解郁通幽汤结合生物反馈治疗盆底失弛缓所致便秘的临床观察

发布时间：2018-09-14 11:58

【摘要】：目的：生物反馈是目前治疗盆底失弛缓所致便秘的一线疗法,但情志因素会制约生物反馈的临床疗效,本课题是观察导师经验方解郁通幽汤结合生物反馈这一双联疗法治疗盆底失弛缓所致便秘(APFS),中医辨证为肝脾不调型的临床疗效。探讨两种疗法结合应用的可行性、有效性以及优势,为其临床推广应用提供依据。方法：选择2013年01月—2014年01月在福建中医药大学附属人民医院肛肠科病人,符合纳入标准的40例便秘患者,随机分成治疗组20例和对照组20例两组。治疗组用口服解郁通幽汤结合生物反馈疗法,对照组单纯采用生物反馈疗法。10天为一疗程。观察患者治疗后便秘主症、心理状态、盆底表面肌电水平的改变情况,记录观察指标,进行统计学分析,分析疗效,得出结论。结果：1.经过2个疗程的治疗,试验组临床痊愈2例,显效14例,有效2例,无效2例,愈显率80%,总有效率90%。对照组临床痊愈0例,显效4例,有效8例,无效8例,愈显率20%,总有效率60%。两组有统计学意义(愈显率P0.01,总有效率P0.01)。 2.治疗组在改善腹胀、善叹息、嗳气、心中烦闷、纳差方面显著优于对照组(P0.01),在改善便质、便意感、排便费力程度、排便时间、排便频率、排便不尽感、肛门坠胀感上等其余各项临床症状方面均优于对照组(P0.05)。 3.经统计处理,盆底表面肌电评估结果与治疗前相比,治疗后Glazer盆底肌电评估中前后基线收缩波幅均明显降低,快速收缩阶段最大收缩波幅明显升高,持续收缩阶段、耐受收缩阶段变异系数明显降低,差异均有统计学意义(P0.05)。 4.治疗组在改善焦虑、抑郁方面方面显著优于对照组(P0.01)。 5.随访2个月后,治疗组1例复发,对照组3例复发。有效率分别为85%,45%。治疗组显著优于对照组(P0.01)。结论：1.生物反馈治疗盆底失弛缓型便秘是有效的。 2.解郁通幽汤结合生物反馈可显著改善患者临床症状、焦虑抑郁情绪。 3.解郁通幽汤结合生物反馈疗法是一种临床疗效好、疗效稳定的治疗方法,在解除主症的同时,以疏肝理脾为根本,弥补了单纯采用生物反馈治疗仪进行生物反馈训练治疗盆底失弛缓型便秘的不足。在临床值得推广应用。
[Abstract]:Objective: biofeedback is a first-line therapy for constipation caused by pelvic floor achalasia, but emotional factors will restrict the clinical efficacy of biofeedback. This subject is to observe the clinical curative effect of the tutors' experience prescription Jieyu Tongyou decoction combined with biofeedback in treating constipation caused by pelvic floor achalasia and constipation caused by (APFS), syndrome differentiation of liver and spleen. To explore the feasibility, effectiveness and advantages of the combination of the two therapies, and to provide the basis for its clinical application. Methods: from January 2013 to January 2014, 40 patients with constipation were randomly divided into two groups: treatment group (n = 20) and control group (n = 20). The treatment group was treated with oral Jieyu Tongyou decoction combined with biofeedback therapy, while the control group was treated with biofeedback therapy for 10 days. To observe the changes of main constipation, psychological state and surface myoelectric level of pelvic floor after treatment, to record the observation index, to make statistical analysis, to analyze the curative effect, and to draw a conclusion. The result is 1: 1. After two courses of treatment, 2 cases were cured, 14 cases were effective, 2 cases were ineffective, the effective rate was 80% and the total effective rate was 90%. In the control group, there were 0 cases of clinical cure, 4 cases of remarkable effect, 8 cases of effective and 8 cases of ineffective. The effective rate was 20 and the total effective rate was 60. The two groups had statistical significance (callus rate P0.01, total effective rate P0.01). The treatment group was significantly better than the control group in improving abdominal distension, sighing, belching, boredom, anorexia (P0.01), improving fecal quality, fecal feeling, defecation effort, defecation time, defecation frequency, defecation inexhaustible feeling. The other clinical symptoms were better than the control group (P0.05). After statistical treatment, compared with before treatment, the baseline systolic amplitude of Glazer pelvic floor electromyography was significantly decreased, the maximum systolic amplitude of rapid contraction phase was significantly increased, and the sustained contraction stage was observed. The coefficient of variation in the period of tolerance to contraction was significantly decreased, and the difference was statistically significant (P0.05). The treatment group was superior to the control group in improving anxiety and depression (P0.01). After 2 months follow-up, 1 case recurred in the treatment group and 3 cases in the control group. The effective rate is 85 and 45, respectively. The treatment group was significantly better than the control group (P0.01). Conclusion 1. Biofeedback treatment of pelvic floor flaccid constipation is effective. 2. 2. Jieyu Tongyou decoction combined with biofeedback can significantly improve the clinical symptoms of patients, anxiety and depression. 3. Jieyu Tongyou decoction combined with biofeedback therapy is a kind of treatment method with good clinical effect and stable curative effect. At the same time, it is essential to soothe the liver and regulate the spleen. It makes up for the deficiency of biofeedback training in the treatment of pelvic floor flaccid constipation. It is worth popularizing in clinic.
【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】：2014
【分类号】：R574.62

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