手汗症术后疼痛特点及其中医证型分布规律研究  

Analysis of Postoperative Pain Characteristics and the Distribution of Traditional Chinese Medicine Syndrome Types in Palmar Hyperhidrosis

作　　者：黄丽芳 沈春辉[2] 王继勇[2] HUANG Li-Fang;SHEN Chun-Hui;WANG Ji-Yong(The First Clinical Medical School of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China;Dept.of Cardiothoracic Surgery,the First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405 Guangdong,China)

机构地区：[1]广州中医药大学第一临床医学院,广东广州510405 [2]广州中医药大学第一附属医院心胸血管外科,广东广州510405

出　　处：《广州中医药大学学报》2021年第9期1780-1785,共6页Journal of Guangzhou University of Traditional Chinese Medicine

基　　金：广州中医药大学第一附属医院青年科研基金项目(编号:2019QN06)。

摘　　要：【目的】总结胸腔镜腋下单孔双侧胸交感神经链切断术治疗手汗症的术后疼痛特点,分析手汗症患者手术前后中医证型变化规律,为中医药应用于手汗症围手术期治疗提供必要的临床依据。【方法】采用回顾性研究方法,收集2019年6月至8月于广州中医药大学第一附属医院心胸血管外科接受胸腔镜腋下单孔双侧胸交感神经链切断术治疗的129例手汗症患者,记录患者术前1 d和术后1 d、2 d、3 d的中医证型;术后进行随访,随访内容包括手术效果、代偿性出汗发生率及术后疼痛情况。【结果】(1)随访情况:129例患者中,排除和失访29例,完成随访100例,随访率为77.5%。(2)一般情况:短期手术有效率为100.0%;手术整体满意度为96.0%;术后疼痛发生率为92.0%;代偿性出汗发生率为90.0%,且代偿性出汗发生部位以躯干和下肢近端多见。(3)术后疼痛特点:术后出现急性疼痛92例(92.0%),其中轻度疼痛38例(41.3%),中重度疼痛54例(58.7%);90.2%(83/92)的患者疼痛出现在术后4 d内,89.1%(82/92)的患者疼痛症状在两周内缓解,疼痛时间超过1个月的患者有2例(2.2%),65.2%(60/92)的患者经过休息可以有效缓解疼痛。(4)中医证型变化情况:术前1 d,患者主要表现为阳明热盛证、营卫不和证和肺卫不固证等证型,且以单纯实证或单纯虚证为主;术后气血亏虚证和气滞血瘀证明显增加,而阳明热盛证明显减少,患者主要表现为虚证和虚实夹杂证。将术前1 d的中医证型与术后1 d、2 d和3 d比较,差异均有统计学意义(P<0.01);而术后1~3 d的中医证型比较,差异均无统计学意义(P>0.05)。(5)疼痛程度与中医证型分布关系:单纯实证患者疼痛较轻微,如无痛及轻度疼痛患者主要为阳明热盛证、营卫不和证及肺卫不固证,中度疼痛患者以气血亏虚证及气滞血瘀证为主,重度疼痛则以气滞血瘀证为主,说明术后疼痛主要与气血亏虚及气滞血瘀关系密�Objective To analyze the characteristics of postoperative pain in the patients with palmar hyperhidrosis(PH) after axillary single-port bilateral thoracic sympathectomy under thoracoscope, and to investigate the changes in the traditional Chinese medicine(TCM)syndrome types in PH patients before and after surgical treatment,so as to provide evidence for the clinical application of Chinese medicine in the perioperative treatment of PH. Methods A retrospective study was conducted. We collected the information of 129 patients with PH who have had the thoracoscopic single-port bilateral thoracic sympathectomy in the Department of Cardiothoracic Surgery and Vascular Surgery of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from June to August of 2019. The TCM syndrome types of the patients one day before surgery and one day,2 days,3 days after surgery were recorded. Follow-up was performed after surgery, and the contents of follow-up consisted of the surgical efficacy, the incidence of compensatory hyperhidrosis rate and postoperative pain.Results(1)The results of follow-up showed that among the 129 patients,there were 29 excluded and fell-off cases,and 100 valid questionnaires were received with a follow-up rate of 77.5%.(2)Overall efficacy:shortterm surgical efficacy was 100.0%,overall surgical satisfaction was 96.0%,incidence of postoperative pain was92.0%, incidence of compensatory hyperhidrosis was 90.0%, and compensatory hyperhidrosis was commonly seen in the trunk and proximal lower extremities.(3)Postoperative pain characteristics:92 cases(92.0%)had acute pain after surgery,including 38 cases(41.3%)with mild pain and 54 cases(58.7%)with moderate to severe pain;90.2%(83/92)of the patients had pain within 4 days after surgery,and 89.1%(82/92)had pain symptoms relieved within two weeks. Two patients(2.2%)had the duration time of pain over one month,and the pain could be effectively relieved after rest in 65.2%(60/92)of the patients.(4)Changes in TCM syndrome types:one day before surgery

关 键 词：手汗症 胸腔镜 腋下单孔双侧胸交感神经链切断术 术后疼痛 中医证型 虚证 虚实夹杂证 

分 类 号：R269[医药卫生—中西医结合]