电针不同穴方治疗功能性便秘疗效比较:随机对照预试验

Comparison of efficacy on functional constipation treated with electroacupuncture of different acupoint prescriptions:a randomized controlled pilot trial

目的:初步评价电针不同穴方治疗功能性便秘的疗效差异,寻找治疗功能性便秘的较佳穴位组方。方法:将104例患者随机分为俞募配穴组(19例)、合穴配穴组(34例)、合募俞配穴组(26例)和西药对照组(25例)。俞募配穴组电针双侧天枢、大肠俞;合穴配穴组电针双侧曲池、上巨虚;合募俞配穴组电针单侧天枢、大肠俞、曲池、上巨虚,以上3组前两周均每周治疗5次,后两周每周治疗3次。西药对照组口服枸橼酸莫沙必利片,每次1片(5mg),每天3次,连续口服4周。研究周期9周,包括基线评价1周、治疗4周、随访4周。以周自主排便次数为主要指标,排便困难程度和生活质量评分为次要指标进行治疗后和随访疗效评价。结果:根据意向性治疗(ITT)分析原则,将104例患者全部纳入分析。(1)治疗后4组患者周自主排便次数均显著增加(P<0.05,P<0.01),3个电针组与西药对照组疗效相当(P>0.05);随访时合穴配穴组可继续维持周排便次数的增加效应(P<0.01),且优于俞募配穴组和西药对照组(P<0.05,P<0.01),而其余3组周排便次数没有良好改善(P>0.05)。(2)治疗后合穴配穴组、合募俞配穴组和西药对照组对排便困难程度均有改善(P<0.05,P<0.01);随访时合穴配穴组和合募俞配穴组依然改善显著(均P<0.01)。(3)治疗后合穴配穴组患者生活质量评分显著提高(P<0.05),其余3组与治疗前比较差异无统计学意义(均P>0.05)。结论:3个电针组均可有效增加周自主排便次数,与西药枸橼酸莫沙必利疗效相当。针刺双侧曲池、上巨虚的合穴配穴法能显著增加周自主排便次数,改善排便困难程度和患者生活质量,针刺疗效可持续4周,是治疗功能性便秘的较佳穴位组方。

Objective To evaluate preliminarily the efficacy on functional constipation treated with electroacupuncture of different acupoint prescriptions. Methods One hundred and four patients were randomized into a front-rnu and back-shu points group （19 cases）, a he-sea points group （34 cases）, a he-sea, front-mu and back-shu points group （26 cases） and a western medication control group （25 cases）. In the front-mu and back-shu points group, electroacupuncture was applied at bilateral Tianshu （ST 25） and Dachangshu （EL 25）. In the he-sea points group, electroacupuncture was applied at bilateral Quchi （LI 11） and Shangjuxu （ST 37）. In the he-sea, front-mu and back-shu points group, electroacupuncture was applied at unilateral Tianshu （ST 25）, Dachangshu （BL 25）, Quchi （LI 11） and Shangjuxu （ST 37）. In the three groups above, the treatment was given 5 times a week in the first two weeks and 3 times a week in the next two weeks. In the western medication control group, mosapride citrate tablets were prescribed for oral administration, 1 table （5 mg） each time, 3 times a day, continuously for 4 weeks. The period of research was 9 weeks, including 1 week for baseline evaluation, 4 weeks for treatment and 4 weeks for follow-up. The weekly defecation frequency was taken as primary index, while the defecation difficulty and life quality score were taken as the secondary indices for the efficacy evaluation after treatment and in follow-up. Results According to the intention-to-treat （ITT） analytic principle, 104 cases were all enrolled in the final analysis. （1） After treatment, the weekly frequency of defecation was all increased significantly in the four groups （P〈0.05, P〈0.01）. The efficacy of the three electroacupuncture groups was similar to that of western medication control group （P〉0. 05）. In follow-up, the increasing effect on the weekly frequency of defecation was maintained in the he-sea points group （P〈0. 01）, superior to the front-mu and back-shu points group and the western medication control group （P〈0.05, P〈0.01） ; the weekly frequency of defecation was not improved in the rest three groups （P〉0.05）. （2） After treatment, defecation difficulty was relieved in the he-sea points group, the he-sea, front-mu and hack-shu points group and the western medication control group （P〈0.05, P〈 0.01）. In follow-up, the improvements were still significant in the he-sea points group and the he-sea, front-mu and back-shu points group （both P〈0.01）. （3） After treatment, the life quality score was significantly improved in the patients of the he-sea points group （P〈0.05）. The difference was not significant in the rest three groups as compared with that before treatment （all P〉0.05）. Conclusion The weekly frequency of defecation is increased effectively after treatment in the three electroacupuncture groups and the efficacy is similar to mosapride citrate tablets. The bilateral Quchi （LI 11） and Shangjuxu （ST 37） in he-sea acupoints increase significantly the weekly frequency of defecation, relieve defecation difficulty and improve life quality. Acupuncture efficacy is sustained for 4 weeks. This acupoints prescription is the best in the treatment of functional constipation.