基于流行病学调查的农村社区居民痔病中医药防治对策探讨
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摘要
目的在对上海市奉贤区农村社区居民痔病流行病学调查的基础上,探讨中医药防治痔病的对策。方法随机选择上海市奉贤区5个农村社区18～80岁的6 000名居民,进行流行病学调查,包括一般情况、个人习惯、病史的询问,痔病相关专科检查,痔病中医证型调查等,进而分析农村社区居民痔病的流行病学特征及其与各种影响因素的相关性。结果①共回收有效调查研究报告表5 897份,报告表回收合格率为98.28%。②在受调查人群中,痔病的总患病率为40.27%,女性患病率(46.22%)高于男性(32.30%);三种痔病的患病率高低分布依次为混合痔、外痔、内痔;痔病分布于各年龄组,其中35～59岁年龄段组患病率最高。③脾虚气陷证(36.97%)和湿热下注证(43.66%)在痔病中医临床证型中占大多数(80.63%)。④饮酒、饮食辛辣、久坐、久站久行、排便习惯不良均与痔病患病存在一定的关系。⑤多因素回归分析显示,饮酒、辛辣饮食、排便习惯不良是痔病发作的独立危险因素,而蔬果摄入较多是痔病发作的独立保护因素;排便习惯不良、久站久行是脾虚气陷证的相关危险因素,排便习惯不良、辛辣饮食是气滞血瘀证的相关危险因素,辛辣饮食是湿热下注证的相关危险因素,蔬果摄入量多是风伤肠络证的相关保护因素。结论上海市农村社区居民的痔病患病率已逾四成(40.27%),女性、中年人及有不良生活习惯者是本病的高发人群。本病的防治工作应将年轻人群作为"未病先防"的重点,关注女性健康及个人日常饮食,进行中医养生宣教,将痔病预防知识融入生活,养成良好生活习惯,并充分发挥以区中医院为主的医疗"三联体"的作用,或是有效的应对策略。
Objective To explore the methods for preventing and treating hemorrhoids with traditional Chinese medicine( TCM) based on epidemiological investigation in rural communities in Fengxian District,Shanghai. Methods 6,000 residents aged 18-80 years in five rural communities in Fengxian District were randomly selected for epidemiological investigation,including general conditions,personal habits,medical history,hemorrhoids-related examination and TCM syndrome types of hemorrhoids. The epidemiological characteristics of hemorrhoids in rural communities and its correlation with various influencing factors were analyzed. Results(1)A total of 5,897 effective questionnaires were collected,with a recovery rate of 98.28%.(2)In the surveyed population,the total prevalence rate of hemorrhoids was 40.27%,and it was higher in females( 46.22%) than in males( 32.30%). The three hemorrhoids were mixed hemorrhoids,external hemorrhoids and internal hemorrhoids in prevalence rate from high to low.Hemorrhoids were distributed in all age groups,with the highest prevalence in the 35-59 age group.(3)The syndrome of spleen deficiency and qi depression( 36.97%) and the syndrome of dampness-heat pouring downward( 43. 66%) accounted for the majority( 80. 63%) of the clinical syndromes in hemorrhoids.(4)Drinking,spicy food,poor bowl habit as well as sitting,standing and walking for a prolonged time had a certain relationship with hemorrhoids.(5)Multi-factor regression analysis showed that drinking,spicy diet,and poor bowel habits were the independent risk factors in occurrence of hemorrhoids,while increased intake of fruits and vegetables was an independent protective factor; poor bowel habits and standing and walking for a prolonged time were risk factors for the syndrome of spleen deficiency and qi depression,poor bowel habits and spicy diet were related to the syndrome of qi stagnation and blood stasis,spicy diet was a relevant risk factor for the syndrome of dampness-heat pouring downward,while increased intake of fruits and vegetables was the relevant protective factor against the syndrome of wind damaging intestinal collaterals.Conclusion The prevalence of hemorrhoids in rural communities in Shanghai has exceeded 40%( 40.27%). Females,the middle-aged and people with bad habits are the high-risk groups of this disease. In prevention and treatment of this disease,the young people should be the focus of"prevention before disease onset". In addition,it is advisable to pay attention to women's health and personal daily diet,provide TCM health education,integrate the knowledge about hemorrhoids prevention into daily life,develop good living habits,and give full play to the role of medical "triple"in district hospitals of Chinese medicine or an effective coping strategy.
Objective To explore the methods for preventing and treating hemorrhoids with traditional Chinese medicine( TCM) based on epidemiological investigation in rural communities in Fengxian District,Shanghai. Methods 6,000 residents aged 18-80 years in five rural communities in Fengxian District were randomly selected for epidemiological investigation,including general conditions,personal habits,medical history,hemorrhoids-related examination and TCM syndrome types of hemorrhoids. The epidemiological characteristics of hemorrhoids in rural communities and its correlation with various influencing factors were analyzed. Results(1)A total of 5,897 effective questionnaires were collected,with a recovery rate of 98.28%.(2)In the surveyed population,the total prevalence rate of hemorrhoids was 40.27%,and it was higher in females( 46.22%) than in males( 32.30%). The three hemorrhoids were mixed hemorrhoids,external hemorrhoids and internal hemorrhoids in prevalence rate from high to low.Hemorrhoids were distributed in all age groups,with the highest prevalence in the 35-59 age group.(3)The syndrome of spleen deficiency and qi depression( 36.97%) and the syndrome of dampness-heat pouring downward( 43. 66%) accounted for the majority( 80. 63%) of the clinical syndromes in hemorrhoids.(4)Drinking,spicy food,poor bowl habit as well as sitting,standing and walking for a prolonged time had a certain relationship with hemorrhoids.(5)Multi-factor regression analysis showed that drinking,spicy diet,and poor bowel habits were the independent risk factors in occurrence of hemorrhoids,while increased intake of fruits and vegetables was an independent protective factor; poor bowel habits and standing and walking for a prolonged time were risk factors for the syndrome of spleen deficiency and qi depression,poor bowel habits and spicy diet were related to the syndrome of qi stagnation and blood stasis,spicy diet was a relevant risk factor for the syndrome of dampness-heat pouring downward,while increased intake of fruits and vegetables was the relevant protective factor against the syndrome of wind damaging intestinal collaterals.Conclusion The prevalence of hemorrhoids in rural communities in Shanghai has exceeded 40%( 40.27%). Females,the middle-aged and people with bad habits are the high-risk groups of this disease. In prevention and treatment of this disease,the young people should be the focus of"prevention before disease onset". In addition,it is advisable to pay attention to women's health and personal daily diet,provide TCM health education,integrate the knowledge about hemorrhoids prevention into daily life,develop good living habits,and give full play to the role of medical "triple"in district hospitals of Chinese medicine or an effective coping strategy.
引文
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[2] 上海市卫生局.上海市中医病证诊疗常规[M].上海:上海中医药大学出版社,2003:229- 231.
[3] 中华医学会外科学分会结直肠肛门外科学组,中华中医药学会肛肠病专业委员会,中国中西医结合学会结直肠肛门病专业委员会.痔临床诊治指南(2006 版)[J].中华胃肠外科杂志,2006,9(5):461- 465.
[4] 罗廷威,陈淑婉,黄瑞凝.活血祛瘀法在嵌顿性混合痔早期治疗的临床疗效和预后转归的比较研究[J].北方药学,2016,13(6):61- 65.
[5] 贾立刚,宋立峰,孙清晨.中医药治疗痔疮的研究概述[J].环球中医药,2012,4(5):317- 320.
[6] 梁县宗.痔的中医外治法研究进展[J].实用中医药杂志,2016,32(2):193- 195.
[7] 张东铭.痔病[M].北京:人民卫生出版社,2004:76.
[8] 何洪芹,李梅岭,刘明发,等.沧州城乡居民痔疮的流行病学调查[J].实用预防医学,2012,19(6):841- 843.
[9] 梁桂贤.中医学与日本汉方医学诊治痔的比较性研究[D].南京:南京中医药大学,2014:7.
[10] 张皛,王剑.赣南地区痔病的危险因素[J].中国老年学杂志,2015,35(22):6554- 6557.
[11] 谢珉宁,徐璇,张磊,等.混合痔中医辨证分型与流行病学特点的相关性研究[J].江苏中医药,2016,48(11):38- 40.