通腑宽中汤联合生物反馈治疗排便障碍型便秘疗效及机制探讨  

Curative effect and mechanism of Tongfu Kuanzhong decoction combined with biofeedback on defecation disorder constipation

作　　者：宋昱佼 刘淑贤 王帅[2] 迟莉丽[2] 孙大娟[2] SONG Yujiao;LIU Shuxian;WANG Shuai;CHI Lili;SUN Dajuan(Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong,China;The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,Jinan 250014,Shandong,China)

机构地区：[1]山东中医药大学,山东济南250014 [2]山东中医药大学附属医院,山东济南250014

出　　处：《现代中西医结合杂志》2022年第14期1928-1933,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：山东省中医药科技发展计划项目(2019-0188)。

摘　　要：目的 观察复方通腑宽中汤联合生物反馈治疗排便障碍型便秘脾虚气滞证的临床疗效及对肛门直肠测压参数的影响,探讨其作用机制。方法 选取2018年10月—2020年12月山东中医药大学附属医院脾胃病科诊治的130例排便障碍型便秘脾虚气滞证患者为研究对象,随机分成3组,中西医结合组50例给予通腑宽中汤联合生物反馈治疗,中医组50例给予通腑宽中汤治疗,西医组30例给予生物反馈治疗,3组疗程均为4周。观察3组治疗前后中医症状积分、便秘患者生活质量量表(PAC-QOL)积分、肛门直肠测压参数变化,比较3组中医证候疗效、治疗安全性及治疗结束随访4周复发率。结果 治疗4周后,3组患者排便费力、排便不爽积分及中西医结合组和中医组腹痛、腹胀、情绪抑郁或急躁易怒、神疲懒言、胸胁痞满积分均明显降低(P均<0.05),且中西医结合组和中医组上述各症状积分均明显低于西医组(P均<0.05);3组患者PAC-QOL积分均明显降低(P均<0.05),且中西医结合组均明显低于中医组和西医组(P均<0.05)。治疗4周后,3组患者直肠排便压均明显增高(P均<0.05),且中西医结合组明显高于中医组和西医组(P均<0.05);3组患者力排肛门残余压、直肠初始感觉阈值、直肠排便窘迫阈值均明显降低(P均<0.05),且中西医结合组均明显低于中医组和西医组(P均<0.05)。中西医结合组、中医组、西医组中医证候总有效率分别为88.0%(44/50)、78.0%(39/50)、66.7%(20/30),随访4周复发率分别为8.0%(4/50)、24.0%(12/50)、33.4%(10/30),中西医结合组中医证候总有效率明显高于中医组和西医组(P均<0.05),随访4周复发率明显低于中医组和西医组(P均<0.05)。3组治疗及随访期间均无明显不良反应发生。结论 通腑宽中汤联合生物反馈治疗排便障碍型便秘的临床疗效明显优于单纯中医和西医治疗,其机制可能与增强肠道动力、提高肠道敏感性有关。Objective It is to observe the clinical efficacy of Tongfu Kuanzhong decoction combined with biofeedback in the treatment of defecation disorder constipation with spleen deficiency and qi stagnation syndrome and its effect on anorectal pressure measurement parameters,and to discuss its mechanism.Methods A total of 130 patients with defecation disorder constipation with spleen deficiency and qi stagnation syndrome diagnosed and treated in the Department of Spleen and Stomach Diseases,Affiliated Hospital of Shandong University of Traditional Chinese Medicine from October 2018 to December 2020 were selected as the research objects.They were randomly divided into 3 groups,50 cases in the the integrated traditional Chinese and western medicine group was treated with Tongfu Kuanzhong decoction combined with biofeedback,the traditional Chinese medicine group was treated with Tongfu Kuanzhong decoction,the western medicine group was treated with biofeedback,all the groups were treated for 3 weeks.The changes in the scores of traditional Chinese medical syndrome and the scores of the Patient-Assessment of Constipation Quality Of Life(PAC-QOL),and the parameters of anorectal pressure measurement before and after treatment observed in the three groups,The efficacy of traditional Chinese medical syndromes,the safety of treatment and the recurrence rate of the 4-week follow-up after treatment were compared among the three groups.Results After 4 weeks of treatment,the scores of difficulty defecation,uncomfortable defecation of the patients in the three groups,the scores of abdominal pain,abdominal distension,emotional depression or irritability,fatigue after defecation,fatigue and laziness,fullness in the chest and flank,bowel sounds and defecation gas of the patients in the integrated traditional Chinese and western medicine group and traditional Chinese medicine group were all significantly decreased(all P<0.05),and the above score of the integrated traditional Chinese and western medicine group,traditional Chinese medicine

关 键 词：排便障碍型便秘 脾虚气滞证 通腑宽中汤 生物反馈 

分 类 号：R574.62[医药卫生—消化系统]