【作者】 冷凯利；

【导师】 黄学阳；

【作者基本信息】 广州中医药大学 ， 中医外科学， 2008， 硕士

【摘要】 背景:结节性甲状腺疾病为甲状腺外科常见疾病之一,巨大甲状腺肿瘤或巨大结节性甲状腺肿尽管在此类疾病中所占比例不大,但仍时有发生,因其病程长,体积大,因此常合并气管软化,术中、术后保持患者呼吸道通畅是手术安全的关键,我科通过16例此类患者的治疗经验总结,认为术后留置气管插管,可有效预防气管软化所致的术后气管塌陷,但如何改善术后患者的不适、促进机体的迅速恢复仍为外科医师所必须重视的问题。目的:本课题旨在通过对此类患者术后的四诊资料搜集,并以普通甲状腺术后病人为对比,总结两部分病人病机特点异同,初步探讨中医治疗巨大甲状腺肿术后留置气管插管患者的辩证规律,以期指导临床实践,充分发挥中医药在围手术期的优势。方法:采用前瞻性观察的手段,对符合纳入标准的16例巨大甲状腺肿患者进行调查,记录术后第一天、拔除气管插管前、拔管后第一天、第三天的相关症状、体征,血常规结果;按1:3比例随机选取48例普通甲状腺术后患者,调查其术后第一天、第三天症状、体征、舌象、脉象、血常规结果。归纳、分析二者四诊资料,对记录内容进行电脑录入,以统计软件SPSS13.0进行频数统计等相关分析,咨询专家以总结两部分病人术后中医病机异同。结果:1.普通组术后第一天以咳嗽、痰白、咽痛、恶寒、低热、纳差、舌红、苔薄、苔黄、脉浮等频数出现为多;术后第三天,上述症状出现频率均较明显下降;舌、脉则以舌淡、舌暗、苔白、脉弦、脉滑为主。2.巨大组术后至拔除气管插管前以乏力、发热、烦躁、咽痛、痰黄、口干、眠差、尿黄、便秘为主,脉象则以脉滑、脉弦为主。3.巨大组拔管后第1天,咳嗽、痰白频率增高,烦躁、眠差、尿黄、便秘等频率减少;舌脉方面,以舌暗、舌红、苔黄或白、苔腻,脉弦、脉滑为多。4.巨大组拔管后第三天,诸症频率均较前一次观察减少,以咳嗽、痰白、乏力、纳差等频率较高,舌脉方面以舌暗、苔白、脉弦、脉细为主,少苔者占25.0096。5.巨大组在病程、手术时间方面显著高于普通组。6.两组两次白细胞计数、中性粒细胞百分比比较无明显差异。结论:1.普通组术后初期符合风热表证、肺卫失宣为主这一证侯特点,部分兼见瘀血阻络之征;2.巨大组术后病机呈本虚标实,虚实夹杂之复杂特点:初期至拔管前,以痰热郁肺扰心为主要病机特点,后期以邪热渐退,气阴不足为主要特点;正气受损、瘀血内停之表现均较普通组更为明显。更多还原

【Abstract】 Background:Tubercular thyroid disease is one of the common in the thyroid surgery. The vast thyroid tumour and the giga-nodular goiters in this kind of illness gets sick accounts for the proportion,But still sometimes occurred.Because its course is long and it bulks hugely,it usually complicates with tracheomalacia. In the Period of Operation,Smoothing respiratory tract is the key point of clinical security.Through 16 this kind of the patients’ treatment experience,we can believe that remaining tracheal intubation after operation is effective to prevent airway from collapse for tracheomalacia.But to surgeon,they are also paying close attention to how to relieves the indisposition and promote the physical instauration.Objective:By Collecting the data gained four methods of examination from patients of huge and common tubercular thyroid disease,and Summarizing the different pathogenesis of TCM from the two part of patients,to make a primary approach to TCM syndrome differentiation of the patients remaining tracheal intubation after operation,then to promote clinical treatment and take advantage of the superiority of TCM in period of Operation.Methods:16 huge goiter patients who had integrated the standard were to carry on prospective study.After Recorded the data included symptom,sign,tongue pictuer, pulse condition,blood regulations on the first day after operation,the time before extubation,the first day after extubation,the third day after extubation. According to 1:3 proportion,48 patients with common tubercular thyroid disease were collected randomly,and it is recorded that included symptom, sign,tongue pictuer,pulse condition,blood regulations on the first, the third day after operation.Analyzed the information by four diagnostic methods of the two parts of patients.After the data inputted the computer,it would been done consistency analyse and related statistics with SPSS13.0.Consulted the related expert to induce the conclusion.Results:1.The common group:on the first day after operation,cough,white sputum, pharyngalgia,phrasthenia,low grade fever,poor appetite,red tongue with thin-yellow coating and floating pulse occurred more frequently;on the third day after operation,the frequecy of the above symtoms was less,and light colored tongue,dark red tongue,whitish fur,string and slippery pulse were the primarily symboms.2.The giant group:tiredness,fever,restlessness,pharyngodynia,yellow sputum,mouth dryness,insomnia,yellowish urine,constipation,tring and slippery pulse occurred more frequently before extubation.3.The giant group:on the first day after extubation,the frequency of cough and white sputum increased:those of restlessness,insomnia,yellowish urine and constipation reduced;in the tongue and pulse picture:dark red tongue, white or yellow greasy coating,string and slippery pulse held main position, and thready pulse occurred more frequently than before.4.The giant group:on the third day after extubation,the frequency of the above symtoms was less than preceding observation.The frequency of Cough,white sputum,tiredness,poor appetite,dark red tongue with white coating,string and thready pulse was relatively high.short fur accouted 25.00%.5.In the spect of disease course and operation time,the giant group was significant higher than the common group.6.There were no significant difference between the giant and the common group in the WBC and NE%level.Conclusion:1.The characteristics of the common group at the initial stage after operation, was wind-heat exterior syndromes and Sluggishness of Lung-Wei;partial cases manifest blood stasis syndromes.2.The giant group TCM pathogenesis was root deficiency and branch excess, asthenia and sthenia inclusion.From the postoperative to extubation,it characterized phlegm-heat accumulated in the lung and the heart;in the anaphase period,pathogenic heat extinction and deficiency of qi and yin.Weakened body resistance and obstruction of collaterals by blood stasis were more obvious than the common one.更多还原