不同证型便秘患者的心理状态调查研
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摘要
【目的】
调查慢性便秘患者的心理状态情况,探讨不同证型慢性便秘患者的心理障碍差异性,有助于从中医辨证的角度了解慢性便秘患者心理障碍的情况,为进一步寻求治疗不同证型慢性便秘的心理辅助方法,以提高患者心理素质。
【方法】
将收集到的100例符合纳入标准的慢性便秘患者进行中医辨证分型,分为四个证型。对其进行一周来情绪及心理状态的问卷调查,使用SPSS 11.5进行统计处理,采用X2检验,比较不同证型之间心理障碍表现的差异性。
【结果】
1.研究发现,便秘患者存在一定的焦虑或抑郁倾向的心理障碍。在100位患者中,诊断有焦虑倾向的有39人,占总人数的39%,其中轻度焦虑者26人(26%)；中度焦虑者13人(13%)；诊断有抑郁倾向的有59人,占总人数的59%,其中轻度抑郁者44人(44%),中度抑郁者15人(15%)。
2.热秘型、气秘型、虚秘型、冷秘型四个不同证型的便秘发病率有差异,其中冷秘型发病率远远低于其它的三种类型,推测与南方的气候、南方人的体质及现代人的饮食习惯、生活作息在习惯息息相关。
3.通过对四个不同证型的患者进行出现焦虑、抑郁倾向的心理障碍表现进行X2检验,发现焦虑、抑郁倾向发病率存在证型差异(P<0.05),进一步进行两两比较,发现热秘证患者比气秘证和热秘证患者比虚秘证更倾向于出现焦虑倾向的心理状态,气秘证患者则比热秘证患者更容易出现抑郁倾向的心理状态(P均<0.008)
【结论】
1.在南方,便秘的冷秘证发病率较其它证型都要低。2.便秘的不同中医证型导致的心理障碍倾向也有所不同,热秘组患者比气秘组、热秘组患者比虚秘组更倾向于出现焦虑倾向的心理状态；而气秘组患者比热秘组患者更容易出现抑郁倾向的心理状态。3.为提高便秘患者的身心健康,需医患两者共同努力,患者需调动自身的积极性,遵从医生的指导,改变不良的饮食结构、不良的生活作息时间及排便习惯,作适当的户外活动,并自行进行相关的心理疗法。
Object i ve:Investigate the psychological status of patients with chronic constipation cases, investigate different syndromes of chronic constipation difference between the psychological barriers, That would Help from the perspective of TCM in patients with chronic constipation and psychological barriers.In order to seek further treatment of chronic constipation with different syndromes psychological support methods, and improve the psychological quality of patients.
Method:To collect the 100 patients met the inclusion criteria for chronic constipation in patients with syndrome differentiation type, divided into four syndromes. Patients a week of emotional and psychological survey,conducted using the SPSS 11.5 statistical processing,by X2 test, comparison of psychological barriers between the different syndromes performance differences.
Result:1. Study found that patients with constipation, there is a certain tendency to anxiety or depression, psychological disorders. In the 100 patients diagnosed with anxiety tend to have 39 people,39% of the total number, of which mild anxiety,26 (26%); moderate anxiety,13 (13%);Diagnosed with depression tend to have 59 people,59% of the total number, of which mild depression in 44 (44%), moderate depression,11 (11%).
2. Hot type, gas type, virtual type, cold type constipation, this four different syndromes differencein incidence of constipation, cold constipation in which the lowest incidence of type. Speculate it closed related with the Southern climate, the physical and the modern southerners eating habits and lifestyle in the habit
3. By four different syndromes of anxiety and depression tend to occur in patients with mental disorders X2 performance tests and found that the incidence of anxiety and depression tend to exist between syndromes (P <0.05). Pairwise comparison further, Hot constipation group patients are more likely than the gas tend and the virtual type to the psychological state of anxiety. Compare to the hot type, the patients with constipationgas of virtual type were more likely to tend to the psychological state of depression. (P all<0.008).
Conclusion:1. In the south, to hot constipation in patients with constipation-type majority.
2.Constipation caused by the different syndromes are different psychological tendencies.Hot constipation group patients are more likely than the gas tend and the virtual type to the psychological state of anxiety. Compare to the hot type, the patients with constipationgas of virtual type were more likely to tend to the psychological state of depression.
3.In order to improve constipation in patients with physical and mental health, both doctors and patients need to work together, Patients should follow the doctor's recommendations, change the bad diet, bad lifestyle time and the bad bowel habits,do more exercise, and the psychological treament if it need.
调查慢性便秘患者的心理状态情况,探讨不同证型慢性便秘患者的心理障碍差异性,有助于从中医辨证的角度了解慢性便秘患者心理障碍的情况,为进一步寻求治疗不同证型慢性便秘的心理辅助方法,以提高患者心理素质。
【方法】
将收集到的100例符合纳入标准的慢性便秘患者进行中医辨证分型,分为四个证型。对其进行一周来情绪及心理状态的问卷调查,使用SPSS 11.5进行统计处理,采用X2检验,比较不同证型之间心理障碍表现的差异性。
【结果】
1.研究发现,便秘患者存在一定的焦虑或抑郁倾向的心理障碍。在100位患者中,诊断有焦虑倾向的有39人,占总人数的39%,其中轻度焦虑者26人(26%)；中度焦虑者13人(13%)；诊断有抑郁倾向的有59人,占总人数的59%,其中轻度抑郁者44人(44%),中度抑郁者15人(15%)。
2.热秘型、气秘型、虚秘型、冷秘型四个不同证型的便秘发病率有差异,其中冷秘型发病率远远低于其它的三种类型,推测与南方的气候、南方人的体质及现代人的饮食习惯、生活作息在习惯息息相关。
3.通过对四个不同证型的患者进行出现焦虑、抑郁倾向的心理障碍表现进行X2检验,发现焦虑、抑郁倾向发病率存在证型差异(P<0.05),进一步进行两两比较,发现热秘证患者比气秘证和热秘证患者比虚秘证更倾向于出现焦虑倾向的心理状态,气秘证患者则比热秘证患者更容易出现抑郁倾向的心理状态(P均<0.008)
【结论】
1.在南方,便秘的冷秘证发病率较其它证型都要低。2.便秘的不同中医证型导致的心理障碍倾向也有所不同,热秘组患者比气秘组、热秘组患者比虚秘组更倾向于出现焦虑倾向的心理状态；而气秘组患者比热秘组患者更容易出现抑郁倾向的心理状态。3.为提高便秘患者的身心健康,需医患两者共同努力,患者需调动自身的积极性,遵从医生的指导,改变不良的饮食结构、不良的生活作息时间及排便习惯,作适当的户外活动,并自行进行相关的心理疗法。
Object i ve:Investigate the psychological status of patients with chronic constipation cases, investigate different syndromes of chronic constipation difference between the psychological barriers, That would Help from the perspective of TCM in patients with chronic constipation and psychological barriers.In order to seek further treatment of chronic constipation with different syndromes psychological support methods, and improve the psychological quality of patients.
Method:To collect the 100 patients met the inclusion criteria for chronic constipation in patients with syndrome differentiation type, divided into four syndromes. Patients a week of emotional and psychological survey,conducted using the SPSS 11.5 statistical processing,by X2 test, comparison of psychological barriers between the different syndromes performance differences.
Result:1. Study found that patients with constipation, there is a certain tendency to anxiety or depression, psychological disorders. In the 100 patients diagnosed with anxiety tend to have 39 people,39% of the total number, of which mild anxiety,26 (26%); moderate anxiety,13 (13%);Diagnosed with depression tend to have 59 people,59% of the total number, of which mild depression in 44 (44%), moderate depression,11 (11%).
2. Hot type, gas type, virtual type, cold type constipation, this four different syndromes differencein incidence of constipation, cold constipation in which the lowest incidence of type. Speculate it closed related with the Southern climate, the physical and the modern southerners eating habits and lifestyle in the habit
3. By four different syndromes of anxiety and depression tend to occur in patients with mental disorders X2 performance tests and found that the incidence of anxiety and depression tend to exist between syndromes (P <0.05). Pairwise comparison further, Hot constipation group patients are more likely than the gas tend and the virtual type to the psychological state of anxiety. Compare to the hot type, the patients with constipationgas of virtual type were more likely to tend to the psychological state of depression. (P all<0.008).
Conclusion:1. In the south, to hot constipation in patients with constipation-type majority.
2.Constipation caused by the different syndromes are different psychological tendencies.Hot constipation group patients are more likely than the gas tend and the virtual type to the psychological state of anxiety. Compare to the hot type, the patients with constipationgas of virtual type were more likely to tend to the psychological state of depression.
3.In order to improve constipation in patients with physical and mental health, both doctors and patients need to work together, Patients should follow the doctor's recommendations, change the bad diet, bad lifestyle time and the bad bowel habits,do more exercise, and the psychological treament if it need.
引文
[1]田德禄.中医内科学(M).第一版.北京：人民卫生出版社,2002：226.
[2]Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders [J]. Gastroenterology,2006,130(5):1480-1491.
[3]KarbomU, et al. Dis Colon rectun (J),1997; 40(10):1149-1155.
[4]张东铭.出口梗阻型便秘的研究进展.盆底与肛门病学(M).第1版.贵阳：贵州科技出版社,2000.481.
[5]张东铭.盆底与肛门病学(M).贵阳：贵州科学技术出版社,2001：300-305.
[6]叶伟明,董娟,徐继飞.女性直肠出口梗阻型便秘与妇科疾病的关系(J).蚌埠医学院学报,2005,9(30)：43.
[7]尹淑慧,丁克.出口梗阻型便秘的研究进展[J).山东医药,2001(21)41：58-59.
[8]宣建明.慢性功能性便秘辨治体会[J].实用中医药杂志.2006,22(11)：709.
[9]徐中一.辨证分型治疗功能性便秘45例[J].实用中医内科杂志,2006,20(4)：387.
[10]张惠萍.老年性便秘的辨证施护及预防[J].现代中西医结合杂志,2004,13(15)：2025—2026.
[11]高峰,黄如华,林巧媚.补中益气汤加减治疗出口梗阻性便秘96例[J].福建中医药,2004, (2)35：30
[12]蔡行平.济川煎加味治疗功能性便秘29例[J].实用中医药杂志,2003,19(2)：71.
[13]辛红,张金泉.增液承气汤加味治疗老年功能性便秘临床疗效观察[J].四川中医,2008,26(3)：58
[14]刘仍海.便秘治疗的辨证思路与方法[J).中国临床医生,2000(3)28：42-43.
[15]郑红.重用百合治疗老年性便秘35例(J).江苏中医,2001,22(4)：24.
[16]林唐唐,唐杨,兰晓玲.自拟莱朴通腑汤加减治疗功能性便秘30例[J].中国医疗前沿,2008,3(23)：72.
[17]徐勇,刑乐友.决明子治疗老年性便秘100例[J].中国中西结合外科杂志,2003,9(1)：14.
[18]张更林.马铃薯与饴糖合用治疗功能性便秘120例[J].中国医药导报,2007,4(26)：162-163.
[19]胡厚君,孙学芹主编.便秘的自我疗法.第1版.北京：中国中医药出版社,2006.1
[20]徐速,王宗荣.行气润肠方灌肠治疗慢性便秘46例疗效观察(J].甘肃中医学院学报,2009,1(26)：21-22.
[21]冯骅.针灸治疗便秘取穴规律探究(J].针灸临床杂志,2003,19(10)：2-3.
[22]孙明明,丁署晴,丁义江,慢性功能性便秘的针灸治疗进展[J).结直肠肛门外科,2007,13(3)：193-194.
[23]高激泳,彭建民,邓金梅,针灸对功能性出口梗阻型便秘患者肛肠动力学的影响[J].海南医学,2010,11(21)：105-106.
[24]李桂萍,针灸治疗中风后便秘42例(J].山西中医,2009,12(25)：34.
[25]刘杰.耳压治疗习惯性便秘88例(J).河北中医,2007, (1)29：25.
[26]张小峰.穴位埋线治疗慢传输性便秘临床观察[J].时珍国医国药,2008,8(19)：2031-2032.
[27]陆金根.大肠肛门病研究新进展(M],第1版.上海：上海中医药大学出版社,2003：55-61
[28]贡呜,李岩.功能性便秘的治疗现状.中国当代医药,2009,16(16)：199-200.
[29]李琳.开塞露保留灌肠治疗老年便秘89例体会(J).中国社区医师·医学专业半月刊,15(11)：39.
[30]侯晓华.消化道运动学(M).北京：北京科学技术出版社,1997.405-406.
[31]曾俊,贾克东,徐伟民.生物反馈训练治疗出口梗阻性便秘的疗效观察(J).实用中西医结合临床,2005,3(5)：27-28.
[32]傅传刚.便秘的手术治疗指征和手术方式选择.中华胃肠科杂志,2007,10(2)：109-110.
[33]喻德洪,李实忠,卢任华等.出口处便秘的外科治疗86倒报告.上海医学.1989.12(1)：19-23.
[34]张胜奉,张连阳,黄里凯等.盆底脱垂与便秘.中华外科杂志,1996,34(12)：770.
[35]张根福,宋安,朱振亚.PPH对出口处梗阻型便秘手术治疗体会.大肠肛门病外科杂志,2005,11(2)：133-134.
[36]李升明,李燕,何玉峰等.直肠周围间隙硬化剂注射治疗盆底松弛综合征[J),大肠肛门病外科杂志,2002,3(8)：148-150.
[37]张东铭.肛肠外科解剖生理学[M].西安：陕西科技出版社,1989：207-218.
[38]缪剑辉.耻骨肌内括约肌部分切除术治疗耻骨直肠肌综合征22例[J].大肠肛门病杂志,2000,6(4)：14-15.
[39]来要良,魏玮.肠易激综合征心理因素的中医认识(J).ZHONGGUO XIAOHUA NEUING,2008, (12)2:28-31.
[40]贺平,王启,吴韬.秘由心生(J].结直肠肛门外科,2009,(5),15：346-348.
[41]李红霞,钟英琦,苌新明.功能性消化不良的精神心理因素及治疗(J].世界华人消化杂志,2002,(4)10：484-485.
[42]李学峰,邹益友.出口梗阻性便秘患者的肛门直肠动力学与精神心理因素研究[J).世界华人消化杂,2005,(1)13：128-129.
[43]何剑琴,王伟岸,胡品津等.肠易激综合征患者睡眠质量特征[J].世界华人消化杂志,2004；12：744-747.
[44]李爱萍,戴林,王永慧.多模式生物反馈治疗慢性特发性便秘的临床观察[J).临床军医杂志,2009(6)37：1024-1026.
[45]张明岛,陈福国.医学心理学[M].上海,上海科学出版社,1997：142-147.
[46]丁美红,林征,王美峰等.功能性便秘患者症状、精神心理状况、自主神经功能相关性研究[J].护理学报,2010, (4A)17：4-7.
[47]高利利,吴本俨,邵勇等.老年特发性便秘患者直肠肛门动力学变化及心理评价[J).解放军医学,2001,26(4)：302-304.
[48]戴菲,龚均.慢性便秘患者精神心理因素的研究[J).中国肛肠病杂志,2000,20(1)：13-14.
[49]林征,林琳,张红杰等.功能性便秘患者社会、心理、行为状况调查及生物反馈治疗效果随访(J].中国临床康复,2005(28)9：67-69.
[2]Longstreth GF, Thompson WG, Chey WD, et al. Functional bowel disorders [J]. Gastroenterology,2006,130(5):1480-1491.
[3]KarbomU, et al. Dis Colon rectun (J),1997; 40(10):1149-1155.
[4]张东铭.出口梗阻型便秘的研究进展.盆底与肛门病学(M).第1版.贵阳：贵州科技出版社,2000.481.
[5]张东铭.盆底与肛门病学(M).贵阳：贵州科学技术出版社,2001：300-305.
[6]叶伟明,董娟,徐继飞.女性直肠出口梗阻型便秘与妇科疾病的关系(J).蚌埠医学院学报,2005,9(30)：43.
[7]尹淑慧,丁克.出口梗阻型便秘的研究进展[J).山东医药,2001(21)41：58-59.
[8]宣建明.慢性功能性便秘辨治体会[J].实用中医药杂志.2006,22(11)：709.
[9]徐中一.辨证分型治疗功能性便秘45例[J].实用中医内科杂志,2006,20(4)：387.
[10]张惠萍.老年性便秘的辨证施护及预防[J].现代中西医结合杂志,2004,13(15)：2025—2026.
[11]高峰,黄如华,林巧媚.补中益气汤加减治疗出口梗阻性便秘96例[J].福建中医药,2004, (2)35：30
[12]蔡行平.济川煎加味治疗功能性便秘29例[J].实用中医药杂志,2003,19(2)：71.
[13]辛红,张金泉.增液承气汤加味治疗老年功能性便秘临床疗效观察[J].四川中医,2008,26(3)：58
[14]刘仍海.便秘治疗的辨证思路与方法[J).中国临床医生,2000(3)28：42-43.
[15]郑红.重用百合治疗老年性便秘35例(J).江苏中医,2001,22(4)：24.
[16]林唐唐,唐杨,兰晓玲.自拟莱朴通腑汤加减治疗功能性便秘30例[J].中国医疗前沿,2008,3(23)：72.
[17]徐勇,刑乐友.决明子治疗老年性便秘100例[J].中国中西结合外科杂志,2003,9(1)：14.
[18]张更林.马铃薯与饴糖合用治疗功能性便秘120例[J].中国医药导报,2007,4(26)：162-163.
[19]胡厚君,孙学芹主编.便秘的自我疗法.第1版.北京：中国中医药出版社,2006.1
[20]徐速,王宗荣.行气润肠方灌肠治疗慢性便秘46例疗效观察(J].甘肃中医学院学报,2009,1(26)：21-22.
[21]冯骅.针灸治疗便秘取穴规律探究(J].针灸临床杂志,2003,19(10)：2-3.
[22]孙明明,丁署晴,丁义江,慢性功能性便秘的针灸治疗进展[J).结直肠肛门外科,2007,13(3)：193-194.
[23]高激泳,彭建民,邓金梅,针灸对功能性出口梗阻型便秘患者肛肠动力学的影响[J].海南医学,2010,11(21)：105-106.
[24]李桂萍,针灸治疗中风后便秘42例(J].山西中医,2009,12(25)：34.
[25]刘杰.耳压治疗习惯性便秘88例(J).河北中医,2007, (1)29：25.
[26]张小峰.穴位埋线治疗慢传输性便秘临床观察[J].时珍国医国药,2008,8(19)：2031-2032.
[27]陆金根.大肠肛门病研究新进展(M],第1版.上海：上海中医药大学出版社,2003：55-61
[28]贡呜,李岩.功能性便秘的治疗现状.中国当代医药,2009,16(16)：199-200.
[29]李琳.开塞露保留灌肠治疗老年便秘89例体会(J).中国社区医师·医学专业半月刊,15(11)：39.
[30]侯晓华.消化道运动学(M).北京：北京科学技术出版社,1997.405-406.
[31]曾俊,贾克东,徐伟民.生物反馈训练治疗出口梗阻性便秘的疗效观察(J).实用中西医结合临床,2005,3(5)：27-28.
[32]傅传刚.便秘的手术治疗指征和手术方式选择.中华胃肠科杂志,2007,10(2)：109-110.
[33]喻德洪,李实忠,卢任华等.出口处便秘的外科治疗86倒报告.上海医学.1989.12(1)：19-23.
[34]张胜奉,张连阳,黄里凯等.盆底脱垂与便秘.中华外科杂志,1996,34(12)：770.
[35]张根福,宋安,朱振亚.PPH对出口处梗阻型便秘手术治疗体会.大肠肛门病外科杂志,2005,11(2)：133-134.
[36]李升明,李燕,何玉峰等.直肠周围间隙硬化剂注射治疗盆底松弛综合征[J),大肠肛门病外科杂志,2002,3(8)：148-150.
[37]张东铭.肛肠外科解剖生理学[M].西安：陕西科技出版社,1989：207-218.
[38]缪剑辉.耻骨肌内括约肌部分切除术治疗耻骨直肠肌综合征22例[J].大肠肛门病杂志,2000,6(4)：14-15.
[39]来要良,魏玮.肠易激综合征心理因素的中医认识(J).ZHONGGUO XIAOHUA NEUING,2008, (12)2:28-31.
[40]贺平,王启,吴韬.秘由心生(J].结直肠肛门外科,2009,(5),15：346-348.
[41]李红霞,钟英琦,苌新明.功能性消化不良的精神心理因素及治疗(J].世界华人消化杂志,2002,(4)10：484-485.
[42]李学峰,邹益友.出口梗阻性便秘患者的肛门直肠动力学与精神心理因素研究[J).世界华人消化杂,2005,(1)13：128-129.
[43]何剑琴,王伟岸,胡品津等.肠易激综合征患者睡眠质量特征[J].世界华人消化杂志,2004；12：744-747.
[44]李爱萍,戴林,王永慧.多模式生物反馈治疗慢性特发性便秘的临床观察[J).临床军医杂志,2009(6)37：1024-1026.
[45]张明岛,陈福国.医学心理学[M].上海,上海科学出版社,1997：142-147.
[46]丁美红,林征,王美峰等.功能性便秘患者症状、精神心理状况、自主神经功能相关性研究[J].护理学报,2010, (4A)17：4-7.
[47]高利利,吴本俨,邵勇等.老年特发性便秘患者直肠肛门动力学变化及心理评价[J).解放军医学,2001,26(4)：302-304.
[48]戴菲,龚均.慢性便秘患者精神心理因素的研究[J).中国肛肠病杂志,2000,20(1)：13-14.
[49]林征,林琳,张红杰等.功能性便秘患者社会、心理、行为状况调查及生物反馈治疗效果随访(J].中国临床康复,2005(28)9：67-69.