头针、雷火灸联合盆底肌训练治疗缺血性脑卒中慢传输型便秘的疗效观察

Clinical Efficacy of Applying Scalp Acupuncture,Thunder Fire Moxibustion Combined with Pelvic Floor Muscle Training in the Treatment of Slow Transit Constipation after Ischemic Stroke

目的:观察头针、雷火灸联合盆底肌训练治疗缺血性脑卒中慢传输型便秘的临床疗效。方法:选择2019年2月~2021年4月缺血性脑卒中伴有STC患者150例,随机将其分为3组,即联合组、雷火灸组、对照组三组各50例。对照组采用包括盆底肌训练的常规干预手段,雷火灸组在对照组基础上,加用雷火灸治疗;联合组在雷火灸组基础上,加用头针治疗。观察治疗前后的便秘症状,肛管直肠压力测定,表面肌电图以及相关实验室指标,包括胃动素(MTL)、血管活性肠肽(VIP)、单核细胞趋化蛋白-1(MCP-1)。结果:在症状方面,治疗前三组在排便困难程度、排便时间、粪便性状、排便频率、腹胀感及其他不适得分相比,差异均无统计学意义(P>0.05)。治疗2周后,三组六项得分均低于治疗前,差异有统计学意义(P<0.05);组间相比,联合组在排便困难程度、排便时间、粪便性状、排便频率、其他不适低于其余两组,差异有统计学意义(P<0.05);在腹胀感得分联合组仅低于对照组,与雷火灸组无差异(P>0.05)。在肛管直肠压力测定方面,治疗前三组在模拟排便动作肛门收缩压、直肠静息压、肛门静息压相比,差异均无统计学意义(P>0.05)。治疗2周后,三组三项指标均高于治疗前,差异有统计学意义(P<0.05);组间相比,联合组在模拟排便动作肛门收缩压高于其余两组,差异有统计学意义(P<0.05);在直肠静息压、肛门静息压方面,三组间无差异(P>0.05)。在表面肌电图方面,治疗前三组在均方根值(RMS)、积分肌电值(iEMG)相比,差异均无统计学意义(P>0.05)。治疗2周后三组两项指标均高于治疗前,差异有统计学意义(P<0.05);组间相比,联合组在两指标高于其余两组,差异有统计学意义(P<0.05)。在实验室检查方面,治疗前三组在MTL、VIP、MCP-1结果相比,差异均无统计学意义(P>0.05)。治疗2周后,三组三项指标均优于治疗前,差异有统计学意义(P<0.05);组间相比,联合组在三项指标均优于其余两组,差异有统计学意义(P<0.05)。结论:头针、雷火灸联合盆底肌训练的三联疗法,通过盆底肌力量和肛门内压强的提高,以及相关炎症因子、胃肠道激素的调节,能改善患者的便秘症状,值得临床进一步研习和推广应用。

Objective:To observe the clinical efficacy of applying scalp acupuncture,thunder fire moxibustion and pelvic floor muscle training in the treatment of slow transit constipation after ischemic stroke.Methods:150 patients with ischemic stroke and STC from February 2019 to April 2021 were randomly divided into three groups:a combined group,a thunder fire moxibustion group and a controlled group.The controlled group was treated with routine intervention including pelvic floor muscle training.The thunder fire moxibustion group was treated with thunder fire moxibustion on the basis of the controlled group.The combined group was treated with scalp acupuncture on the basis of the thunder fire moxibustion group.The symptoms of constipation,anorectal pressure,surface electromyography and related laboratory indexes,including motilin(MTL),vasoactive intestinal peptide(VIP)and monocyte chemoattractant protein-1(MCP-1),were observed before and after treatment.Results:In terms of symptoms,there was no significant difference in the degree of defecation difficulty,defecation time,stool characteristics,defecation frequency,abdominal distension and other discomfort scores among the three groups before treatment(P>0.05).After 2 weeks of treatment,the six scores of the three groups were lower than those before treatment(P<0.05).Compared with the other two groups,the degree of defecation difficulty,defecation time,fecal characteristics,defecation frequency and other discomfort in the combined group were significantly lower than those in the other two groups(P<0.05).The score of abdominal distension in the combined group was only lower than that in the controlled group,and there was no difference between the combined group and the thunder fire moxibustion group(P>0.05).In the measurement of anorectal pressure,there was no significant difference in anal systolic pressure,rectal resting pressure and anal resting pressure between the three groups before treatment(P>0.05).After 2 weeks of treatment,the three indexes of the three groups were higher than those before treatment(P<0.05).Compared with the other two groups,the anal systolic pressure in the combined group was higher than that in the other two groups(P<0.05).There was no difference in rectal resting pressure and anal resting pressure among the three groups(P>0.05).In terms of surface electromyography,there was no significant difference in root mean square(RMS)and integrated electromyography(iEMG)among the three groups before treatment(P>0.05).After 2 weeks of treatment,the two indexes of the three groups were higher than those before treatment(P<0.05).Compared with the other two groups,the two indexes in the combined group were higher than those in the other two groups,and the difference was statistically significant(P<0.05).In terms of laboratory examination,there was no significant difference in MTL,VIP and MCP-1 among the three groups before treatment(P>0.05).After 2 weeks of treatment,the three indexes of the three groups were better than those before treatment(P<0.05).Compared with the other two groups,the three indexes of the combined group were better than those of the other two groups,and the difference was statistically significant(P<0.05).Conclusion:The triple therapy of scalp acupuncture,thunder fire moxibustion and pelvic floor muscle training can improve the symptoms of constipation through the improvement of pelvic floor muscle strength and anal pressure,as well as the regulation of related inflammatory factors and gastrointestinal hormones,which is worthy of further clinical study and popularization.