益气活血灌肠方联合比沙可啶治疗老年排便障碍型便秘的临床疗效及机制探讨  

Clinical effects and mechanism of Yiqi Huoxue enema combined with bisacodyl in the treatment of defecation disorder consti⁃pation in elderly patients

作　　者：孙健 陆金根[2] 林晖 张宸 丁超 Sun Jian;Lu Jingeng;Lin Hui;Zhang Chen;Ding Chao(Department of Proctology,Tianshan Traditional Chinese Medicine Hospital in Changning District,Shanghai,200051,P.R.China;Department of Proctology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shang-hai,200032,P.R.China)

机构地区：[1]上海市长宁区天山中医医院肛肠科,上海200051 [2]上海中医药大学附属龙华医院肛肠科,上海200032

出　　处：《老年医学与保健》2023年第2期390-397,共8页Geriatrics & Health Care

基　　金：上海市长宁区科学技术委员会科研课题(CNKW2002Y27);中医特色诊疗技术提升项目(zyjx-2017040);全国名老中医药专家传承工作室建设项目[国中医药人教教育便函(2016)167号];上海市长宁区卫计委“青年中医医师培养计划”项目(2015CNQNZY005)。

摘　　要：目的 观察益气活血灌肠方联合比沙可啶治疗排便障碍型便秘气虚证的临床疗效及对肛门动力学的影响。方法 将2018年11月—2021年5月在上海市长宁区天山中医医院肛肠科门诊及病房就诊的排便障碍型便秘气虚证的80例患者采用随机数字表法分为观察组、对照组,每组40例。观察组采用益气活血灌肠方保留灌肠配合口服比沙可啶,对照组采用口服比沙可啶,2组均治疗14 d。观察2组患者在肛门动力学方面的变化情况、临床疗效、便秘主要症状积分及PAC-QOL评分。结果 (1)最终完成试验者77例,其中观察组39例、对照组38例。(2)观察组的总有效率(92.31%)高于对照组(73.68%)(P<0.05)。(3)治疗前后组内比较,2组便秘症状各项积分、PAC-QOL四个维度方面的分值均较治疗前降低(P<0.05);组间治疗后比较,观察组的便秘症状积分及PAC-QOL分值均低于对照组(P<0.05)。(4)在肛门动力学方面,观察组在治疗后FSV、DSV、MTV等直肠阈感觉得到改善(P<0.05);肛管最大收缩压与治疗前相比有提升(P<0.05);直肠肛管抑制反射的例数较治疗前增加(P<0.05)、矛盾收缩的例数较治疗前减少(P<0.05)。而对照组治疗前后各项肛门动力学指标之间无显著性差异(P>0.05)。结论 益气活血灌肠方联合比沙可啶能明显改善排便障碍型便秘患者的临床症状,其机制可能与通过中医灌肠技术改善患者的直肠阈感觉、增加肛管收缩力,改善直肠肛门括约肌的不协调运动有关。Objective To observe the clinical effects of Yiqi Huoxue enema combined with bisacodyl in the treatment of defecation disorder constipation with Qi deficiency syndrome and its effects on anal dynamics.Methods 80 patients with defe⁃cation disorder constipation with Qi deficiency syndrome admitted to outpatient and ward of Department of Proctology of Tians⁃han Hospital of Traditional Chinese Medicine from November 2018 to May 2021 were divided into observation group and con⁃trol group by random number table method,with 40 cases in each group.The observation group was treated with retention ene⁃ma with Yiqi Huoxue enema combined with oral bisacodyl,while the control group was treated with oral bisacodyl.Both groups were treated for 14 days.The changes of anal dynamics,clinical efficacy,constipation main symptom score and PAC⁃QOL score in both groups were observed.Results(1)A total of 77 patients completed the experiment,including 39 in the observation group and 38 in the control group.(2)The total effective rates of the observation group(92.31%)was higher than that of the control group(73.68%)(P<0.05).(3)Intra⁃group comparison before and after treatment:The scores of various constipation symptoms and scores of PAC⁃QOL in four dimensions after treatment were lower than those before treatment in both groups(P<0.05).Comparison between groups after treatment:The constipation symptom score and PAC⁃QOL score of the observation group were lower than those of the control group(P<0.05).(4)Anal dynamics comparison:In the observa⁃tion group,rectal threshold sensation such as FSV,DSV and MTV were significantly improved after treatment(P<0.05).The maximum systolic blood pressure of anal canal increased compared with that before treatment(P<0.05).There was an increase in the number of cases of rectal anal reflex inhibition(P<0.05)and a decrease in the number of contradictory con⁃tractions(P<0.05)compared to the pre⁃treatment period.But there was no significant difference in the anal dynamics indexes before a

关 键 词：老年 中药保留灌肠 肛门动力学 便秘 益气活血方 比沙可啶 

分 类 号：R574.62[医药卫生—消化系统]