本文關鍵詞： 腹腔鏡膽囊切除術 中醫(yī)體質 胃腸道功能恢復　出處：《安徽中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的探討膽囊結石患者中醫(yī)體質與其腹腔鏡術后胃腸功能恢復的相關性,找出影響術后胃腸功能恢復的體質類型。方法選擇武警安徽總隊醫(yī)院2015年1月至2015年12月收治的480例膽囊結石伴急性膽囊炎患者作為研究對象。中醫(yī)體質的分類方法采用2009年國家制定的《中醫(yī)體質分類與判定》標準進行分類,中醫(yī)體質辨識方法采用王琦教授團隊研發(fā)的體質量表進行問卷調查。由患者獨立填寫問卷表,填完后當場收回。對填寫有障礙者則由調查員協(xié)助填寫。收集中醫(yī)體質類型資料和不同體質患者手術時間、術后腹脹時間、腸鳴音恢復時間、肛門排氣、排便時間變化資料,以及手術前后胃腸激素水平變化資料。建立數(shù)據(jù)庫,采用SPSS16.0統(tǒng)計分析軟件進行數(shù)據(jù)統(tǒng)計和計算。觀察480例膽囊結石患者中醫(yī)體質分布情況,比較不同體質患者手術時間、術后腹脹時間、腸鳴音恢復時間、肛門排氣、排便時間差異,比較不同體質患者手術前后血清胃腸激素水平變化差異。P0.05為顯著性差異。找出影響腹腔鏡膽囊切除術后胃腸功能恢復的中醫(yī)體質類型。結果本次參與調查的480例膽囊結石患者九種中醫(yī)體質類型由多到少的分布順序為:濕熱質、痰濕質、氣虛質、平和質、氣郁質、血瘀質、陰虛質、陽虛質、特稟質。不同體質患者手術時間雖然不同,但無統(tǒng)計學意義,而術后腹脹時間、腸鳴音恢復時間、肛門排氣、排便時間存在差異性,以氣虛質、濕熱質患者術后腹脹時間、腸鳴音恢復時間、肛門排氣、排便時間與其他體質顯著不同(P0.05)。不同體質患者術后血清胃動素(MTL)、胃泌素(GAS)水平較術前下降(P0.05),血管活性腸肽(VIP)水平較術前升高(P0.05),生長抑素(SS)水平較術前下降(P0.05)。以氣虛質和濕熱質患者MTL、GAS水平顯著低于其他體質(P0.05),VIP水平顯著高于其他體質(P0.05),但兩者SS水平與其他體質相比無顯著差異(P0.05)。結論不同中醫(yī)體質的膽囊結石患者行腹腔鏡手術后胃腸功能恢復不同。相比其他中醫(yī)體質類型,氣虛質和濕熱質患者術后胃腸功能恢復較慢。
[Abstract]:Objective to investigate the relationship between the physique of traditional Chinese medicine (TCM) and the recovery of gastrointestinal function after laparoscopic surgery in patients with cholecystolithiasis. Methods 480 patients with cholecystolithiasis associated with acute cholecystitis were selected from January 2015 to December 2015 in Anhui General Hospital of Armed Police. For example, the classification method of TCM constitution is classified according to the Standard of Classification and judgment of TCM Constitution established by the State in 2009. The physique identification method of TCM was based on the physique scale developed by Professor Wang Qi. The patients filled out the questionnaire independently. On the spot after filling out. For those with disabilities, the investigators help fill in. Collect the information of TCM physique type and different physique patient operation time, postoperative abdominal distension time, bowel sound recovery time, anal exhaust. Data of defecation time change and gastrointestinal hormone level before and after operation. The distribution of TCM constitution in 480 patients with cholecystolithiasis was observed and the time of operation and postoperative abdominal distension were compared by using SPSS16.0 software. The recovery time of bowel sounds, anal exhaust, defecation time difference. To compare the changes of serum gastrointestinal hormone levels before and after operation in patients with different physiques. P05 was a significant difference. To find out the influence of laparoscopic cholecystectomy on the recovery of gastrointestinal function of traditional Chinese medicine physique type. The distribution order of nine types of TCM constitution in 480 patients with cholecystolithiasis was as follows:. Wet and hot. Phlegm dampness, qi deficiency, calmness, qi stagnation, blood stasis, yin deficiency, yang deficiency, intrinsic quality. Different physique patients have different operation time, but no statistical significance, and postoperative abdominal distension time. The recovery time of bowel sound, anal exhaust and defecation time were different. The time of abdominal distension, the recovery time of bowel sound and anal exhaust existed in patients with deficiency of qi and damp and heat. The time of defecation was significantly different from that of other physiques (P 0.05). The serum levels of motilin and gastrin in patients with different physiques after operation were significantly lower than those before operation (P 0.05). The level of vasoactive intestinal peptide (VIP) was higher than that before operation (P 0.05), and the level of somatostatin (SS) was lower than that before operation (P 0.05). MTL was found in patients with deficiency of qi and dampness and heat. The level of GAS was significantly lower than that of other constitution (P0.05). However, there was no significant difference in SS level between the two groups compared with other physique. Conclusion the gastrointestinal function of cholecystolithiasis patients with different constitution of traditional Chinese medicine is different after laparoscopic operation. The recovery of gastrointestinal function was slower in patients with qi deficiency and damp heat after operation.
【學位授予單位】：安徽中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R269

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