针药结合治疗急性脑梗死痰热腑实型便秘临床观察

Clinical observation of integrated acupuncture and herbal medicine for constipation of excess fu syndrome due to phlegm heat in acute cerebral infarction

目的:探寻治疗急性脑梗死痰热腑实型便秘的较佳疗法。方法:将160例患者随机分为针药组、中药组、针刺组、开塞露组,每组40例。4组患者均在神经内科常规处理及石氏醒脑开窍针刺法治疗基础上,针药组予针刺配合中药口服,针刺穴取少商、商阳、丰隆、天枢、支沟等,中药组成为金银花、连翘、黄芩、栀子、胆南星、全瓜蒌等;针刺组单纯给予针刺疗法;中药组单纯给予中药口服;开塞露组采用开塞露纳肛。比较治疗7天、21天后的排便间隔时间、便质情况、便秘疗效及神经功能评分。结果:治疗7天后便秘总有效率针药组97.5%(39/40),明显优于中药组的87.5%(35/40)、针刺组82.5%(33/40)、开塞露组80.0%(32/40)(均P<0.05);治疗21天后便秘总有效率针药组92.5%(37/40),明显优于中药组82.5%(33/40)、针刺组80.0%(32/40)、开塞露组67.5%(27/40)(均P<0.01)。4组治疗7天、21天的排便间隔时间及神经功能评分组间比较差异均具有统计学意义(P<0.05,P<0.01),针药组明显优于其他组。结论:针药结合治疗急性脑梗死便秘效果确切,同时可以提高治疗脑梗死的临床疗效,提示针灸与中药具有协同作用。

Objective To explore the optimal therapy for constipation of excess fu syndrome due to phlegm heat in acute cerebral infarction. Methods One hundred and sixty cases were randomized into acupuncture plus herbal medicine group, Chinese herbal medicine group, acupuncture group and Glycerine Enema group, 40 cases in each one. All the patients of 4 groups had received the conventional management in neurological internal medicine department and acupuncture according to the theory of SHI＇s regaining consciousness. Additionally, in acupuncture plus herbal medicine group, acupuncture and oral administration of Chinese herbal medicine were adopted. Acupuncture was applied to Shaoshang （LU 11）, Shangyang （LI 1）, Fenglong （ST 40）, Tianshu （ST 25）, Zhigou （TE 6）, etc. Chinese herbal medicine was composed of Jinyinhua （Lonicera Japonica） , Liangqiao （Fructus Forysthiae; Weeping Forsythia）, Huangqin （Radix Scutellariae）, Zhizi （Gardenia jasminoides Ellis; Cape Jasmine）, Dannanxing （Rhizoma Arisaematis Curn Bile）, Quangualou （Fructus Trichosanthis）, etc. In acupuncture group, acupuncture was used simply. In Chinese herbal medicine group, only Chinese herbal medicine was admin- istered orally. In Glycerine Enema group, Glycerine Enema was adopted. The interval time of defecation, stool quality, efficacy on constipation and nerve function score in 7 days and 21 days after treatment were compared among groups. Results After 7 days treatment of constipation, the total effective rate was 97.5% （39/40） in acupuncture plus herbal medicine group, which was superior apparently to 87.5 % （35/40） in Chinese herbal medicine group, 82.5% （33/40） in acupuncture group and 80.0% （32/40） in Glycerine Enema group （all P〈0.05）. After 21 days treatment, the total effective rate of constipation was 92.5 % （37/40） in acupuncture plus herbal medicine group, which was superior apparently to 82.5 % （33/40） in Chinese herbal medicine group, 80.5% （32/40） in acupuncture group and 67.50//oo （27/40） in Glycerine Enema group （all P〈0.01）. The differences in the interval time of defection, stool quality and nerve function score after 7 days and 21 days treatment were significant statistically in comparison among 4 groups （P〈0.05, P〈0.01）. The results in acupuncture plus herbal medicine group were superior apparently to the other groups. Conclusion The integrated acupuncture and herbal medicine is effectivedefinitely on constipation in acute cerebral infarction. Additionally, this therapy may improve the clinical efficacy of cerebral infarction and suggest the coordination between acupuncture-moxibustion and Chinese herbal medicine.