest: the treatment group: compared with before treatment, the treatment group and the treatment 1 cycle, after the 2 cycle and after the 1 cycle of the treatment of constipation symptoms obviously improved (P0.05); 2. Compared with the treatment before treatment, treatment The quality of life was not significantly improved after 1 cycles in the treatment group (P0.05), and the quality of life was significantly improved after the treatment of 2 cycles and after the 1 cycle of cessation treatment (K0.05); the control group was compared with before treatment, and after the treatment of the 1 cycle of the control group, the constipation symptoms were significantly improved after the treatment of 2 cycles and after the 1 period of cessation treatment (P0.05); (2) compared with before treatment, After the treatment of 1 cycles, after the treatment of 1 cycles, after the treatment of 2 cycles and after the 1 cycle of the treatment, there was no significant improvement in the quality of life (P0.05) between group.2.. The effects of each group showed significant difference between the constipation score and the quality of life score between the treatment group and the control group (P0.05). The treatment group and the control group at different time points were found. The results showed that there was no significant difference in constipation score between the treatment group before and after the 1 cycle (P0.05) compared with the control group, but the constipation score was significantly different after the treatment of 2 cycles and after the 1 cycle of the treatment (P0.05), and the treatment group was superior to the control group; the treatment group and the control group at different time points were compared with the control group. Compared with the control group, the results showed that compared with the control group, there was no significant difference in the quality of life score between the treatment group before and after the 1 cycle (P0.05). The quality of life score of the treatment group was significantly different after the 2 cycle and after the 1 cycle of the treatment (P0.05). The treatment group was better than the control group.3. constipation scale and the quality of life. Comparison of single symptom: the treatment group: (1) the score of constipation form items, compared with before treatment, the treatment group stopped 1 cycles after the treatment of the treatment group, "defecation frequency", "defecation feel not clear" no obvious improvement (P0.05), "defecation effort", "abdominal pain", "every time need time", "type of defecation needs" and "every day" The 5 items of unsuccessful defecation were obviously improved (P0.05); (2) compared with before treatment, there was no significant improvement in the single item of daily life (P0.05), and 4 items of "mental state", "fatigue", "appetite" and "sleep" were obviously improved (P0.05), and the control group: (1) constipation scale In the single score, compared with the treatment before treatment, the control group treated 1 cycles after the treatment, "the defecation felt not clear", "abdominal pain", "every time the stool needed time", "every day the number of defecation unsuccessful times" 4 items had no obvious improvement (P0.05), "defecation frequency", "defecation difficulty", "defecation needs type" 3 items have obviously improved (P0.05). In the score of quality of life forms, compared with before treatment, the 5 items of "mental state", "fatigue", "appetite", "sleep" and "daily life" were not improved significantly after the treatment of 1 cycles in the control group (P0.05). The above results showed that the thermosensitive moxibustion treatment for the patients "defecation hard", "abdominal pain", "every time the stool needs to be needed." There were improved 5 aspects of constipation symptoms: "mental state", "tired" "appetite", "sleep", and 4 aspects of the quality of life. Oral Phenolphthalein Tablets has improved the "defecation frequency", "defecation effort" and "type of defecation needs" in 3 aspects. There were no obvious improvements in the 5 single aspects of the quality of life of the patients: 35 cases in the treatment group and 35 cases in the control group. After 1 cycles of cessation of treatment, the treatment group recovered 7 cases, 15 cases were markedly effective, 8 effective, 5 invalid, total effective rate 85.8%; the control group recovered 2, effective 10, valid 13, invalid 10, total effective efficiency 71.4%. conclusion: 1. thermosensitive effect, total effective efficiency conclusion: total effective efficiency conclusions: 1. thermosensitive efficiency conclusion: total effective efficiency conclusion: total effective efficiency conclusion: effective efficiency conclusion: total effective efficiency conclusion: effective efficiency conclusion: total effective efficiency conclusions: 1. thermosensitive efficiency conclusion: total effective efficiency. Moxibustion treatment can effectively improve the symptoms of opioid related constipation.2. thermosensitive moxibustion treatment is better than the oral Phenolphthalein Tablets.3. thermosensitive moxibustion treatment in improving constipation symptoms, but also can improve the quality of life of the tumor patients.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R246.1

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