针灸治疗结肠慢传输性便秘30例

作者	单位
丁曙晴	南京中医药大学第三附属医院全国中医肛肠医疗中心南京中医药大学研究生部
丁义江	南京中医药大学第三附属医院全国中医肛肠医疗中心
王小峰	南京中医药大学第三附属医院全国中医肛肠医疗中心
谭妍妍	南京中医药大学第三附属医院全国中医肛肠医疗中心
金洵	南京中医药大学第三附属医院全国中医肛肠医疗中心
霍维宇	南京中医药大学研究生部
季新涛	南京中医药大学研究生部
丁康	南京中医药大学研究生部

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中文摘要:

目的评估针灸治疗结肠慢传输性便秘的疗效及作用特点。方法通过建立结肠慢传输性便秘的临床路径,以患者报告结果(patient-reported outcomes,PROs)为疗效评估的主要方法,30例慢传输性便秘患者,共采用两组穴位:第一组天枢、大横、腹结、气海、关元、足三里、上巨虚;第二组大肠俞、肾俞、八髎、四神聪,对腹部和背部穴位深刺,灸四神聪,两组穴位隔日交替使用,20次为1个疗程。采用患者评价便秘生活质量问卷(PAC-QOL问卷)评估法,比较治疗前、治疗后1、2、3周便质评分、便意感次数、排便次数、腹胀程度和生活质量。结果治疗前与治疗后1、2、3周比较,开塞露或泻药使用例数减少,Bristol便质评分达正常例数比例上升;便意感次数增多;排便次数增多;腹胀减轻(P<0·01)。治疗前后PAC-QOL比较,治疗后患者身体不适、心理不适、便秘相关的焦虑和关心、满意度4方面分值及总分差值均明显下降(P<0·01)。治疗期间未发生不良事件。治疗结束时临床痊愈13例,好转9例,无效8例;治疗后1月随访临床痊愈10例,好转7例,无效13例。治疗后3月随访临床痊愈7例,好转8例,无效15例。结论在建立临床路径的基础上,采用PROs疗效评估法,凸显了针灸改善便秘症状同时提高患者生活质量的特点。

英文摘要:

Objective To assess the therapeutic effects and acting specialty of acupuncture and moxibustion for treatment of slow-transmission constipation (STC).Methods A clinical pathway was created and Patient-Reported Outcomes (PROs) method was taken for efficacy evaluation dominantly.Acupuncture and moxibustion were applied to 30 STC patients on two groups of acupoints in alternation,with acupoints of Tianshu (ST25),Daheng (SP15),Fujie (SP14),Qihai (RN6),Guanyuan (RN4),Zusanli (ST36),and Shangjuxu (ST37) as group 1;Dachangshu (BL25),Shenshu (BL23),Baliao (BL31、BL32、BL33、BL34),and Sishencong (Ex-HN1) as group 2.Deep needling was applied on acupoints of abdominal and back region and moxibustion was put on Sishencong,20 times as one course.The therapeutic effect was assessed based on the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) method by comparing the Bristol scoring on quality of stool,awareness and frequency of defecation,degree of abdominal fullness sensation,and patients’ quality of life (QOL) at different time points,i.e.pre-treatment,after 1,2 and 3 weeks of treatment.Results Compared with the condition of pre-treatment,after 1,2 and 3 weeks of treatment,cases using irritant laxative or glycerin enema reduced,with quality of stool normalized,scores for awareness and frequency of defecation increased,and abdominal fullness sensation lessened (all P<0.01);both the total score and scores on the 4 domains of QOL (malaise,psychosocial complaint,anxiety and interest related to constipation,and satisfaction) were obviously reduced.No adverse event occurred during the treatment course.Therapeutic effectiveness assessment at the end of treatment showed that 13 patients were cured,9 improved and 8 treated in vain;the corresponding cases assessed at 1 month after treatment were 10,7,13;and those at 3 months after were 7,8,15,respectively.Conclusion Establishing a clinical pathway is helpful to patients in their continuous diagnosis and treatment.Using PROs method to evaluate the therapeutic effect could clearly reveal the superiority of acupuncture and moxibustion in improving symptoms and QOL in patients of STC.

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