术前体质辨证术后快速整体康复模式在剖宫产的临床应用学习教案

1、会计学1术前体质术前体质(tzh)辨证术后快速整体康复模辨证术后快速整体康复模式在剖宫产的临床应用式在剖宫产的临床应用第一页，共28页。Company Logo剖宫产术是解决难产及某些(mu xi)高危妊娠的重要手段之一；Cesarean Section is one of the important approaches of solving some of the dystocia and high-risk pregnancy cases.近年来随着医学发展及各种社会因素(yn s)的影响，剖宫产率有所升高；In recent years, cesarean section has sh

2、owed an increasing trend since medicine develops and the various social factors infer.第1页/共28页第二页，共28页。Company Logo腹部(f b)切口疼痛abdominal incision pain交感神经(jiogn-shnjng)兴奋synthetic excited麻醉(mzu)anesthesia 情绪紧张 anxiety影响产妇的休息、食欲和泌乳，而且产后康复时间长affect patients sleep, appetite and lactation. More over, the

3、 prolonged rehabilitative period严重影响产妇术后生活质量seriously affect the maternal quality of life第2页/共28页第三页，共28页。Company Logo我院自2006年以来，在潘佩光教授提出的术科“术前体质辨证、术后快速(kui s)整体康复”理念模式的指导下进行产前体质辨证，术后采取快速(kui s)整体康复，再结合剖宫产后“多虚多瘀”这一共同特点，从常规的术后被动等待康复转变为积极进取。Since 2006, professor Peiguang Pan has put forward the concep

4、t of “preoperative pattern differentiation and postoperative fast holistic rehabilitation” model for surgery. Under his guidance, we have done pattern differentiation for maternal patients and applied the integrative treatments of “postoperative fast holistic rehabilitation”, which turns negative po

5、stoperative waiting into positive recovery.第3页/共28页第四页，共28页。Company Logo提高术后生活质量达到快速整体(zhngt)康复accelerate wound recovery and holistic rehabilitation, improve patients quality of life第4页/共28页第五页，共28页。Company Logo2000年1月2007年8月在广州中医药大学附属(fsh)南海妇产儿童医院产科通过剖宫产术分娩的产妇。 Patients who underwent cesarean secti

6、on from Jan 2000 to Aug 2007 in Guangzhou University of Chinese Medicine affiliated Children and Maternity Hospital. 胎膜早破者；有潜在性易感因素者（如前置胎盘、胎盘早剥、严重贫血者）；产前体温有异常者。 patients with placental abruption; potential susceptive to be placenta praevia, placental abruption, severe anemia; abnormal temperature be

7、fore delivery.第5页/共28页第六页，共28页。Company Logo 研究对象对照组（the control group）2000年1月2005年12月通过剖宫产术分娩(fnmin)产妇，年龄26.34.0岁，胎次14胎，共5500例（Patients who underwent cesarean section from Jan 2000 to Dec 2005）治疗组（ the therapeutic group ）2006年1月2007年8月通过剖宫产术分娩(fnmin)产妇，年龄26.64.1岁，胎次14胎，共2300例 （ Patients who underwen

8、t cesarean section from Jan 2006 to Aug 2007 ）第6页/共28页第七页，共28页。Company LogoAB产前体质辨证(binzhng)（preoperative pattern differentiation）根据王琦九型中医体质辨证(binzhng)标准according to Qi Wang criteria of TCM 9 pattern differentiation产后中药体质调理（ postoperative TCM herbal treatment ）“多虚多瘀”的共同特点祛瘀生新 主方：益气活血生肌汤 黄芪、丹参(dn cn)

9、各15g，田七5g，鸡血藤30g“Qi replenishing, blood activating and muscle generating decoction” (QRBAMG): Huangqi (Radix Astragali)15g, Danshen(Radix Salviae Mitiorrhzae)15g, Tianqi(Panax notoginseng)5g, Jixueteng(Cualis Spatholobi)30g第7页/共28页第八页，共28页。Company Logo益气(y q)活血生肌汤QRBAMG1.平和(pngh)质祛瘀生新Equilibrium pat

10、tern-stasis dispelling and tissue generating益气活血生肌汤加党参或红参QRBAMG+Renshen(Radix Ginseng) or Dangsheng(Radix codonopsis)2.气虚质培补元气，补气健脾Qi deficiency pattern-nourishing original Qi and replenishing spleen Qi益气活血生肌汤加附子、肉桂QRBAMG +Fuzhi(Radix aconite lateralis praeparata), Rougui(Cortex cinnamomi)3.阳虚质补肾温阳，

11、益火之源Yang deficiency pattern-tonify kidney and reinforce Yang第8页/共28页第九页，共28页。Company Logo益气(y q)活血生肌汤加女贞子、旱莲草QRBAMG+Nuzhenzi(Fructus ligustri lucidi), Hanliancao(Herba ecliptae)4.阴虚(yn x)质滋补肾阴，壮水制火Yin deficiency pattern-nourishing kidney Yin to eliminateYang益气(y q)活血生肌汤加当归、桃仁QRBAMG+Danggui(Radix Ang

12、elicae Sinensis), Taoren(Semen Persicae)5.瘀血质活血祛瘀、疏经通络Blood stasis pattern-blood activating, stasis dispelling and regulate the meridians益气活血生肌汤加茯苓、白术QRBAMG+Fuling(Poria), Baishu(Rhizoma Atractyodis Macrocephalae)6.痰湿质健脾利湿，化痰泻浊Phlegm and dampness pattern-invigorate spleen, remove dampness, phlegm an

13、d turbidity第9页/共28页第十页，共28页。Company Logo益气(y q)活血生肌汤加苡米、金银花QRBAMG+Yiyiren(Semen Coicis), Jinyinhua(Flos Lonicerae)7.湿热(sh r)质分消湿浊，清泻伏火Damp heat pattern-dispel dampness and clear away heat益气活血(hu xu)生肌汤加柴胡、郁金QRBAMG+Chaihu(Radix Bupleuri), Yujin(Radix Curcumae)8.气郁质疏肝行气，开其郁结Qi stasis pattern-regulate

14、Liver Qi and disperse nodulation益气活血生肌汤加玉屏风散或参附汤或生脉散QRBAMG+Jade screen powder or Pulse activating powder or Shenfu decoction9.特禀质益气固表，养血消风或培补元阴元阳Prenatal deficiency pattern-invigorate Qi and consolidate the external, nourish blood disperse wind or replenish original Yan and Yin第10页/共28页第十一页，共28页。Com

15、pany LogoCDE耳针(r zhn)（术后第一日）Ear acupuncture (the first day after operation)耳针(r zhn)用穴：胸、内分泌、肝(Ear acupoints: chest、endocrine、liver)穴位注射(zhsh)（术后第一、二日，每日一次） acupoint injection 维生素B1穴注双侧足三里(Vitamin B1 injection: bilateral side of Zusanli ST36)穴位(xuwi)贴敷（术后第一、二日，每日一次）Acupoints pasting 厚朴粉敷贴双侧足三里(Houpu

16、(Cortex Magnoliae Officinalis)powder pasting: bilateral side of Zusanli ST36)第11页/共28页第十二页，共28页。Company LogoAB围手术(shush)期预防感染使用抗生素1-2次(Perioperative prophylactic use of antibiotics 1 2 times )术后1-2天能量(nngling)合剂、维生素等支持疗法(Postoperative energy and vitamin supportive therapy applied for 12 days)第12页/共2

17、8页第十三页，共28页。Company Logo术后胃肠道恢复情况(qngkung)（排气、排便情况(qngkung)）比较（h）Comparison of gastrointestinal function recovery第13页/共28页第十四页，共28页。Company Logo术后伤口感染(gnrn)情况比较Comparision of wound infection between 2 groups 伤口情况伤口情况感染感染无感染无感染治疗组治疗组5 5例例22952295例例对照组对照组3030例例54705470例例第14页/共28页第十五页，共28页。Company Logo

18、术后24小时(xiosh)出血量比较（ml）post operative bleeding volume in 24h 第15页/共28页第十六页，共28页。Company Logo术后泌乳情况比较 （按产妇胀奶情况和是否能满足(mnz)婴儿需要） Comparision of lactation (breast bulging and babies feeding satisfaction) between 2 groups第16页/共28页第十七页，共28页。Company Logo术后伤口疼痛情况(qngkung)比较（VAS评分）Comparison of symptom of pai

19、n (VAS scoring) (first day after operation)第17页/共28页第十八页，共28页。Company Logo宫底下降高度(god)比较（术后第六日）decline of uterine fundus(sixth day after operation) 第18页/共28页第十九页，共28页。Company Logo产妇是健康人群，“以人为本”的快速整体康复理念尤为重要。Maternal patients come from healthy populations, so the humanity-concerned concept of fast hol

20、istic rehabilitation is prone to be more important近年来，剖宫产率不断上升，并发症日益增多，特别是术后伤口愈合不良、脂肪液化(yhu)，子宫复旧不良，恶露量多且持续时间延长、乳汁分泌不足致母乳喂养率下降，术后感染率增高等。In recent years, the various factors induced cesarean section has showed an increasing trend, the incidence of postoperative complications increase, especially the

21、poor healing of wound, fat liquefaction, sabinvolution of uterine, excessive or prolonged lochia, poor lactation leads to fewer breast feeding, morbidity of postoperative infection increased and so on.第19页/共28页第二十页，共28页。Company Logov我院产科在潘佩光教授的带领下，剖宫产术前辨证中医体质，术后针对不同体质实施个体化的中西医结合干预手段，并施以情志、饮食调护的方法。通过

22、几年如一日的工作，我院在减少剖宫产后并发症、促进伤口(shngku)愈合、子宫复旧及胃肠功能恢复等方面都取得了一定的成绩，达到了令产妇术后“快速整体康复”的目的。 vUnder the guidance of Professor Peiguang Pan, the obstetric department of Guangzhou University of Chinese Medicine affiliated Children and Maternity Hospital has carried out pattern differentiation before cesarean sec

23、tion and applied integrative individually-concerned treatment on patients, along with emotional therapy and health keeping diet therapy. Through years of effort we have obtained certain achievements in reducing post cesarean section complications, accelerating wound healing, imvolution of uterine an

24、d gastrointestinal function recovery, which embodied the purpose of fast holistic recovery of surgical maternal patients.第20页/共28页第二十一页，共28页。Company Logo产后(chn hu)元气、津血俱伤，百节空虚，若起居不慎，感受寒热之邪，寒凝热灼成瘀产后(chn hu)妇女的病变基础“多虚多瘀”the pathological basis of post cesarean section patients is tending to be more def

25、iciency and blood stasis胞衣(boy)、胎盘残留，瘀血内阻，败血为病第21页/共28页第二十二页，共28页。Company Logo体质是对人体形态结构、生理功能、心理状态(zhungti)等方面的综合评价，是一种客观存在的生命现象，与人体的健康和疾病息息相关Physical pattern is the comprehensive appraisal of a mans structure, physical function and psychological condition. It is also a life phenomenon, which is rel

26、ated to humans health and diseases.体质具有(jyu)相对的稳定性，体质辨证对术后康复具有(jyu)决定性的指导意义。 Physical pattern is relatively steady. So the performance of pattern differentiation is of crucial guiding significance in postoperative rehabilitation.第22页/共28页第二十三页，共28页。Company Logo我们发现，不同体质的产妇在剖宫产后都有“多虚多瘀”的特点，在此基础上，按照各自

27、的体质差异，再结合临床辨证，为临床快速整体康复(kngf)奠定理论基础。We have found that post cesarean section patients with various patterns have had common feature of tending to be more deficiency and blood stasis. Base on this rule, we further differentiated patients with diversity of patterns, with which will shed some light on the basis of fast holistic rehabilitation.第23页/共28页第二十四页，共28页。Company Logo黄芪(hungq)Huangqi鸡血藤Jixueteng丹参(dn cn)Danshen田七Tianqi扶正补气生肌祛腐活血通络补血养血活血活血化瘀第24页/共28页第二十五页，共28页。Company LogoClick to edit ti