【作者】 徐丽；

【导师】 张启明；

【作者基本信息】 山东中医药大学 ， 中医基础理论， 2010， 博士

【摘要】 目的：尝试从“自身对照”、“月经量、色在经期每天的变化”角度对月经量、色症状补充新的认识,从而规范月经量、色症状的名称和内涵。方法：综合运用文献、历代医案数据库和编制问卷进行流行病学调查相结合的方法进行研究。查阅文献后综述月经量、色症状规范的研究方法和现状,目前尚存在对月经量、色症状认识上的不统一；基于历代医案数据库,提取月经量、色症状数据,遵循逻辑学分类原理和定义方法,在对月经量、色症状进行命名、定义、分类整理规范基础上,应用频数分析、φ相关分析方法,统计分析月经量、色症状单元出现频次、及症状单元间相关性；借鉴流行病学现场调查研究,调查问卷的设计以“定量化、个体化、客观化”为特征,设“自身为参照”,作正常、异常时个体自身前后对比、按照周期和经期天数变化、经期每天卫生用品使用情况进行定量化测量。在文献和医案数据库对月经颜色的描述基础上,结合临床实践确定五种月经颜色,依据比拟标准将国际标准颜色色卡与被测者观察自身新擦拭在卫生用品上月经颜色作比对,并用相应经验类物质作类比,如月经黄褐类似于咖啡色。问卷效度和信度检验分别采用因子分析和Chronbach’sα系数信度检验,调查结果用频数分析、φ相关统计分析。结果：从历代医案数据库包含月经量、色的医案中,整理获得8个月经量、色症状单元,并统计出在历代医案数据库中对应的频次,包括月经量多(658次)、月经量少(767次)、经量时多时少(51次)、月经淡红(312次)、月经鲜红(176次)、月经暗红(365次)、月经发黑(257次)、月经黄褐(26次)；由φ相关统计分析,月经量多与先期相关性是显著的,呈正相关。月经量少与后期相关性是显著的,呈正相关。月经量多与经期延长相关性是显著的,呈正相关。月经量少与经期缩短相关性是显著的,呈正相关。症状单元间各自独立,可独立发生也可伴随发生。临床问卷检验中Chronbach’α系数均大于0.6,多数在0.7以上,具有较好内部一致性；月经量的结构按照3个维度、月经颜色按照2个维度分类结构较为合理；问卷能获得预期结果,内容易于理解和回答,所用时间较少,可接受性考评较好；临床调查结果显示：临床就诊的生育期女性月经量少症状的发生率高于月经量多症状的发生率,且月经量时多时少的症状较少。以“自身为参照”,用每天卫生用品使用的增、减量可有效规避个体间差异的干扰,提高可操作性和实用性。观察自身正常、异常时新排出的月经量、色在每天的变化有差异。问卷统计发现以“经期第2、3天为时间窗”观察月经的量和颜色变化,是较为稳定的观察时间点。结论：运用文献、医案数据库可获得月经量、色定性描述并给出定义,结合临床调查问卷可对月经量、色进行定量描述并能形成客观化测量方法,同时月经量、色症状调查问卷的设计突出了“以自身为参照”,自身正常、异常时月经量、色症状同时被测进行前后对比。应用临床流行病学调查可以进行前瞻性研究,与文献、医案资料回顾性研究形成相得益彰的相互验证、相互补充的结论。提出“症状单元”和“经期第2、3天观察窗”的假说,为症状规范化研究拓展思路,提供方法,使难以获得、难以量化、难以客观化的指标转换为相对量化、客观化的临床证据,从临床中来,到临床中去,使理论和临床相互验证、相互补充,为中医临床疗效评价走向科学化、客观化道路做初步探索性研究。更多还原

【Abstract】 Objective:To standardize the symptoms on volume and color of menstruation, attempting from the perspective "self-control", "the volume of menstrual flow, the color in the menstrual period daily change" to supplement the the new understanding about the volume and color of menstruation symptoms.Method:Unifies the methods which using the literature, the database and the clinical questionnaire conducts the research. It provides the theory instruction that consult literature to understand present situation of symptom standardized research. Based on all previous dynasties medical notes database, Extracted volume of menstrual flow, color symptom data, follows the logic classification principle and the definition method, Carries on the naming, the definition and the classified reorganization to the volume of menstrual flow, the color symptom. Apply the frequency analysis, Phi correlation analysis method to analyze the results of menstrual symptoms. Combination of on-site epidemiological investigation, Questionnaire’s design take "quantifying, the individuation, the objectification" as a characteristic. Supposes oneself is the reference, Compare to oneself normally and abnormally when the individual own around contrasts. According to cycle and menstrual period number of days change, The menstrual period daily using the sanitary napkin condition carried on the quantitative survey. the clause were designed from the menstrual cycle, the menstrual period duration, using the amount sanitary napkin and abnormal changes in volume of menstruation and so on aspects. The menstruation color clause were designed according to the menstruation first half and the latter half normally,abnormally changes forms in pairs.It takes the description of menstrual colors in literature and medical database as the model. Determines five kind of menstrual colors initially, Based on comparison standard makes rightly objectively compared to the international standard color chip and the menstrual colors investigation,and takes the sensory image analogy with the corresponding experience class material for the analogy, such as the menstruation yellowish-brown is similar to the coffee color. Questionnaire validity and reliability testing were used factor analysis and reliability testing Chronbach’sa coefficient, the investigation results is analyzed by frequency and the Phi correlation analysis.Result:Eight symptoms units was established after mestrual volum and color symptoms were standardized. And counts the frequency which corresponds in previous dynasties medical notes database. Including menstruation much (658times), menstruation less (767times), menstruation sometimes much sometimes few (51times),menstruation pale red (312times), menstruation bright red (176times), menstruation dark red (365times), menstruation similars dark (257times),menstruation yellowish-brown (26times). According to Chinese and West medical authoritative work and in medical notes database symptom description, makes the definition separately. Statistical analysis obtained by the relevant volume and menstrual cycle, menstruation period correlation is significant. Questionnaire validity and reliability testing were used factor analysis and reliability testing Chronbach’sa coefficient, The survey questionnaire Chronbach’a coefficients were larger than 0.6, mostly in the 0.7 and above, with good internal consistency.It is more reasonable that the volume of menstrual flow structure according to 3 dimensions and the menstruation color according to 2 dimensions classification structure. Questionnaire is easy to understand and answer, spent less time, acquire a better evaluation of acceptability. The clinical investigation result confirmed it is higher that the incidence of fewer menstrual symptoms than Multi-menstrual symptoms among the reproductive period of women seeking medical help. Correlation is significant between the changes of volume of menstruation with menstrual cycle and menstrual period. Menstrual colors can be divided into five kinds of color. Clinical questionnaire results show:the "self as a reference", with increased or reduced use of sanitary products every day, can effectively avoid the interference, improved maneuverability and practicality. Observe the normal,abnormal menstrual volume and color difference between the daily change. Statistics found that the questionnaire as "the first 2,3 days for the time period window of the observation period" to observe the amount and color change is a more stable time points.Conclusion:Through literature and the medical database available to menstrual volume and color qualitative description,and made the definitions separately. Unifies the clinical questionnaire to be possible to the volume of menstrual flow, the color to carry on the quota description and can form the objectification measuring technique. Simultaneously the symptoms of normative research should pay attention to its own oneself as a reference to the "individual" of measurement. Proposes "the symptom unit" and "the menstrual period 2,3 day of observation window" hypothesis, for symptom standardization research development mentality, Providing the methods.The research on standardization provide developed ideas for the normative study, provide a way which make difficult to obtain, quantify, be objective to an indicator is converted to the relative quantitative and objective clinical evidence. From clinical, to clinical.Those causes the theory and clinical confirms mutually. It does the preliminary exploration studies that can move Chinese medicine towards the scientific and objective way更多还原