中医辨证施治结合生物反馈训练治疗功能性排便障碍的临床疗效观察

发布时间：2018-06-15 06:36

本文选题：功能性排便障碍 + 中西医　；参考：《福建中医药大学》2017年硕士论文

【摘要】：目的:本课题通过采取中医辨证施治结合生物反馈训练治疗功能性排便障碍,对比采用单纯生物反馈训练治疗对功能性排便障碍患者临床症状、生活质量、盆底Glazer评估各项指标的影响,比较二者之间的疗效差异,为后期临床治疗提供参考。方法:在福建省第二人民医院脾胃病重点专科门诊或住院便秘患者中选取符合功能性排便障碍诊断标准和纳排标准患者72例(就诊于2016年2月-2017年2月)。采用简单随机方法将72例患者分为中医辨证施治结合生物反馈训练组(治疗组)和单纯生物反馈训练组(对照组)各36例,治疗组脱落4例(中途服用其他通便药物),最终纳入统计分析32例;对照组脱落6例(中途服用其他通便药物)6例,最终纳入统计分析30例。治疗2个疗程后观察比较两组临床主症积分、生活质量问卷(PAC-QOL)积分及盆底Glazer评估各项指标情况。用SSPS20统计软件进行分析。P0.05表示有统计学意义。结果:1.总体疗效比较:两组比较具有统计学差异(P0.05),治疗组优于对照组。符合方案集:治疗组总有效率93.75%,对照组总有效率80.00%;全分析集:治疗组总有效率83.33%;对照组总有效率66.67%。2.两组治疗前后便秘主症积分、生活质量问卷(PAC-QOL)积分比较:两组患者治疗后便秘主症、生活质量问卷(PAC-QOL)积分均较治疗前明显下降,具有统计学意义(P0.05),提示两种方案均可明显改善本病症状、生活质量。两组治疗后积分比较均具有统计学差异(P0.05),治疗组积分均低于对照组,提示治疗组在改善便秘临床症状、生活质量上更为显著。3.盆底Glazer评估:两组治疗后与治疗前相比快速、持续和耐久收缩波幅较治疗前明显升高(P0.05);快速收缩反应时间、持续和耐久收缩变异系数较治疗前降低(P0.05);前基线波幅、后基线波幅及变异系数均值较治疗前降低,但无统计学差异(P0.05)。两组治疗后盆底Glazer评估各项指标比较(P0.05)。可以看出二组经过训练,盆底肌纤维收缩力较前明显升高,募集功能较前好转,稳定性升高,且治疗组改善程度优于对照组。前基线、后基线波幅、前基线变异系数及后基线变异系数均值较治疗前降低(P0.05),但无统计学意义。结论:本研究结果表明,采取中医辨证施治结合生物反馈训练与单纯生物反馈训练治疗功能性排便障碍相比,在改善功能性排便障碍患者临床症状、生活质量及总体疗效上均具有明显优势;中医辨证施治结合生物反馈训练治疗功能性排便障碍在改善患者盆底肌功能方面也优于单纯生物反馈训练治疗;可见二者结合可以提高临床治疗效果。
[Abstract]:Objective: to treat functional defecation disorder by TCM syndrome differentiation and biofeedback training, and to compare the clinical symptoms and quality of life of patients with functional defecation disorder treated by biofeedback training alone. The pelvic floor Glazer was used to evaluate the effect of each index, to compare the curative effect between the two indexes, and to provide reference for the later clinical treatment. Methods: a total of 72 patients with constipation who met the diagnostic criteria of functional defecation disorder and those who were in constipation were selected from the inpatient department of the second people's Hospital of Fujian Province from February 2016 to February 2017. 72 patients were randomly divided into two groups: the treatment group (treatment group) and the control group (36 cases). In the treatment group, 4 cases were dropped off (other defecation drugs were taken midway, 32 cases were included in the statistical analysis), and 6 cases in the control group (6 cases took other defecating drugs in the midway, 30 cases were included in the statistical analysis). After two courses of treatment, the clinical main symptom score, quality of life questionnaire PAC-QOLscore and pelvic floor Glazer evaluation were observed and compared between the two groups. Statistical software SSPS20 was used to analyze. The result is 1: 1. Comparison of the total curative effect: there was statistical difference between the two groups (P 0.05), and the treatment group was superior to the control group. The total effective rate of the treatment group was 93.75 and the total effective rate of the control group was 80.00. the total effective rate of the treatment group was 83.33; the total effective rate of the control group was 66.67.2. Comparison of PAC-QOLI scores of patients with constipation before and after treatment: the scores of PAC-QOLs in patients with constipation before and after treatment were significantly lower than those before and after treatment, and the scores of PAC-QOLs in the two groups were significantly lower than those before and after treatment. The results showed that the two schemes could significantly improve the symptoms and quality of life. The scores of the treatment group were lower than that of the control group, indicating that the clinical symptoms of constipation were improved and the quality of life was more significant in the treatment group than in the control group. Pelvic floor Glazer evaluation: after treatment, the amplitude of sustained and durable contraction was significantly higher in both groups than that before treatment, and the response time, coefficient of variation of sustained and durable contraction was significantly lower than that before treatment, and the amplitude of anterior baseline wave was decreased. The amplitude and coefficient of variation of posterior baseline were lower than those before treatment, but there was no statistical difference (P 0.05). Comparison of various indexes of pelvic floor Glazer evaluation between the two groups after treatment (P 0.05). It can be seen that after training, the contractility of pelvic floor muscle fiber was obviously increased, the recruitment function was improved, the stability was improved, and the improvement degree of the treatment group was better than that of the control group. The amplitude of the front baseline, the amplitude of the posterior baseline, the coefficient of variation of the anterior baseline and the coefficient of variation of the posterior baseline were lower than those before treatment (P 0.05), but there was no statistical significance. Conclusion: the results of this study indicate that the clinical symptoms of patients with functional defecation disorder can be improved by applying TCM syndrome differentiation combined with biofeedback training and treating functional defecation disorder with biofeedback training alone. The treatment of functional defecation disorder with TCM syndrome differentiation combined with biofeedback training is also superior to that of pure biofeedback training in improving the function of pelvic floor muscle. It can be seen that the combination of the two can improve the effect of clinical treatment.
【学位授予单位】：福建中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R574.62

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