【作者】 刘春丽；

【导师】 梁雪芳；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2008， 硕士

【摘要】 研究目的:手术治疗是许多妇科疾病,如子宫肌瘤、卵巢囊肿等的重要治疗方法之一,妇科脏器位于下腹部,故妇科手术以腹部手术为主。中医治疗是术后重要的治疗方法,而辨证论治是中医治疗的精髓所在。中医辨证论治的特色在于整体的调节,作用机制是多部位、多环节和多靶点的,这对于改善患者术后的全身状况具有重要的意义。目前对腹部术后中医辨证分型的研究还停留在各家的经验上,不同地域乃至相同地区不同医家之间均存在较大差异,还没有形成临床指导作用强与可操作强的规范化诊疗体系,法依证立,方随法转,辨证的差异导致治法和方药的多样性和不规范性,既不利于推广交流,也不利于对围手术期中医临床疗效的评价及疗效优势的判定。这一现状已成为制约中医临床诊疗水平提高及深入发展的瓶颈。因此,进行妇科腹部手术后中医证候的研究具有重要的现实意义。本研究旨在通过对广东省中医院行妇科腹部手术住院患者符合纳入标准的病例进行问卷调查,应用数理统计的方法对腹部术后的中医证候进行研究,初步探讨妇科腹部术后中医证型分布及证候表现规律,从而为妇科腹部手术后的中医药临床辨治、疗效评价提供科学依据。研究方法:本研究旨在采用现代科研方法、临床流行病学,用综合的数理统计分析方法及数理统计分析技术,对250例妇科腹部手术术后患者进行时期横断面观察,采集证候信息,运用数据库,开展对妇科腹部手术后中医证候分布规律的研究,以期为构建妇科腹部手术后证候诊断标准提供研究思路,为术后中医药诊疗规范的确立及辨证论治疗效的提高提供依据。研究结果:1.妇科腹部手术前中医证候多为虚实夹杂,多兼夹血瘀证;2.妇科腹部手术后第一天病例中医证型有:脾胃气虚证,阳明腑实证,脾虚湿困证,阴虚火旺证,血瘀证共五种;3.妇科腹部手术后第三天病例中医证型有:脾虚湿困证,阴虚火旺证,血瘀化热证,肝郁脾虚证,肾阳虚证共五种;4.妇科腹部手术后第七天病例中医证型有:气血两虚证,肾虚血瘀证,脾虚湿困证共三种。研究结论:本研究对妇科腹部手术术后病例进行样品聚类分析,妇科腹部手术后第一天中医证型共有五种,分别为脾胃气虚证,阳明腑实证,脾虚湿困证,阴虚火旺证,血瘀证;术后第三天中医证型亦有五种,分别是脾虚湿困证,阴虚火旺证,血瘀化热证,肝郁脾虚证,肾阳虚证;术后第七天有三种中医证型:气血两虚证,肾虚血瘀证,脾虚湿困证。更多还原

【Abstract】 Objectives:The operation is an important cure method of gynaecology disease, such as myoma of uterus and ovarian tumour. The gynaecology visceral organ is located in underbelly, so gynaecology operation gives first place to abdominal surgery. TCM treatment is an important cure method after abdominal surgery, treatment by differentiation of syndromes(TDS) is the core of TCM. the character of treatment by differentiation of syndrome tapys lies in the overall adjustment,effect mechanism of TDS is many locations, too many levels and many target spots, it has important significance to improving the whole body situation that of the patient after abdominal surgery. At present, the study on syndromes of TCM stays on doctors’ experiences, there are bigger differences between different doctors of different area, even if from the same area. It has not take form standardization diagnoses system which has strongly clinical instruction affects and the operatability. Current situation has restrict the rising and the development of clinical diagnoses and treatment level of TCM. Therefore, doing the study on syndromes of TCM in patients after gynecologic abdominal surgery has important practical and immediate significance. This study is for the purpose of by making questionnaire survey with GuangDong Province TCM Hosipital in-patients who are brought into the standard, applying statistics method, making the study on syndromes of TCM after abdominal surgery. Doing first step investigation and discussion on syndrome types of TCM distributed law in patients after gynecologic abdominal surgery, in order to providing a basis of appraising a curative effectes of syndrome types of TCM after gynecologic abdominalsurgery.Methods:This research is for the purpose of using the modern scientific researchmethods, the clinical epidemiology, with synthesis mathematicalstatistic analysis method and mathematical statistic parsing technique,doing the time cross section observation on 250 patients that aftergynecologic abdominal surgery, collecting informations on syndrome typesof TCM, utilizing the database, carrying out the research on syndrometypes of TCM in patients after gynecologic abdominal surgery, in orderto providing the train of thought studying to look forward to being tostructure the diagnose standard of syndromes of TCM after gynecologicabdominal surgery and the rise being that skill queen TCM diagnosesstandard establishing and discriminates theory curing an effect providesa basis.Results:1.The syndrome types of TCM in patients before gynecologic abdominalsurgery are intermingled asthenia and sthenia syndrome, which are alwaysincluded blood stasis syndrome;2. The syndrome types of TCM in patients after gynecologic abdominal surgery for the first day are spleen-stomach qi-deficiency, yangming sthenic syndrome, slenasthenic fluid-retention syndrome, hyperactivity of fire owing to yin-deficiency syndrome and blood stasis syndrome;3. The syndrome types of TCM in patients after gynecologic abdominal surgery for the third day are slenasthenic fluid-retention syndrome, hyperactivity of fire owing to yin-deficiency syndrome, heat by blood stasis syndrome, the depressed liver with insuficient spleen syndrome and kidney-yang deficiency syndrome;4. The syndrome types of TCM in patients after gynecologic abdominal surgery for the seventh day are qi-blood deficiency syndrome, kidney -yang deficiency with blood stasis syndrome and slenasthenic fluid-retention syndrome.Conclusion:The study showed that the syndrome types of TCM in-patients aftergynecologic abdominal surgery for the first day are spleen-stomach qi-deficiency, yangming sthenic syndrome, slenasthenic fluid-retention syndrome, hyperactivity of fire owing to yin-deficiency syndrome and blood stasis syndrome. The syndrome types of TCM in-patients after gynecologic abdominal surgery for the third day are slenasthenic fluid-retention syndrome, hyperactivity of fire owing to yin-deficiency syndrome, heat by blood stasis syndrome, the depressed liver with insuficient spleen syndrome and kidney-yang deficiency syndrome. The syndrome types of TCM in-patients after gynecologic abdominal surgery for the seventh day are qi-blood deficiency syndrome, kidney -yang deficiency with blood stasis syndrome and slenasthenic fluid-retention syndrome.更多还原