产后盆底功能障碍的中医证素特征研究

刘倩+吴冬梅+张敏

摘要：目的 探討产后盆底功能障碍的证素分布特征及组合规律，阐释其中医病机及证候特点，为该病的中医证候规范化研究提供依据。方法 选取262例产后盆底功能障碍患者，运用证素辨证方法，探究其病位证素、病性证素分布及组合规律。结果 常见病位证素为肾、胞宫、心神、肝；常见病性证素为气不固、气虚、气滞、阳虚、气陷。病位多为两脏器、三脏器组合，以肾+心神、肾+胞宫多见。病位+病性证素组合以肾+心神+气不固最常见。与肾相关的证候还可见肾气虚、肾阳虚、肾阳气虚、肾阴虚；与肝相关的证候为肝郁气滞；与肝、肾二脏相关的证候为肝肾阴虚；与脾、肾相关的证候为中气下陷、脾肾气虚。结论 产后盆底功能障碍的病位主要在肾，涉及胞宫、心神、肝；病性以虚为主，重要病机为气不固。

关键词：产后盆底功能障碍；证素；分布；组合

DOI：10.3969/j.issn.1005-5304.2017.12.004

中图分类号：R271.91 文献标识码：A 文章编号：1005-5304（2017）12-0012-05

Study on Distribution Features of Syndrome Elements of Postpartum Pelvic Floor Dysfunction LIU Qian1， WU Dong-Mei1， ZHANG Min2 （1. The Second Affiliated Hospital， Fujian University of Traditional Chinese Medicine， Fuzhou 350003， China； 2. Fujian University of Traditional Chinese Medicine， Fuzhou 350122， China）

Abstract： Objective To explore the distribution and combination rules of TCM syndromes of postpartum pelvic floor dysfunction patients； To interpret its pathogenesis and characteristics of TCM syndromes； To provide evidence for the TCM syndrome standardization study of the disease. Methods Totally 262 cases of postpartum pelvic floor dysfunction patients were included as the research objects. The distribution and combination rules of syndrome elements were analyzed by using the method of syndrome elements differentiation. Results The common syndrome elements of disease locations of postpartum pelvic floor dysfunction were kidney， uterus， mind and liver； the common syndrome elements of disease nature were insecurity of qi， qi deficiency， qi stagnation， yang deficiency and qi collapse. Usual form was two-viscera and three-viscera combination； the majority of combination were kidney+mind and kidney+uterus. The most common combination form of disease location and nature was kidney+mind+insecurity of qi. Moreover， there were other syndromes related to kidney， including kidney qi deficiency， kidney yang deficiency， dual vacuity of kidney yang and qi， kidney yin deficiency were associated with kidney syndromes； liver depression and qi stagnation was associated with liver； liver and kidney yin deficiency was associated with liver and kidney. Conclusion Kidney is the primary disease location of postpartum pelvic floor dysfunction， which also involves uterus， mind and liver. The main disease nature is deficiency， and insecurity of qi is the important pathology characteristic of this disease.

Key words： postpartum pelvic floor dysfunction； syndrome elements； distribution； combinationendprint

女性盆底功能障碍（pelvic floor dysfunction，PFD）是指由于盆底支持结构缺陷、损伤及功能障碍

基金项目：福建省卫生厅青年科研课题（2014-2-32）

造成的疾患，主要表现为压力性尿失禁、盆腔器官脱垂和性功能障碍。国内流行病学调查表明，产后6周育龄期女性PFD发生率为25.08%～31.78%[1-2]；若涵盖不同年龄段（15～86岁）女性，PFD发生率高达58.8%[3]。研究表明，妊娠、分娩是产后PFD重要的独立发病因素，PFD患病率随产次增加而上升[4-6]。因此，防治PFD应从产后开始。

产后PFD属中医学“遗溺”“小便不禁”“肠风”“便秘”“阴挺”“产肠不收”等范畴，中药内服、外敷、针灸、推拿及中医综合治疗临床疗效显著[7-9]。……