热敏灸治疗阿片类药物相关性便秘的临床研究

发布时间：2018-07-03 14:04

本文选题：阿片类药物 + 便秘　；参考：《广州中医药大学》2016年硕士论文

【摘要】：便秘是使用强阿片类药物后最常见的不良反应之一,影响患者镇痛治疗的效果,加重患者痛苦的情绪。阿片类药物相关性便秘已经成为肿瘤科医生亟待解决的问题。本文总结了肿瘤患者使用阿片类药物镇痛治疗后引起便秘的中医病因病机、西医机制及中西医治疗方法,提出采用中医热敏灸作为治疗阿片类药物相关性便秘的治疗方法。在系统整理了中西医治疗阿片类药物相关性便秘的文献资料后,发现对该类型药源性不良反应,中医相对于西医积累了更为丰富的治疗经验,临床效果更为理想。灸法是中医临床中常用的治疗手段,热敏灸作为艾灸的一种新型灸法,适应症更广,便秘为其优势病种。本研究与口服酚酞片作为对照,来观察热敏灸治疗阿片类药物相关性便秘的临床效果。目的：观察热敏灸疗法治疗阿片类药物相关性便秘的临床效果及对患者生活质量的改善情况。方法：采用随机对照试验研究方法,将广州市中医医院符合纳入标准的病例70例,随机分成治疗组和对照组,两组病例各35例。治疗组以热敏灸疗法治疗,对照组给予口服酚酞片治疗。观察时间为3周期(5天为1周期,共15天),其中治疗2周期,停治疗1周期。分别在治疗1周期后、治疗2周期后及停止治疗1周期后进行随访观察,记录患者便秘症状及生活质量的改善情况,并进行统计学处理,得出结论。结果：1.纵向比较：两组治疗前后自身对照研究,经重复测量方差分析比较两组不同测量时间差异,结果提示：治疗组：①与治疗前比较,治疗组与治疗1周期后、治疗2周期后及停止治疗1周期后便秘症状明显改善(P0.05)；②与治疗前比较,治疗组治疗1周期后比较生活质量改善不明显(P0.05),治疗2周期后及停止治疗1周期后生活质量明显改善(K0.05)；对照组：①与治疗前比较,对照组治疗1周期后、治疗2周期后及停止治疗1周期后便秘症状明显改善(P0.05)；②与治疗前比较,对照组治疗1周期后、治疗2周期后及停止治疗1周期后比较生活质量均无明显改善(P0.05)。2.组间比较：各组间效应经Bonferroni检验显示治疗组和对照组组间便秘评分和生活质量评分均存在显著性差异(P0.05)。对不同时间点治疗组和对照组便秘评分进行比较,结果提示：与对照组比较,治疗组治疗前和治疗1周期后便秘评分比较无显著性差异(P0.05),而在治疗2周期后及停止治疗1周期后便秘评分比较具有显著性差异(P0.05),治疗组优于对照组；对不同时间点治疗组和对照组生活质量评分进行比较,结果提示：与对照组比较,治疗组治疗前和治疗1周期后生活质量评分无显著性差异(P0.05),在治疗2周期后及停止治疗1周期后生活质量评分比较具有显著性差异(P0.05),治疗组优于对照组。3.便秘量表和生活质量单项症状的比较：治疗组：①便秘量表单项评分中,与治疗前比较,治疗组停止治疗1周期后“排便频率”、“排便感到未排净”2项无明显改善(P0.05),“排便费劲”、“腹部疼痛”、“每次大便需要时间”、“排便需要的类型”及“每天排便不成功的次数”5项均明显改善(P0.05)；②生活质量量表单项评分中,与治疗前比较,停止治疗1周期后“日常生活”单项无明显改善(P0.05),“精神状态”、“疲乏”、“食欲”、“睡眠”4项均有明显改善(P0.05)；对照组：①便秘量表单项评分中,与治疗前比较,对照组治疗1周期后“排便感到未排净”、“腹部疼痛”、“每次大便需要时间”、“每天排便不成功次数”4项均无明显改善(P0.05),“排便频率”、“排便费劲”、“排便需要的类型”3项均有明显改善(P0.05)。②生活质量量表单项评分中,与治疗前比较,对照组停止治疗1周期后、“精神状态”、“疲乏”、“食欲”、“睡眠”及“日常生活”5项均无明显改善(P0.05)。以上结果说明,热敏灸治疗对患者“排便费劲”、“腹部疼痛”、“每次大便需要时间”、“排便需要的类型”及“每天排便不成功的次数”便秘症状5方面有改善,对“精神状态”、“疲乏”“食欲”、“睡眠”生活质量4方面有改善；口服酚酞片对患者“排便频率”、“排便费劲”及“排便需要的类型”3方面有改善,而对患者生活质量5个单项方面均无明显改善。4.治疗有效率：治疗组35例,对照组35例。停止治疗1周期后,治疗组痊愈7例,显效15例,有效8例,无效5例,总有效率85.8%；对照组痊愈2例,显效10例,有效13例,无效10例,总有效率71.4%。结论：1.热敏灸治疗能有效改善阿片类药物相关性便秘的症状。2.热敏灸治疗改善便秘症状的疗效优于口服酚酞片。3.热敏灸治疗在改善便秘症状的同时,还可以提高肿瘤患者的生活质量。
[Abstract]:Constipation is one of the most common adverse reactions after the use of strong opioid drugs, which affects the effect of the patient's analgesic treatment and aggravates the suffering emotion of the patients. Opioid related constipation has become an urgent problem for the oncologist. This paper summarizes the causes of constipation caused by opioid analgesics in patients with cancer. The pathogenesis, the western medicine mechanism and the traditional Chinese and Western medicine treatment methods, proposed the use of traditional Chinese medicine hot moxibustion as the treatment of opioid related constipation. After systemically collating the literature on the treatment of opioid related constipation in Chinese and Western medicine, it was found that the negative response to this type of drug origin was found, and the traditional Chinese medicine has accumulated a more abundant treatment relative to the western medicine. The clinical effect is more ideal. Moxibustion is a common therapeutic method in traditional Chinese medicine. Thermosensitive moxibustion is a new moxibustion method of moxibustion. It is more widely used and constipation is the dominant disease. The clinical effect of thermosensitive moxibustion on the treatment of opioid related constipation is observed with oral Phenolphthalein Tablets. Objective: To observe the thermal moxibustion The clinical effect of the treatment of opioid related constipation and the improvement of the quality of life of the patients. Methods: 70 cases of Guangzhou traditional Chinese medicine hospital were randomly divided into the treatment group and the control group, and the two groups were 35 cases. The treatment group was treated with thermosensitive moxibustion therapy and the control group. The oral Phenolphthalein Tablets treatment was given. The observation time was 3 cycles (5 days as 1 cycles, 15 days), of which 2 cycles were treated and 1 cycles were stopped. After the 1 cycle, after the 2 cycle, and after the cessation of the 1 cycle, the patients were followed up to record the symptoms of constipation and the improvement of the quality of life, and the results were statistically treated. The results were concluded. 1. longitudinal comparison: two groups of self-control study before and after treatment, through repeated measurement of variance analysis to compare the difference between the two groups of different measurement time, the results suggest: the treatment group: compared with before treatment, the treatment group and the treatment 1 cycle, after the 2 cycle and after the 1 cycle of the treatment of constipation symptoms obviously improved (P0.05); 2. Compared with the treatment before treatment, treatment The quality of life was not significantly improved after 1 cycles in the treatment group (P0.05), and the quality of life was significantly improved after the treatment of 2 cycles and after the 1 cycle of cessation treatment (K0.05); the control group was compared with before treatment, and after the treatment of the 1 cycle of the control group, the constipation symptoms were significantly improved after the treatment of 2 cycles and after the 1 period of cessation treatment (P0.05); (2) compared with before treatment, After the treatment of 1 cycles, after the treatment of 1 cycles, after the treatment of 2 cycles and after the 1 cycle of the treatment, there was no significant improvement in the quality of life (P0.05) between group.2.. The effects of each group showed significant difference between the constipation score and the quality of life score between the treatment group and the control group (P0.05). The treatment group and the control group at different time points were found. The results showed that there was no significant difference in constipation score between the treatment group before and after the 1 cycle (P0.05) compared with the control group, but the constipation score was significantly different after the treatment of 2 cycles and after the 1 cycle of the treatment (P0.05), and the treatment group was superior to the control group; the treatment group and the control group at different time points were compared with the control group. Compared with the control group, the results showed that compared with the control group, there was no significant difference in the quality of life score between the treatment group before and after the 1 cycle (P0.05). The quality of life score of the treatment group was significantly different after the 2 cycle and after the 1 cycle of the treatment (P0.05). The treatment group was better than the control group.3. constipation scale and the quality of life. Comparison of single symptom: the treatment group: (1) the score of constipation form items, compared with before treatment, the treatment group stopped 1 cycles after the treatment of the treatment group, "defecation frequency", "defecation feel not clear" no obvious improvement (P0.05), "defecation effort", "abdominal pain", "every time need time", "type of defecation needs" and "every day" The 5 items of unsuccessful defecation were obviously improved (P0.05); (2) compared with before treatment, there was no significant improvement in the single item of daily life (P0.05), and 4 items of "mental state", "fatigue", "appetite" and "sleep" were obviously improved (P0.05), and the control group: (1) constipation scale In the single score, compared with the treatment before treatment, the control group treated 1 cycles after the treatment, "the defecation felt not clear", "abdominal pain", "every time the stool needed time", "every day the number of defecation unsuccessful times" 4 items had no obvious improvement (P0.05), "defecation frequency", "defecation difficulty", "defecation needs type" 3 items have obviously improved (P0.05). In the score of quality of life forms, compared with before treatment, the 5 items of "mental state", "fatigue", "appetite", "sleep" and "daily life" were not improved significantly after the treatment of 1 cycles in the control group (P0.05). The above results showed that the thermosensitive moxibustion treatment for the patients "defecation hard", "abdominal pain", "every time the stool needs to be needed." There were improved 5 aspects of constipation symptoms: "mental state", "tired" "appetite", "sleep", and 4 aspects of the quality of life. Oral Phenolphthalein Tablets has improved the "defecation frequency", "defecation effort" and "type of defecation needs" in 3 aspects. There were no obvious improvements in the 5 single aspects of the quality of life of the patients: 35 cases in the treatment group and 35 cases in the control group. After 1 cycles of cessation of treatment, the treatment group recovered 7 cases, 15 cases were markedly effective, 8 effective, 5 invalid, total effective rate 85.8%; the control group recovered 2, effective 10, valid 13, invalid 10, total effective efficiency 71.4%. conclusion: 1. thermosensitive effect, total effective efficiency conclusion: total effective efficiency conclusions: 1. thermosensitive efficiency conclusion: total effective efficiency conclusion: total effective efficiency conclusion: effective efficiency conclusion: total effective efficiency conclusion: effective efficiency conclusion: total effective efficiency conclusions: 1. thermosensitive efficiency conclusion: total effective efficiency. Moxibustion treatment can effectively improve the symptoms of opioid related constipation.2. thermosensitive moxibustion treatment is better than the oral Phenolphthalein Tablets.3. thermosensitive moxibustion treatment in improving constipation symptoms, but also can improve the quality of life of the tumor patients.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.1

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