摘要
目的：
慢性盆腔炎是指女性生殖器官如子宫、输卵管、卵巢、宫旁结缔组织、盆腔腹膜等处的慢性炎症,往往由急性盆腔炎延误诊治,或治疗不彻底或患者体质虚弱,病程迁延难愈演变所致或无明显急性发作史,起病缓慢病情反复所致。这是妇科的常见病,好发于性活跃期及有月经的女性。现代社会工作压力大,加上反复人工流产和药物流产后,性生活泛滥,致盆腔炎发病率有明显上升的趋势。据美国资料,盆腔炎性疾病的高发年龄在15-25岁;国外其它有关资料报道发病年龄多为25-40岁患者,发病率在30%-60%。16岁以前开始性活动的妇女较更晚些性生活者,慢性盆腔炎发病率高;性生活频率与此病的发病率呈正相关,性卫生习惯不良,不洁性交(指性交一方患有可通过性接触传播的疾病或带有病原体)等,均与慢性盆腔炎的发病有关。据报道采用避孕套、阴道隔膜、宫颈帽达2年以上的妇女较采用上述工具低于2年者,盆腔炎性疾病发生率降低,而不采用上述工具避孕者易患盆腔炎性疾病;长期口服避孕药较未服用者患盆腔炎性疾病的危险性减少50%,使用宫内节育器(工UD)者较不使用者盆腔炎性疾病的相关危险性提高了2.5～7.3倍。据世界卫生组织估计,性传播疾病泛滥导致全世界每年新增3亿3千多万性病患者,其中有10%—20%发展为慢性盆腔炎。
由于慢性盆腔炎带来的长期慢性盆腔痛,不孕不育或宫外孕等,影响了患者的生活质量。因此,预防及治疗慢性盆腔炎,减少将来发展为不孕、异位妊娠、慢性盆腔痛等并发症是一项急切的工作。中医药治疗具有疗效确切、无耐药性、复发可能性小的特点。随着健康观念和医学模式的转变,以及人们生活水平的提高,生存质量的研究越来越受重视,并得到了广泛的应用。生存质量是一个综合了生理、心理和社会因素的评价指标。目前已广泛应用于各种慢性病和肿瘤疾病,作为一种终点评价指标,并已受到国内外学者的日益重视。在临床实践中,生命质量的测定能够帮助临床医生判断病人受疾病影响最严重的方面,从而决定治疗方法；在一些发展中国家,卫生资源缺乏,旨在通过缓解症状提高生命质量的治疗方法是有效而不昂贵的,与其它手段相结合,生存质量表还能帮助医学研究者评价治疗过程中生命质量的变化。
研究发现慢性盆腔炎妇女在躯体功能,总体健康活力,社会功能及心理健康分数等方面随着慢性疼痛的加剧而下降,慢性盆腔疼痛可引起患者生活质量、婚姻质量和性功能的明显下降,当慢性盆腔炎部分患者的预后仅仅是部分恢复,治疗只是缓解症状,而不是治愈疾病的手段,生存质量表别具意义。因此,本研通过不同证型慢性盆腔炎患者的病因病机,症状与生存质量作归纳总结,运用统计学方法对不同证型慢性盆腔炎患者的生存质量作出调查研究,仔细分析其与中医辩证的相关性,寻求治疗慢性盆腔炎及具体改善生存质量的方法,除主症外,整体分析患者的生活质量,作为评价该病的补充,以便日后除了主症疗效后,得到更全面的治疗,更能针对每项的生存质量有效地提供辩证施治,有助发挥中医药的治疗优势。
内容与方法：
生活质量(Quality of life,简称QOL),又译为生存质量或生命质量等,1993年在日内瓦所召开的世界卫生组织(World Health organization,WHO)对生活质量进行了最新的定义：指不同文化和价值体系中的个体,对与他们的目标、期望、标准以及所关心的事情有关的生存状况的体验。根据上述定义,世界卫生组织研制了一量表,该量表包含不同问题,覆盖了与生命质量有关的不同领域。
生存量表调查表采用世界卫生组织生存质量测定量表简表中文版(WHO—BREF),通过计算慢性盆腔炎患者各条目得分,统计各领域及条目间得分是否具有统计学意义,说明慢性盆腔炎患者的生存量表状况。WHOQOL-BREF量表中文版由26个条目组成,每个条目均有5个选项,得分按从好到差(或非常满意到极不满意)的等级正向赋以1～5分,但其中第3、4和26条目是反向条目。另外,家庭摩擦、食欲和自评生存质量总分这三项各有一评分。对患者4个领域(生理、心理、社会关系、环境)的情况以及自身总体生存质量、总体健康状况的主观感受进行评估。按照相应的计分标准公式,将5分制的四领域得分换算成百分制(自评生存质量总分是百分制),得分越低,生存质量越差。量表的测量主要采取访谈式,门诊病例由临床医生及患者自填,对文化程度较低者或对生存质量条目有不理解地方则出临床医生负责解释,在正式研究之前,主要测量人员进行主要调查方法及注意事项的培训,以保证测量的一致性。在填写完毕后,调查员进行全面检查和核对调查内容,如有疑问重新进行询问调查。所有原始数据经过核查、整理及计算准确无误后,采用spss分析,经过二次核对以保证录入的准确性。
收集了2012年7月-2013年2月广州中医药大学第一附属医院妇科门诊就诊的慢性盆腔炎患者的相关资料,将符合本研究所制定诊断标准、纳入标准和排除标准选择入组标准的200例患者并根据其具体临床表现诊断,参照《中药新药临床研究指导原则》,行辨证分型分组为湿毒壅盛、瘀毒内结、湿热蕴结、湿热瘀结、气滞血瘀和寒湿凝滞型,通过WHOQOL-BREF量表问卷调查形式记录患者的于生存质量的生理、心理、社会、环境四个领域的状况,然后将收集到的相关信息和数据,探讨慢性盆腔炎患者的不同中医证型与生存质量的相关性。
结果：
1不同证型慢性盆腔炎患者,以瘀毒内结及气滞血瘀的总平均得分最低。分开不同范畴,在生理领域方面,湿热蕴结得分最低。在心理领域方面,寒湿凝滞得分最低,在社会领域方面,寒湿凝滞得分最低,在环境领域方面,瘀毒内结得分最低。
2自我评价方面,瘀毒内结型慢性盆腔炎患者生存质量感受与身体健康状况得分最低,可见主观感受最差。
3在生理领域,湿毒壅盛、瘀毒内结和气滞血瘀在医疗依赖及疼痛方而使生存质量降低;湿热蕴结、湿热瘀结和寒湿凝滞在医疗依赖及精力使生存质量降低。除寒湿凝滞外,各个证型的医疗依赖,精力,睡眠及疼痛不适使慢盆腔炎患者在此领域的生存质量降低。
4在心理领域,湿毒壅盛、瘀毒内结和气滞血瘀在注意力及消极感影响生存质量低;湿热蕴结、湿热瘀结则注意力及生活乐趣影响生存质量低,寒湿凝滞在注意力及外型方面影响生存质量低。普遍而言,注意力及消极感(寒湿凝滞外)使不同证型的慢性盆腔炎在此领域的生存质量降低。
5在社会领域,性生活使不同证型的慢性腔炎患者在此领域的生存质量降低。
6在环境领域,湿毒壅盛的慢性盆腔炎患者的卫生保健得分最低;瘀毒内结和湿热蕴结的患者经济条件得分最低;湿热瘀结和寒湿凝滞的患者进行休闲活动的得分最低;气滞血瘀的患者日常安全感得分最低。环境因素影响无统一性,不同证型的慢性盆腔炎患者受着不同的环境因素影响生存质量。
结论：
1不同证型的慢性盆腔炎患者在生存质量的不同领域具有自身的特异性及相关性。
2不同证型慢性盆腔炎患者普遍的生存质量偏低。
3湿毒壅盛型的慢性盆腔炎患者的在医疗需求及疼痛,注意力及消极感,性生活,和卫生保健服务的满意度的生存质量得分最低。
4瘀毒内结的在生存质量的感受及自我健康状况,医疗需求及疼痛,注意力及消极感,性生活和经济条件的生存质量得分最低。
5湿热蕴结在医疗依赖及精力,注意力及生活乐趣,性生活和经济条件的生存质量得分最低。
6湿热瘀结在医疗依赖及精力,注意力及生活乐趣,性生活和进行休闲活动机会的生存质量得分最低。
7气滞血瘀在医疗依赖及疼痛,注意力及消极感,性生活和日常安全感的生存质量得分最低。
8寒湿凝滞在医疗依赖及精力,注意力及外型,性生活和进行休闲活动机会的生存质量得分最低。
Objective
Chronic pelvic inflammatory disease refers to female genital organs such as the uterus, fallopian tubes, ovaries, uterine connective tissue, pelvic peritoneum, etc. The chronic inflammation, often by the evolution of acute pelvic inflammatory disease delay in treatment, or to inadequate treatment or patients with physical weakness, duration of protraction caused no significant history of acute onset, slow onset due to repeated illness. It is a common disease in gynecology, occur in sexually active and menstruating women. Pressure of modern social work, the proliferation of sexual life, the with repeated abortion drug flow, making a clear upward trend in the incidence of pelvic inflammatory disease brought about by the long-term chronic pelvic pain, infertility, or ectopic pregnancy, affected patients quality of life.
According to U. S. data, high incidence of pelvic inflammatory disease aged15-25years old reported age of onset of25to40year-old patient in foreign countries, the incidence rate between30%and60%.16-year-old before the onset of sexual active women than later life chronic high incidence of pelvic inflammatory disease; frequency of sex, and the incidence of the disease was positively correlated with sexual health habits, unclean sexual intercourse (sex party suffering the disease can be transmitted through sexual contactor with pathogens) are associated with the incidence of chronic pelvic inflammatory disease. It is reported that using a condom, diaphragm or cervical cap of more than2years compared with women using the tool less than2years, pelvic inflammatory diseaserate decreases, rather than the tool contraception are susceptible to pelvic inflammatory disease; risk of long-term oral contraceptives compared with those not taking, the risk of pelvic inflammatory disease reduced by50%. The risk of pelvic inflammatory disease, comparing using the IUD rather than not using it increased from2.5to7.3times According to the World Health Organization estimates, the spread of sexually transmitted diseases result in an annual increase of330million patients with sexually transmitted diseases around the world, including10%to20%developed into chronic pelvic inflammatory disease
Prevention and treatment of chronic pelvic inflammatory disease, reduce the development of infertility, ectopic pregnancy, chronic pelvic pain and other complications is an urgent work in the future. Chinese medicine treatment efficacy, no drug resistance, the possibility of recurrence is small features With the concepts of health and medical model, as well as the improvement of people's living standards, quality of life draws researchers more and more attention, and has been widely used. Quality of life is a comprehensive evaluation of the physical, psychological and social factors, can help clinicians determine the patients affected by which the disease is the most serious aspects, provides an effective and inexpensive method to help clinicians determine the treatment method and, designed to work with other means of phase combined through relieve symptoms and improve quality of life. Quality of life model has been widely used in a variety of chronic diseases and neoplastic diseases, as an end-point evaluation, and has been the growing importance of the domestic and foreign scholars. In clinical practice, the determination of the quality of life that can help clinicians in diagnosing a patient affected by which the disease the most serious aspects, to determine treatment; lack of health resources in some developing countries, treatment aims to relieve symptoms and improve quality of life effective and inexpensively, with other means of combining the quality of life table can also help medical researchers to evaluate the therapeutic process changes in the quality of life
The research found that women with chronic pelvic inflammatory disease in physical functioning, general health, vitality, social functioning and mental health scores as chronic pain intensifies decline Chronic pelvic pain can cause the quality of life of patients, the quality of marriage and sexual function decreased significantly, when part of the prognosis of patients with chronic pelvic inflammatory disease is only part of the recovery, treatment is to relieve symptoms, rather than the means to cure the disease, quality of life table is meaningful, therefore, the research through different syndromes in patients with chronic pelvic inflammatory disease etiology pathogenesis, symptoms and quality of life as summarized research on the quality of life of different syndromes in patients with chronic pelvic inflammatory disease, the use of statistical methods, careful analysis with the Chinese dialectical, seeking treatment for chronic pelvic inflammatory disease and to improve the quality of life specific method, in addition to the primary disease, the overall analysis of the quality of life of patients with the disease as an evaluation supplement for the future, in addition to the main symptom, more comprehensive treatment, provide better quality of life for each dialectical therapy, help to play the advantages of Chinese medicine treatment
Content and Methods
Quality of life (QoL), the origin of the United States in the1930s, the beginning is only a sociological indicators; In1993at the World Health organization (WHO) in Geneva defined quality of life:refer to different culture and value system of the individual, their goals, expectations, standards and concerns things the living conditions of experience-This is a broad concept connotation, which contains the individual's physical health, psychological state, independence, social relationships, personal beliefs and relationship with the surrounding environment. Under this definition, the quality of life refers to the individual's subjective evaluation, self-evaluation which is rooted in the cultural, social environment. According to the above definition, the World Health Organization (WHO) has developed a scale, including different questions, covering different areas and aspects related to the quality of life
Survival scale questionnaire with the World Health Organization Quality of Life BREF Chinese version (WHO-BREF) was measured by calculating the patients with chronic pelvic inflammatory disease each entry score, various fields of statistics and entry score is statistically significant, indicating chronic pelvic the survival of patients with inflammatory scale conditions. WHOQOL-BREF scale Chinese version of the26entries, each entry has five options, score from good to bad (or very satisfied to very dissatisfied) assignedal to5, but number3,4, and26entry is the reverse entry. In addition, family friction, loss of quality of life and self-assessment score each area has its own rating. Subjective feelings of the patients in four areas (physical, psychological, social relationships, environment) as well as their overall quality of life, general health status evaluated. Scores can range according to the formula, the5-point scale in four areas score converted into percentile (self-assessment quality of life score is the percentage system), the lower the score, the worse the quality of life. Interviews is taken as a measurement, questionnaire is filled in by the clinician or patient themselves, lower education level or quality of life entries do not understand the questions would have the interpretation by the clinician. Prior to the formal research, training was provided to the key measurement personnel of the main survey methods and precautions to ensure the consistency of the measurement. After the questionnaire completed, interviewer conduct a comprehensive inspection and verification. Re-interview the survey, if in doubt. All the original data after verification, organized and calculation accuracy will then use SPSS to analysis. Double check is adopted to ensure the accuracy of the entry。
Collected, from, July2012to February2013, the gynecological outpatient of the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, the patients with chronic pelvic inflammatory disease, those,who were accordance to the diagnostic, inclusion and exclusion criteria,were selected into the standard set of200patients. According to the specific clinical manifestations, reference materials<> syndrome type are grouped into Group of dampness-poison stagnation, Group of blood stasis-poison stagnation, Group of heat-dampness stagnation, Group of damp-heat-blood stasis accumulation, Group of qi stagnation and blood stasis, and Group of cold-dampness stagnation. To record the condition of the patients, by WHOQOL-BREF scale survey form, in four areas of quality of life in the physiological, psychological, social, environmental, and then the collected information and data to explore different TCM syndrome and quality of life of patients with chronic pelvic inflammatory disease.
Results:
1Among different syndromes in patients with chronic pelvic inflammatory disease, total average score of Group of blood stasis-poison stagnation and Group of qi stagnation and blood stasish is minimum. Separate different areas in the field of physiological, Group of heat-dampness stagnation had the lowest score. In the field of mental, Group of cold-dampness stagnation score the lowest. In the field of social areas, Group of cold-dampness stagnation score the lowest. In the environmental field, the lowest score is the Group of dampness-poison stagnation
2In self-assessment, the Group of blood stasis-poison stagnation patients with chronic pelvic inflammatory disease in quality of life feelings and physical health score lowest, visible subjective feelings of the worst
3in the field of physiology, Group of dampness-poison stagnation, Group of blood stasis-poison stagnation and Group of qi stagnation and blood stasis in medical dependence and pain reduced the quality of life;Apart from the Group of cold-dampness stagnation, medical dependence, energy, sleep and pain of all others groups reduce the slow pelvic inflammatory disease quality of life in this area
4in the field of psychology, the Group of dampness-poison stagnation, Group of blood stasis-poison stagnation and Group of qi stagnation and blood stasis in the sense of attention and negative impact lower the quality of life; attention and enjoyment of life in Group of heat-dampness stagnation, Group of damp-heat-blood stasis accumulation affect the quality of life is low,. Group of cold-dampness stagnation affect the quality of life in terms of attention and appearance. In general, attention and negative sense of the different syndromes of chronic pelvic inflammatory disease (except Group of cold-dampness stagnation) reduce the quality of life in this area
5in the social sphere, sex life with different syndromes of chronic pelvic inflammatory patients reduce the quality of life in this area.
6in the field of the environment, the health care of patients with chronic pelvic inflammatory disease in Group of dampness-poison stagnation got the lowest score; Group of blood stasis-poison stagnation, Group of heat-dampness stagnation patients with the lowest score in economic conditions; damp-heat-blood stasis accumulation and cold-dampness stagnation in patients with the lowest score of the leisure activities; qi stagnation and blood stasis in patients with the lowest score in the everyday sense of security. Environmental factors without unity, different syndromes in patients with chronic pelvic inflammatory disease is being affected by different environmental factors on the quality of life.
Conclusion
1Different syndromes in patients with chronic pelvic inflammatory disease in different areas of the quality of life has its own specificity and correlation.
2different syndromes in patients with chronic pelvic inflammatory disease generally had low quality of life.
3Group of dampness-poison stagnation of chronic pelvic inflammatory disease in patients with the lowest score of satisfaction with the quality of life in the medical dependence and pain, a sense of attention and negative, sex life, and health care services.
4Group of blood stasis-poison stagnation results the lowest score in the feelings of quality of life and self-health status, medical needs and pain, a sense of attention and negative, sexual and economic conditions of quality of life.
5Group of heat-dampness stagnation results the lowest score of quality of life in medical dependence and energy, attention and enjoyment of life, sex life and economic conditions.
6Group of damp-heat-blood stasis accumulation results the lowest score of quality of lif in the medical dependence and energy, attention and enjoyment of life, sex life and active leisure opportunities.
7Group of qi stagnation and blood stasis results a minimum score of qual ity of lifein medical dependence and pain, attention and negative sense, sex life and day-to-day sense of security.
8Group of cold-dampness stagnation results the lowest score of quality of life in medical dependence and energy, attention and appearance, sex life and opportunity for active.
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