针刺配合穴位贴敷治疗卒中后排便障碍的疗效观察  

Therapeutic efficacy of acupuncture combined with acupoint application in the treatment of defecation disorder after stroke

作　　者：余洪敏 刘淑萍[1] 刘更[1] 华雪君 卜秀焕[1] 支建梅 李文静 王田[1] YU Hongmin;LIU Shuping;LIU Geng;HUA Xuejun;BU Xiuhuan;ZHI Jianmei;LI Wenjing;WANG Tian(Qinhuangdao Hospital of Chinese Medicine,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市中医医院,秦皇岛066000

出　　处：《上海针灸杂志》2024年第9期963-968,共6页Shanghai Journal of Acupuncture and Moxibustion

基　　金：河北省医学科学研究课题(20201609);河北省秦皇岛市科学技术研究与发展计划项目(202005A043)。

摘　　要：目的观察针刺配合穴位贴敷治疗卒中后排便障碍的临床疗效及其对患者营养状况、肠道菌落数及肛管直肠动力学影响。方法将94例卒中后排便障碍患者随机分为观察组和对照组,每组47例。两组均接受基础治疗,观察组采用针刺配合穴位贴敷治疗,对照组采用单纯穴位贴敷治疗。观察两组治疗前后各项营养状况指标[转铁蛋白(transferrin,TRF)、前白蛋白(prealbumin,PA)、血清白蛋白(albumin,ALB)水平]、肠道菌落数指标[双歧杆菌、肠杆菌、乳杆菌计数及短链脂肪酸(short-chain fatty acids,SCFAs)含量]、肛管直肠动力学指标(直肠初始阈值、肛管静息压、肛管最大收缩压、直肠排便感觉阈值)、临床症状评分(排便困难、排便频率、排便时间和腹胀评分)、便秘评分系统(constipation scoring system,CSS)评分及便秘患者生活质量量表(patient assessment of constipation quality of life questionnaire,PAC-QOL)评分的变化情况,比较两组临床疗效。结果观察组总有效率为97.9%,明显高于对照组的83.0%(P<0.05)。两组治疗后各项营养状况指标、SCFAs含量及双歧杆菌、乳杆菌计数均较同组治疗前显著升高,肠杆菌计数、各项肛管直肠动力学指标、各项临床症状评分、CSS评分及PAC-QOL评分均显著降低,差异均具有统计学意义(P<0.05)。观察组治疗后各项营养状况指标、SCFAs含量及双歧杆菌、乳杆菌计数均明显高于对照组,肠杆菌计数、各项肛管直肠动力学指标、各项临床症状评分、CSS评分及PAC-QOL评分均明显低于对照组,差异均具有统计学意义(P<0.05)。结论在基础治疗的基础上,针刺配合穴位贴敷治疗卒中后排便障碍疗效确切,可改善患者营养状态、肛管直肠动力学指标和临床症状,提升SCFAs含量,调节肠道菌落微生态。Objective To observe the clinical efficacy of acupuncture combined with acupoint application in the treatment of defecation disorders after stroke and its effect on patients’nutritional status,intestinal colonization number and anorectal dynamics.Method A total of 94 patients with post-stroke defecation disorder were randomly divided into the observation group and the control group,47 cases in each group.Both groups received basic treatment.The observation group was treated by acupuncture combined with acupoint application therapy,and the control group was treated by acupoint application therapy alone.The changes in nutritional status indexes[transferrin(TRF),prealbumin(PA),serum albumin(ALB)levels],intestinal colonization indexes[bifidobacteria,Enterobacteriaceae,Lactobacillus counts,and short-chain fatty acids(SCFAs)content],anorectal dynamics indexes(rectal initial threshold,anal canal resting pressure,anal canal maximal systolic pressure,rectal defecation sensation threshold),clinical symptom scores(defecation difficulty,defecation frequency,defecation time,and abdominal distension scores),constipation scoring system(CSS)score and patient assessment of constipation quality of life questionnaire(PAC-QOL)before and after treatment were compared between the two groups.The clinical efficacy of the two groups was compared.Result The total effective rate of the observation group was 97.9%,which was significantly higher than that of the control group,which was 83.0%(P<0.05).After treatment,the nutritional status indexes,SCFAs content and bifidobacteria and lactobacillus counts of the two groups were significantly higher than those of the same group before treatment,and the Enterobacteriaceae counts,anorectal dynamic indexes,clinical symptom scores,CSS scores,and PAC-QOL scores were all significantly lower than those before treatment,and the differences were all statistically significant(P<0.05).In the observation group,all nutritional status indexes,SCFAs content and bifidobacteria and lactobacillus counts were si

关 键 词：针刺疗法 穴位贴敷法 便秘 脑梗死 肠道菌落微生态 肛管直肠动力学 

分 类 号：R246.6[医药卫生—针灸推拿学]