加味枳术汤治疗气阴两虚型老年原发性便秘的临床疗效  

Clinical Observation of Modified Zhizhutang in Treatment of Senile Primary Constipation Due to Qi-Yin Deficiency

作　　者：刘芳[1] 张智彬 王邦林[3] 唐学贵[1] LIU Fang;ZHANG Zhi-bin;WANG Bang-lin;TANG Xue-gui(Affiliated Hospital of North Sichuan Medical College,Nanchong 637001,China;North Sichuan Medical College,Nanchong 637001,China;The People's Hospital of Yanting City,Mianyang 621600,China)

机构地区：[1]川北医学院附属医院,四川南充637001 [2]川北医学院,四川南充637001 [3]盐亭县人民医院,四川绵阳621600

出　　处：《中国实验方剂学杂志》2021年第17期99-105,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家自然科学基金项目(81573990)。

摘　　要：目的:探讨加味枳术汤治疗气阴两虚型老年原发性便秘的临床疗效及对胃肠神经递质和胃肠动力的影响。方法:将121例符合要求的患者随机分为对照组60例和观察组61例。两组均行生活方式调整。对照组口服芪黄通便软胶囊,3粒/次,3次/d。观察组口服加味枳术汤,1剂/d。两组疗程均为8周。记录治疗前后完全自主排便次数(CSBM,CSBM≥3次/周,视为排便正常);进行治疗前后便秘主要症状评分、便秘患者生存质量自评量表(PAC-QOL)评分和中医证候评分;进行治疗前后肛门直肠压力测定和结肠传输试验;检测治疗前后生长抑素(SS),胃动素(MTL),P物质(SP)和血管活性肠肽(VIP)水平。结果:观察组患者周平均CSBM多于对照组(P<0.01),中医证候评分低于对照组(P<0.01);观察组排便正常率为57.38%(35/61),高于对照的35%(21/60)差异有统计学意义(χ^(2)=6.092,P<0.05);观察组患者便秘各主要症状评分均显著低于对照组(P<0.01);观察组患者PAC-QOL各维度评分和总分均显著低于对照组(P<0.01);观察组患者肛管静息压和肛管最大收缩压高于对照组(P<0.01),初始感阈值、排便感阈值和最大耐受容量低于对照组(P<0.01);观察组患者在24,48,72 h标志物的排出率均高于对照组(P<0.01);观察组患者血清MTL和SP高于对照组(P<0.01),SS和VIP水平低于对照组(P<0.01);观察组复发率为34.29%(12/35),低于对照组的61.90%(13/21),差异有统计学意义(χ^(2)=5.051,P<0.05)。观察组临床疗效总有效率为95.08%(58/61),高于对照组的81.67%(49/60)差异有统计学意义(χ^(2)=5.321,P<0.01)。结论:加味枳术汤内服治疗老年气阴两虚型原发性便秘能调节胃肠神经递质,改善胃肠动力和胃肠排空率,减轻便秘症状,有助于恢复自主排便功能,提高生活质量,且复发率低,临床疗效优于芪黄通便软胶囊。Objective:To explore the clinical efficacy of modified Zhizhutang in treating senile primary constipation due to Qi-Yin deficiency and its influences on gastrointestinal neurotransmitters and gastrointestinal motility. Method: One hundred and twenty-one eligible patients were randomly divided into a control group(n=60)and an observation group(n=61). On the basis of lifestyle adjustments,patients in the control group further received oral Qihuang Tongmi soft capsule,three capsules per time,three times per day,whereas those in the observation group were further treated with modified Zhizhutang,one bag per day,for eight successive weeks. The number of complete spontaneous bowel movements(CSBM,normal defecation was considered if CSBM ≥ three times per week)before and after treatment was recorded. The main symptoms of constipation,the patient assessment of constipation quality of life(PAC-QOL),and the traditional Chinese medicine(TCM)syndrome before and after treatment were scored,followed by the anorectal pressure measurement and colonic transit test before and after treatment. The levels of somatostatin(SS),motilin(MTL),substance P(SP)and vasoactive intestinal peptide(VIP) before and after treatment were detected. Result: The weekly average number of CSBM in the observation group was greater than that of the control group(P<0.01),but the TCM syndrome score was lower than that of the control group(P<0.01). The normal defecation rate in the observation group was 57.38%(35/61),which was higher than 35%(21/60)of the control group(χ^(2)=6.092,P<0.05). The scores of the main symptoms of constipation in the observation group were significantly lower than those in the control group(P<0.01). The PAC-QOL subscale scores and the total score of the observation group significantly declined as compared with those of the control group(P<0.01). The anal resting pressure and anal maximum systolic pressure of the observation group were higher than those of the control group(P<0.01),while the first sensation volume,urge sensation v

关 键 词：原发性便秘 老年 气阴两虚证 加味枳术汤 神经递质 

分 类 号：R22[医药卫生—中医基础理论] R242[医药卫生—中医学]