柴胡疏肝散加减合脐敷（通便贴）治疗功能性便秘的远期疗效观察

发布时间：2018-04-25 09:30

本文选题：柴胡疏肝散 + 脐敷　；参考：《北京中医药大学》2016年硕士论文

【摘要】：目的：近年来由于诸多方面因素的影响,功能性便秘的发病率在全球范围内逐年上升,而目前西医治疗方法存在着相对局限且副作用大,远期疗效较差等方面的问题,本研究旨在观察柴胡疏肝散加减合脐敷(通便贴)治疗功能性便秘的远期疗效,并探索其用药时间长短对功能性便秘的远期疗效的影响,为中医治疗功能性便秘提供新的思路。方法：1选取符合试验标准的64例患者,均为2015年01月至2015年12月在北京中医药大学东直门医院消化科门诊就诊的病例,随机分为观察组和对照组,每组均为32例,其中观察组2例失访,最终疗效评价30例；对照组3例失访,最终疗效评价29例。共观察59例便秘患者的远期疗效,两组患者年龄、性别、病程、治疗前症状总积分等方面的比较无显著性差异(P0.05),具有可比性。2对照组使用柴胡疏肝散加减联合通便贴脐敷治疗。观察组在对照组的基础上延长其用药时间。中药主方为柴胡疏肝散加减而成,具体药物组成：北柴胡15g,炒枳壳15g,白芍10g,陈皮l0g,炙香附l0g,川芎l0g,川楝子15g,醋莪术l0g,酒大黄6g,生甘草6g(北京康仁堂药业有限公司生产的免煎颗粒,每日一剂,分2次口服)。通便贴(由大黄、木香、紫苏梗、薄荷组成,为北京康仁堂药业有限公司生产的免煎颗粒,按6：3：1：0.6的比例配成,取适量以黄酒调成膏状装于贴敷膜中)神阙穴位贴敷,每日1次,每次2h。观察组疗程为4周,对照组疗程为2周,两组治疗结束后统计疗效。治疗期间均给予一般治疗包括合理饮食,增加膳食纤维,良好的生活习惯,心身调护。3采用SPSS20.0统计软件分析,对计量资料符合正态分布方差齐性组内采用配对t检验,组间采用独立t检验,对不符合正态分布方差齐性采用非参数检验,计数资料采用X2检验,P0.05为差异显著,有统计学意义。结果：两组患者便秘症状总分及各单项症状包括排便间隔时间、排便速度、粪便性状、排便不尽感、排便难度、腹胀、腹痛、暖气、纳差、肠鸣、烦躁易怒评分在治疗结束时及结束1周、4周、8周时均较治疗前均有明显降低。其中两组在治疗结束时及治疗结束1周、4周、8周时便秘远期症状总分、排便间隔时间评分、粪便性状评分、排便难度评分、排便不尽感评分、腹胀评分及纳差评分有显著性差异(P0.05),观察组明显低于对照组；两组的排便速度评分、暖气评分、肠鸣评分、烦躁易怒评分方面在治疗结束1周、4周有显著性差异(P0.05),观察组明显低于对照组,但在治疗结束8周,两组之间无显著性差异(P0.05)；腹痛评分在治疗结束1周、4周和8周时,两组之间无显著性差异(P0.05)。结论：1柴胡疏肝散加减合脐敷(通便贴)总体治疗效果是显著的,其疗效随时间的推移而持续发挥作用,远期疗效较好。2柴胡疏肝散加减合脐敷(通便贴)用药时间的长短对于维持远期疗效有非常重要的影响,用药4周疗程的远期疗效优于用药2周疗程。
[Abstract]:Objective: due to the influence of many factors, the incidence of functional constipation has been increasing year by year in the world in recent years. The purpose of this study was to observe the long term curative effect of Chaihu Shugan San plus subtractive umbilical compress (defecation plaster) in the treatment of functional constipation, and to explore the influence of the duration of medication on the long term curative effect of functional constipation, and to provide a new way of thinking for the treatment of functional constipation in traditional Chinese medicine. Methods from January 2015 to December 2015, 64 patients who met the test criteria were randomly divided into observation group (n = 32) and control group (n = 32) in Dongzhimen Hospital, Beijing University of traditional Chinese Medicine. There were 2 cases in the observation group, 30 cases in the final curative effect evaluation, 3 cases in the control group, 29 cases in the final curative effect evaluation. The long-term effect of 59 patients with constipation was observed. There was no significant difference in age, sex, course of disease and total score of symptoms before treatment between the two groups. The treatment time of the observation group was prolonged on the basis of the control group. The main prescription of traditional Chinese medicine is Chaihu Shugan Powder added or subtracted. Specific drug composition: North Bupleurum 15g, fried Fructus Aurantii 15g, Radix Paeoniae Alba 10g, Chen Pei 10g, broiled Rhizoma Cassiae l0g, Chuanxiong 10g, Chuanxiong 10g, Zedoary Curcuma 10g, Wine rhubarb 6g, Licorice 6g (Beijing Kangrentang Pharmaceutical Industry Co., Ltd.) Tongbian paste (composed of rhubarb, wood incense, perilla pedicel, mint, for the non-fried granules produced by Beijing Kangrentang Pharmaceutical Co., Ltd., according to the ratio of 6: 3: 1: 0.6, apply appropriate amount of rice wine to paste and mount in the film) the Shenque Point Application, once a day, Each time is 2 hours. The course of treatment was 4 weeks in the observation group and 2 weeks in the control group. During the course of treatment, general treatment including reasonable diet, increasing dietary fiber, good living habits, psychosomatic nursing. 3 was analyzed by SPSS20.0 statistical software, and matched t test was used in the group with homogeneity of variance of normal distribution of metrological data. Independent t test was used among groups, nonparametric test was used for homogeneity of variance of nonconforming normal distribution, and X2 test was used for counting data. Results: the total score and individual symptoms of constipation in both groups included defecation interval, defecation speed, fecal traits, defecation, defecation difficulty, abdominal distension, abdominal pain, heating, anorexia, bowel ringing. The scores of irritability and irritability were significantly lower at the end of treatment and at the end of 1 week and 4 weeks and 8 weeks than before treatment. In the two groups, the long-term symptom score, defecation interval score, fecal trait score, defecation difficulty score and defecation sensation score were evaluated at the end of treatment and at the end of 1 week and 4 weeks and 8 weeks after treatment. There was significant difference in abdominal distension score and anorexia score between the two groups (P 0.05), and the observation group was significantly lower than the control group, and the defecation velocity score, warm air score and bowel pain score were significantly lower in the observation group than in the control group. The scores of irritability and irritability in the treatment group were significantly lower than those in the control group at the end of 1 week and 4 weeks, but there was no significant difference between the two groups at the end of 8 weeks, and the abdominal pain score was at the end of 1 week, 4 weeks and 8 weeks after treatment. There was no significant difference between the two groups (P 0.05). Conclusion the overall therapeutic effect of Chaihu Shugan Powder plus subtraction and umbilical compress (defecation plaster) is remarkable, and its effect continues to play an important role with the passage of time. The long term curative effect is better. 2 the time of treatment of chaihu Shugan powder plus subtractive umbilical compress (defecation plaster) is very important to maintain the long term curative effect. The long term curative effect of 4 weeks treatment course is better than that of 2 weeks treatment course.
【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R256.35

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