通腑宽中汤治疗便秘型肠易激综合征的疗效观察及对结肠动力学的影响  

Clinical Efficacy of Tongfu Kuanzhong Decoction on Constipation-predominant Irritable Bowel Syndrome and Its Effect on Colonic Dynamics

作　　者：梁峻尉 白文筠[2] 高祖 孙大娟 LIANG Junwei;BAI Wenjun;GAO Zu;SUN Dajuan(First Clinical Medical College,Shandong University of Traditional Chinese Medicine(TCM),Jinan 250014,China;Affiliated Hospital of Shandong University of TCM,Jinan 250014,China;Kashgar TCM Hospital,Kashgar 844000,China;College of TCM,Shandong University of TCM,Jinan 250355,China)

机构地区：[1]山东中医药大学第一临床医学院,济南250014 [2]山东中医药大学附属医院,济南250014 [3]喀什地区中医医院,新疆喀什地区844000 [4]山东中医药大学中医学院,济南250355

出　　处：《中国实验方剂学杂志》2025年第9期150-156,共7页Chinese Journal of Experimental Traditional Medical Formulae

基　　金：国家重点研发计划项目(2022YFC3500605,2019YFC1712103);山东省中医药科技项目(M-2023072);济南科技发展创新计划项目(202225072)。

摘　　要：目的:观察通腑宽中汤治疗脾虚气滞型便秘型肠易激综合征(IBS-C)的临床疗效及对肛门直肠测压、结肠电活动参数的影响。方法:纳入符合标准的64例脾虚气滞型IBC-C患者作为研究对象,随机分为观察组与对照组,各32例,对照组口服枸橼酸莫沙必利片,观察组口服通腑宽中汤。两组均连续治疗4周,观察两组患者治疗前后中医证候积分、便秘症状自评量表(PAC-SYM)评分、广泛性焦虑量表(GAD-7)评分、患者健康问卷抑郁量表(PHQ-9)评分、肛门直肠测压、结肠电活动参数变化。结果:治疗后两组中医证候总积分均显著降低(P<0.01),观察组更低(P<0.05)。两组患者的粪便症状、直肠症状、腹部症状及症状总积分均较治疗前显著下降(P<0.01),观察组直肠症状、腹部症状及症状总积分更低(P<0.05,P<0.01)。两组力排肛门残余压、直肠初始感觉阈值均较治疗前下降(P<0.05,P<0.01),对照组力排肛门残余压低于观察组(P<0.01)。治疗后,两组患者的GAD-7与PHQ-9评分均显著下降(P<0.01),观察组GAD-7评分显著低于对照组(P<0.01)。治疗后,两组患者各导联不同时间平均波幅较治疗前均显著上升(P<0.01),观察组饭前5 min、饭后10 min的升结肠、降结肠、乙状结肠、直肠及饭后20、30 min的升结肠、直肠各导联平均波幅均高于对照组(P<0.05)。结论:通腑宽中汤治疗IBS-C疗效确切,其机制可能与下调力排肛门残余压、直肠初始感觉阈值,上调结肠各肠段肠电幅值、肠电频率,调整结肠功能的电生理有关。Objective:To observe the clinical efficacy of Tongfu Kuanzhong decoction(TFKZ)in the treatment of constipation-predominant irritable bowel syndrome(IBS-C)with spleen deficiency and Qi stagnation and its effects on anorectal manometry and colonic electrical activity parameters.Methods:Sixty-four patients with IBS-C of the spleen deficiency and Qi stagnation type were included as research subjects and were randomized into the observation group(thirty-two cases)and control group(thirty-two cases).The control group was orally administered mosapride citrate tablets,and the observation group was orally administered TFKZ.Both groups were treated for 4 weeks.The traditional Chinese medicine(TCM)syndrome scores,patient assessment of constipation symptoms(PAC-SYM)score,general anxiety disorder-7(GAD-7)score,patient health questionnaire-9(PHQ-9)score,anorectal manometry,and colonic electrical activity parameters were observed before and after treatment in the two groups.Results:The total points of TCM syndromes were significantly lower in both groups after treatment(P<0.01)and lower in the observation group(P<0.05).The fecal symptoms,rectal symptoms,abdominal symptoms,and total symptom scores of the patients in both groups were significantly decreased after treatment(P<0.01),and the rectal symptoms,abdominal symptoms,and total symptom scores of the observation group were lower(P<0.05,P<0.01).In both groups,the forced anal residual pressure and the initial rectal sensation threshold decreased after treatment(P<0.05,P<0.01),and forced anal residual pressure in the control group was lower(P<0.01).After treatment,the GAD-7 and PHQ-9 scores of patients in both groups decreased significantly(P<0.01),and the GAD-7 score of the observation group was significantly lower(P<0.01).After treatment,the average wave amplitude at different time points of each lead increased significantly in both groups,compared with that before treatment(P<0.01).The average wave amplitude of each lead of the ascending colon,descending colon,sigmoid colon,a

关 键 词：通腑宽中汤 便秘型肠易激综合征 焦虑抑郁状态 肛门直肠测压 结肠电活动 

分 类 号：R256[医药卫生—中医内科学] R287[医药卫生—中医学] R574