泻黄散加味治疗脾胃积热型小儿便秘疗效及对证候积分的影响

Efficacy of Modified Xiehuang Powder(泻黄散加味)in Treating Spleen-stomach Heat Accumulation of Constipation in Children and Its Influence on Syndromes Scores

目的研究泻黄散加味与排便训练联合治疗脾胃积热型小儿便秘疗效以及对证候积分和复发的影响。方法将2019年7月—2021年7月共101例脾胃积热型便秘患儿纳入研究,采用随机数字表法将患儿分为两组,分别为对照组50例和观察组51例,对照组接受双歧杆菌三联活菌胶囊和排便训练,而观察组采用泻黄散加味颗粒和排便训练治疗。观察治疗后2组患儿用药前后便秘改善程度及临床疗效差异,比较治疗前后2组患儿中医证候积分、胃肠激素水平[血清胃动素(MTL)、胃泌素(GAS)、胃饥饿素(GHR)]、血清学指标水平[血清P物质(SP)、血管活性肠肽(VIP)、一氧化氮(NO)],统计2组不良反应以及半年内复发率并进行比较。结果治疗4周后,2组便秘患者症状自评量表(PAC-SYM)各项评分、大便干结、腹胀、舌红苔黄、口干口臭均较治疗前明显降低(P<0.05),且观察组低于对照组(P<0.05);2组患儿MTL、GAS、GHR、SP、VIP指标均较治疗前显著提升(P<0.05),且观察组比对照组更高(P<0.05),NO显著降低(P<0.05),且观察组比对照组更低(P<0.05)。2组患儿在治疗期间不良反应发生率相似,差异没有统计学意义(P>0.05)。所有患儿治疗2个月均已治愈,经过6个月的随访,观察组便秘复发率明显低于对照组(P<0.05)。结论泻黄散加味与排便训练联合治疗脾胃积热型患儿便秘表现出显著效果,使患儿便秘症状和胃肠激素表达均得到可观改善,纠正其消化系统的神经调节机制,有利于预防复发。

Objective To study the efficacy of Modified Xiehuang Powder(泻黄散加味)combined with defecation training in the treatment of spleen-stomach heat accumulation of constipation in children and its influence on syndromes scores and recurrence.Methods 101 children with spleen-stomach heat accumulation of constipation from July 2019 to July 2021 were included for the study.The children were divided into two groups by random number table method,including control group(50 cases)and observation group(51 cases).The control group received bifidobacterium triple viable capsule and defecation training,while the observation group was given Modified Xiehuang Powder granule and defecation training.The differences in constipation improvement degree and clinical efficacy in the two groups were observed after treatment.TCM syndromes scores,gastrointestinal hormones[serum motilin(MTL),gastrin(GAS),ghrelin(GHR)]and serological indicators[serum substance P(SP),vasoactive intestinal peptide(VIP),nitric oxide(NO)]were compared before and after treatment,and adverse reactions and recurrence rate within six months were statistically analyzed and compared.Results After 4 weeks of treatment,the scores of items of patient assessment of constipation symptoms(PAC-SYM)and scores of dry stool,abdominal distension,red tongue and yellow fur,dry mouth and halitosis in both groups were significantly declined compared to before treatment(P<0.05),and the scores in observation group were lower than those in control group(P<0.05).The levels of MTL,GAS,GHR,SP and VIP were significantly increased in the two groups compared with those before treatment(P<0.05),and the levels in observation group were higher(P<0.05),NO was significantly decreased(P<0.05),and the level was lower than that in control group(P<0.05).The incidence rates of adverse reactions were similar between the two groups during treatment(P>0.05).All the children were cured after 2 months of treatment.After 6 months of follow-up,the recurrence rate of constipation in observation group was significantly lower than that in control group(P<0.05).Conclusion The combination of Modified Xiehuang Powder and defecation training has a remarkable effect in the treatment of spleen-stomach heat accumulation of constipation in children,which can significantly improve the symptoms of constipation and expressions of gastrointestinal hormones,correct the neuroregulatory mechanism of the digestive system,and help prevent recurrence.