“调神健脾”配穴针刺改善腹泻型肠易激综合征症状和睡眠质量:随机对照试验

Acupuncture with regulating mind and spleen for diarrhea irritable bowel syndrome and sleep quality:a randomized controlled trial

目的:比较"调神健脾"配穴针刺与西药治疗腹泻型肠易激综合征(IBS-D)的临床疗效差异。方法:按2∶1比例将81例IBS-D患者随机分为针刺组(54例)和西药组(27例)。针刺组采用"调神健脾"配穴针刺,穴取百会、印堂、天枢、足三里、上巨虚、三阴交、太冲,隔日治疗1次,1周治疗3次,共治疗6周;西药组口服匹维溴铵片,每次50mg,每日3次,共治疗6周。分别于治疗前、治疗1周、6周后观察IBS症状严重度积分(IBS-SSS),于治疗前和治疗6周时观察匹兹堡睡眠质量指数(PSQI)评分,并评定两组疗效。结果:针刺组脱落病例3例、西药组脱落1例。除西药组治疗1周后腹胀程度积分无显著改善外,两组治疗1周、6周后IBS-SSS各单项积分和总积分均明显降低(P<0.01,P<0.05);治疗1周后,针刺组腹痛程度积分较西药组降低更明显(P<0.05);治疗6周后,针刺组除了保持缓解腹痛的优势外,在腹痛天数、排便满意度、生活干扰度积分及总积分方面降低也较西药组明显(P<0.01,P<0.05);治疗6周后,针刺组PSQI评分及治疗前后评分差值均优于西药组(均P<0.05)。针刺组临床缓解率和临床缓解合显效率均高于西药组[(51.0%(26/51)vs 19.2%(5/26),P<0.01;64.7%(33/51)vs 34.6%(9/26),P<0.05)]。结论:"调神健脾"配穴针刺治疗腹泻型肠易激综合征,在治疗早期缓解腹痛即优于西药匹维溴铵片,治疗后期可明显地改善腹痛程度与发作频率,可提高排便满意度和减少生活干扰、优化睡眠质量,总体疗效优于西药匹维溴铵片。

Objective To compare the effects between acupuncture with regulating mind and spleen and western medication for diarrhea irritable bowel syndrome（IBS-D）.Methods Eighty-one patients were randomly at the ratio of 2 to 1 assigned into an acupuncture group（54cases）and a western medication group（27cases）.Acupuncture with regulating mind and spleen was applied in the acupuncture group for 6weeks at Baihui（GV 20）,Yintang（GV 29）,Tianshu（ST 25）,Zusanli（ST 36）,Shangjuxu（ST 37）,Sanyinjiao（SP 6）,and Taichong（LR 3）,once every other day,3times a week.Pinaverium bromide tablet was used orally in the western medication group for 6 weeks,50 mg a time,3 times a day.IBS symptom severity score（IBS-SSS）were observed before and after 1-week,6-week treatment.Pittsburgh sleep quality index（PSQI）was applied before and after 6-week treatment.Also,clinical efficacy was evaluated in the two groups.Results Three patients dropped out in the acupuncture group,and 1 in the western medication group.Except abdominal distension score after 1-week treatment in the western medication group,single scores and total scores of IBS-SSS apparently reduced in the two groups after 1-week and 6-week treatment（P〈0.01,P〈0.05）.After 1-week treatment,the abdominal pain score of the acupuncture group was obviously lower than that of the western medication group（P〈0.05）.After 6-week treatment,with abdominal pain relief advantage,other results including the number of pain days,defecation satisfaction,life disturbance degree and total score of the acupuncture group were obviously lower than those of the western medication group（P〈0.01,P〈0.05）.After 6-week treatment,the PSQI score and its change before and after treatment in the acupuncture group were superior to those in the western medication group（both P〈0.05）.The relief rate and relief plus obvious effective rate in the acupuncture group were higher than those in the western medication group[51.0%（26/51）vs 19.2%（5/26）,P〈0.01;64.7%（33/51）vs 34.6%（9/26）,P〈0.05].Conclusion Acupuncture with regulating mind and spleen for diarrhea irritable bowel syndrome can more effectively relieve abdominal pain than pinaverium bromide tablet at the early stage.Its total effect and single effects are better at the later stage on abdominal pain,seizure frequency,defecation satisfaction,life disturbance,and sleep quality.