针药结合分型辨治老年功能性便秘的随机对照试验  

Complex Treatments of Acupuncture and Chinese Herbal Medicine Based on Syndrome Differentiation for Senile Functional Constipation:A Randomized Controlled Trial

作　　者：施一春[1] 王超[1] 汪玲羽[1] 陈利芳[1] SHI Yichun WANG Chao WANG Linyu et al(The Third Affiliated Hospital of Zhejiong Chinese Medical Universit Hangzhou,310012, China)

机构地区：[1]浙江中医药大学附属第三医院,杭州310005

出　　处：《浙江中医药大学学报》2017年第6期464-470,共7页Journal of Zhejiang Chinese Medical University

基　　金：国家中医药管理局全国名老中医药专家传承工作室建设项目(方剑乔全国名老中医药专家传承工作室);编号:国中医药人教发[2013]47号;浙江省名老中医专家传承工作室建设计划(浙江省方剑乔名老中医专家传承工作室);编号:GZS2012014~~

摘　　要：[目的]评价针药结合分型辨治老年功能性便秘的临床疗效。[方法]将174例老年功能性便秘患者按照1:1比例随机分为针药结合组和杜密克组,信封法进行随机隐蔽。针药结合组按照气虚型、阴虚型、阳虚型、气滞型、燥热型五种分型施以中药煎剂口服(每日1剂)和针灸治疗(每周3次);设置杜密克组为对照组,每次1包,每日3次口服。治疗周期为8周,随访期12周。主要疗效指标为治疗后6周期间平均每周完全排净感的自主排便次数(complete spontaneous bowel movements,CSBMs)较治疗前增加2次的病例数所占的百分率;次要疗效指标为治疗前后的周平均CSBM及其增加次数,便秘患者生活质量量表(patient assessment constipation-quality life questionnaire,PAC-QOL)评分,两组患者Bristol大便性状积分和排便困难程度评分。[结果]138位受试者完成本项试验,两组患者的一般情况和基线值具有可比性;对两组患者的周平均CSBM增加2次的百分比进行卡方检验,结果显示针药结合组的百分比明显高于杜密克组,差异有统计学意义(P<0.05);通过重复测量方差分析(ANOVA)发现针药结合组的周平均CSBM次数较杜密克组高,差异有统计学意义(P<0.05),其周平均增加值也较杜密克组明显偏多,差异有统计学意义(P<0.05);PAC-QOL量表评分的统计结果显示针药结合组患者经治疗后其生活质量明显优于杜密克组,差异有统计学意义(P<0.05);针药结合组的Bristol大便性状和排便困难程度均优于杜密克组,差异有统计学意义(P<0.001)。[结论]针药结合分型辨治可以明显增加老年功能性便秘患者的CSBM,改善Bristol大便性状和排便困难程度,提高其生活质量。[Objective] To evaluate the effect of complex treatments of acupuncture and Chinese herbal medicine based on syndrome differentiation for senile functional constipation. [Methods] 174 elderly patients with functional constipation randomized into the complex treatment group（included acupuncture and Chinese herbal medicine） and Duphalac group（1：1 ratio）.The envelope method was used for random concealment. The complex treatment group received Chinese herbal medication decoction（one dose per day） and acupuncture（three times a week） according to the following five syndrome differentiation： Qi deficiency, Yin deficiency, Yang deficiency, Qi stagnation, and dry-heat. Duphalac group was designed as control group, received one bag of Duphalac per time, three times a day. The treatment period was 8 weeks, and the follow-up period was 12 weeks. The primary outcome was the percentage of patients whose weekly average number of CSBMs was increased ≥2 compared with baseline during the last 6 weeks in the treatment period. The secondary efficacy indicators were as follows： weekly average numbers and increased numbers of CSBM, the quality of life of patients with constipation（PAC-QOL）, the Bristol stool character score, and the assessment of difficulty in defecation. [Results] 138 subjects finally completed the intervention; the general situation and the baselines of two groups were comparable. The percentage of patients whose weekly average number of CSBMs was increased ≥2 in the complex treatment group was significantly increased compared with Duphalac group by chi square test（P0.05）; the average weekly numbers and increased numbers of CSBM in complex treatment group was higher than that in the Duphalac group, tested by repeated measurement analysis of variance analysis（ANOVA）（both with P0.05）; the PAC-QOL scores, the Bristol assessment of stool character and the difficulty assessment of defecation in complex treatment group were all significantly improved than those of Duphalac group�

关 键 词：便秘 功能性 老年 针刺 中药 分型 杜密克 随机对照 

分 类 号：R245.9[医药卫生—针灸推拿学]