枳实生白术配伍联合生物反馈治疗混合型功能性便秘临床观察

Clinical Observation on Fructus Aurantii Immaturus and Raw Rhizoma Atractylodis Macrocephalae Combined with Biofeedback Therapy in Treating Mixed Functional Constipation

【目的】评价枳实生白术配伍联合生物反馈治疗混合型功能性便秘的临床疗效。【方法】将符合入选标准的60例混合型功能性便秘患者随机分为对照组和观察组,每组各30例。对照组给予生物反馈治疗,观察组在对照组基础上给予加服枳实生白术为基本方的水煎剂治疗,疗程30 d,并随访4周。观察2组治疗前后便秘症状体征评分、肛门直肠动力学指标、便秘患者生活质量量表(PAC-QOL)评分的变化情况,评价2组疗效和复发情况。【结果】(1)治疗30 d后,观察组总有效率为96.6%,对照组为80.0%,观察组的总有效率及总体疗效均优于对照组(P<0.01)。(2)治疗后及随访期间,2组大便性状、大便间隔时间、排便困难度、排便时间、排便不尽感、肛门阻塞感、气短、腹胀胸闷评分均较治疗前改善,除对照组的气短、腹胀胸闷外,差异均有统计学意义(P<0.05或P<0.01),且观察组的改善情况均优于对照组(P<0.05)。(3)治疗后,2组肛管静息压、直肠静息压、肛管最大收缩压、初始感觉阈值、排便窘迫感觉阈值和直肠最大耐受量等肛门直肠动力学指标均较治疗前改善(P <0.05),且观察组的改善情况均优于对照组(P <0.05)。(4)治疗后,2组患者身体不适、心理社会不适、担心和焦虑及满意度等PAC-QOL 4个维度评分均较治疗前改善(P <0.01),且观察组的改善情况均优于对照组(P <0.05)。(5)随访4周和8周,观察组的复发率均低于对照组(P <0.05或P <0.01)。【结论】枳实生白术配伍联合生物反馈治疗混合型功能性便秘患者疗效确切,可有效降低便秘患者的症状体征评分,改善肛门直肠动力学指标,提高患者生活质量。

Objective To evaluate the efficacy of Fructus Aurantii Immaturus and raw Rhizoma Atractylodis Macrocephalae combined with biofeedback therapy for the treatment of mixed functional constipation. Methods A total of 60 patients with mixed functional constipation were randomly divided into control group(n = 30)and observation group(n = 30). The two groups were given biofeedback therapy, and additionally the observation group was treated with oral use of the decoction of recipe mainly composed of Fructus Aurantii Immaturus and raw Rhizoma Atractylodis Macrocephalae. The two groups were treated for 30 days and were followed-up for 4 weeks. Before and after treatment,the scores of constipation symptoms and signs,anorectal dynamics parameters and the scores of Patient-Assessment of Constipation Quality Of Life(PAC-QOL)in the two groups were observed. After treatment,the clinical efficacy and recurrence rate in the two groups were evaluated. Results(1)After treatment for 30 days,the total effective rate in the observation group was 96.6%,and was 80.0% in the control group. The total effective rate and overall therapeutic efficacy in the observation were superior to those in the control group(P< 0.01).(2)After treatment and during the follow-up,the scores of stool property,interval time for defecation, defecation difficulty, defecation time, incomplete evacuation, anals obstruction sense, shortness of breath, abdominal distension, and chest distress in the two groups were improved, and the differences of the above indexes except for shortness of breath, abdominal distension, and chest distress in the control group were significant(P<0.05 or P<0.01). The observation group had stronger effect than the control group(P < 0.05).(3) After treatment, anal resting pressure, rectal resting pressure, anal canal maximum squeeze pressure, initial sensory threshold,sensory threshold of defecation distress,and rectal maximum tolerance in the two groups were improved(P < 0.05 compared with those before treatment), and the improvement in the observation group was superior to that in the control group(P < 0.05).(4)After treatment, the scores of the dimensions of physical discomfort,psychosocial discomfort,worry and anxiety,and satisfaction in PAC-QOL were improved(P < 0.05 compared with those before treatment),and the improvement in the observation group was superior to that in the control group(P < 0.05).(5)The results of follow-up for 4 and 8 weeks showed that the recurrence rate in the observation group was lower than that in the control group(P < 0.05 or P < 0.01). Conclusion Fructus Aurantii Immaturus and raw Rhizoma Atractylodis Macrocephalae combined with biofeedback therapy exert certain efficacy for the treatment of mixed functional constipation by relieving constipation symptoms and signs, and improving anorectal dynamics parameters and quality of life of patients with mixed functional constipation.